When Do Hemorrhoids Require Medical Intervention
Your hemorrhoids can be an embarrassing topic to discuss with anyone, even your doctor. But hemorrhoids are common and affect 5% of adults in the United States every year, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Its estimated, in fact, that as many as three in four adults will experience problems with hemorrhoids at some point in their lives.
Though you can find many treatments for hemorrhoids at your local pharmacy, home remedies dont help everyone. At Rivas Digestive Center, located in Hollywood, Florida, our expert gastroenterologist, Dr. John Rivas, wants you to know when its time to get medical help for your hemorrhoids.
What Is A Hemorrhoid
A hemorrhoid is essentially an engorged or swollen blood vessel, says Sameet Shah, D.O., a gastroenterologist at Mountainside Medical Group.
Hemorrhoids can be inside or outside your body. With external hemorrhoids, you can see them and they tend to hurt. With internal hemorrhoids, you dont see or feel them, but a symptom might be bleeding during a bowel movement.
The most common cause of hemorrhoids is due to constipation or straining while using the toilet. Women are prone to hemorrhoids during pregnancy and after giving birth because of the increased pressure on the pelvic floor and hormonal changes that can lead to constipation. Children and adolescents can also get hemorrhoids.
How To Prevent Hemorrhoids
The most emphasized topic regarding hemorrhoids is its prevention . It’s high prevalence worldwide has become a significant concern, and various guidelines have been made to prevent its occurrence.
Dietary improvement is the best preventive strategy for this condition. Eating fiber-rich foods such as beans, vegetables, and fruits help to soften the feces. Fiber supplements are also a great alternative. Another critical and often neglected point is not to restrain bowel movement. One should not delay an urge to defecate.
If you place a step stool in front of the toilet seat and prop your feet up a bit while defecating, it helps you pass stools with ease and with minimum straining. Also, drinking 6 to eight glasses of water daily is a solution to softening the stool.
Refrain from straining and holding breath during defecation as this creates an increased force in the veins of the lower rectal canal and increases the chance of hemorrhoidal changes. Exercising regularly helps to prevent constipation, and in turn, the chances of developing hemorrhoids. Sitting for long periods is not healthy for overall body health and especially for hemorrhoids.
If you still develop constipation or suffer from long-standing constipation, take laxatives prescribed by your doctor, as constipation is a leading cause of hemorrhoidal disease. It is noteworthy to know that hemorrhoids are not cancerous, and they will not progress into cancers.
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Temporary Hemorrhoid Treatment Options
Relief Using Hemorrhoid Creams
Hemorrhoid creams, such as those made by Tucks and Preparation H, are an appealing medicine to many people suffering from hemorrhoids as they can be purchased from the drugstore without a prescription and used in the privacy of the home. These creams typically contain a medicinal ingredient such as hydrocortisone along with a soothing agent to provide quick relief from hemorrhoid symptoms like itching and burning.
Whichever hemorrhoid cream you choose, it will have to be applied several times per day, especially in the morning and at night.
For External use:
Squeeze a small amount of the cream onto your finger and apply to the outside of the anus. Be sure to wash your hands thoroughly with warm soap and water before and after application or use a disposable glove or finger cot.
For Internal use:
If you do not see hemorrhoid relief from external application, some creams are able to be applied inside the anus. It is best to have a bowel movement before attempting to apply hemorrhoid cream this way.
Then, after thoroughly washing your hands, attach the rounded applicator tip to the cream tube. Gently squeeze the tube in order to in order to test the applicator to see how much ointment comes out. You want to aim for an amount that is similar to the length of the tip of your index finger.
What You Should Know About Hemorrhoid Creams Like Preparation H
Home Remedies for Hemorrhoids
Some examples of hemorrhoid home remedies include:
How Do Doctors Treat Severe Hemorrhoids
Hemorrhoidectomy: Your doctor surgically removes very large or painful hemorrhoids. Its effective for both external hemorrhoids and internal ones that are protruding. Hemorrhoid stapling: Your doctor uses this technique to cut off a hemorrhoids blood supply. This is usually done on internal hemorrhoids.
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What Type Of Doctor Fixes Hemorrhoids
While your family physician is most certainly qualified to treat hemorrhoid issues, a gastroenterologist has received years of training in disorders of the intestines, rectum, and anus.
If you have persistent and chronic hemorrhoids, your family doctor may recommend you to a gastroenterologist for further treatment.
Gastroenterologists are skilled in diagnosis and non-operative procedures, like rubber band ligation or sclerotherapy.
A gastroenterologist will send you to a proctologist if operative surgery is needed for your hemorrhoids.
For invasive hemorrhoid surgery, a proctologist takes over. A proctologist is well trained in operations concerning the intestine, rectum, and anus, and unlike a gastroenterologist, performs surgeries.
Severe Hemorrhoids Vs Mild Hemorrhoids: Stages
Many physicians use a grading system to categorize hemorrhoids along four stages:
- First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse. These are slightly enlarged hemorrhoids, but they do not protrude outside the anus.
- Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own . These may come out of the anus during certain activities like passing stool, and then return back inside the body.
- Third-degree hemorrhoids: Hemorrhoids that prolapse and must be pushed back in by a finger.
- Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed or that pull much of the lining of the rectum through the anus.
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The Four Grades Of Hemorrhoids
There are four grades of hemorrhoidal disease, which makes it easy for doctors to diagnose and treat them accordingly.
Grade 1 hemorrhoids bleed, but they do not protrude out from the anal canal. Grade 2 hemorrhoids protrude out, but they go back inside simultaneously. Grade 3 hemorrhoids also protrude, but they require manual help to push them back in. Grade 4 disease protrudes and bleeds, and the manual reduction does not help in this grade.
The hemorrhoidal disease has been thoroughly researched to date, and effective treatments are available for every stage of the disease, both through medication or surgery. Unfortunately, most people do not seek medical advice because of privacy concerns and a fear of being ridiculed, resulting in the disease progressing to a higher grade when they finally seek medical intervention. This stigma concerning piles should be progressively dealt with and reduced.
Different methods and tests are present to diagnose hemorrhoids. The first-line test is a digital rectal examination where the doctor inserts a well-lubricated finger inside the patient’s anus to check for any mucosa abnormalities. Other more advanced tests include proctoscopy, sigmoidoscopy, and colonoscopy.
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Different Types of Hemorrhoids
There are two types of hemorrhoids: external and internal. External hemorrhoids arise from the anal canal, while internal hemorrhoids arise from the rectum, immediately above the anal canal. According to Cuckoo Choudhary, MD, associate professor of gastroenterology at Thomas Jefferson University in Philadelphia, one type is not worse than the other, but both can cause problems. “It all depends on the size and degree of the hemorrhoid,” Dr. Choudhary says. “Untreated internal hemorrhoids can cause bleeding. External hemorrhoids can cause thrombosis , which gives way to severe pain from hemorrhoidal strangulation.”
If you know you have hemorrhoids and you have acute and severe anal pain, it could be a sign of thrombosed hemorrhoids.
Know When to See Your Doctor
Though the annoyance of hemorrhoids can be reason enough to call your doctor, use this checklist to know when a visit is a must:
- If you’re experiencing any type of rectal bleeding
- If the hemorrhoids are causing you pain or discomfort
- If the problems persist despite trying over-the-counter hemorrhoid creams or other remedies
- If you’re passing stools that look maroon in color or tarry in color, a sign of bleeding
If you experience a large amount of rectal bleeding that is accompanied by dizziness or faintness, be sure to seek emergency medical care immediately.
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How Long Do Hemorrhoids Last
How long hemorrhoids last will vary from person to person.
In general, small hemorrhoids can go away on their own in a few days. Larger hemorrhoids, particularly ones that cause a lot of pain, swelling, and itchiness, cant go away on their own and may require treatment from a doctor to heal. Pregnant patients may find that hemorrhoids only go away after they give birth.
Its possible for hemorrhoids to return after theyve been treated. A gastroenterologist can help recommend solutions if you find youre struggling with hemorrhoids that dont go away or keep coming back.
What Is A Hemorrhoid Specialist
A hemorrhoid specialist is a physician who specializes in treating, managing, and preventing hemorrhoids, inflammations around the anus and rectum. General practitioners, internal medicine specialists, gastroenterologists, and proctologists can all choose to pursue careers as hemorrhoid specialists. People who experience recurrent hemorrhoids may find it helpful to see a hemorrhoid specialist for more in-depth care than a regular doctor can provide.
These specialists usually handle other medical issues as well, but have received some special training in hemorrhoids and pursue continuing education to keep up with the latest advances in treatment and management. When a patient goes to a hemorrhoid specialist, the doctor will take a complete patient history, review the patients chart for more information, and conduct a physical exam. This will be used to develop a treatment plan.
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What Training Does A Proctologist Have
To become a proctologist, you must first become a general surgeon. This includes 5 years of surgical residency after medical school. During their training, the general surgeons learn to perform different types of surgeries, such as hernia surgery, hemorrhoidal surgery, gallbladder surgery, breast surgery, and even vascular surgery. Thereafter, they do an extra year of specialized surgical training in surgeries on the colon, rectum, and anus to practice as a proctologist.
How To Fix Prolapsed Hemorrhoids
Sometimes, an internal hemorrhoid can become prolapsed. This means that the hemorrhoid falls through the anal opening. While this can be scary when it occurs, know that you are able to gently push this hemorrhoid back inside with your fingers.
Keep in mind that a prolapsed hemorrhoid can go inside the rectum again on its own. If you have a prolapsed hemorrhoid, the best fix is to let your doctor know.
While hemorrhoids can be irritating, there are plenty of remedies you can use at home to relieve the frustrating and painful symptoms.
Wondering how to stop hemorrhoid itching and burning? Check out our full guide here.
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How Are Anal Fissures Treated
Most anal fissures can be successfully healed with non-invasive treatments. Doctors often recommend non-prescription stool softeners or stool-bulking medications to relieve constipation and soften stools. Softer stools are less painful and easier to pass for those with anal fissures. This also gives the anus the opportunity to heal without further injury. Most patients are put on a high-fiber diet, and some are also prescribed laxatives to prevent constipation.
Doctors also recommend soaking in a shallow sitz bath several times a day to relieve symptoms, stop any spasms that may occur, and speed healing. Sitz baths can be especially helpful following bowel movements, when cleaning with toilet paper can cause pain.
If the fissure needs additional help healing, doctors may prescribe prescription drugs alongside conservative treatments. These may include:
- Anesthetic ointments for pain relief
- Topical steroids
- Calcium channel blockers, known as CCBs
- Nitroglycerin gel or cream
Commonly, a topical preparation of 0.4 percent nitroglycerin is applied directly to the affected area. This ointment, sometimes known as NTG or glycerol trinitrate, relaxes the internal sphincter, helps reduce spasms and allows the anal fissure time to heal. It may also increase blood flow to the area, meaning healing can occur faster. NTG treatment is often effective, but there are some adverse effects that limit its use. This may include severe headache and dizziness.
Hemorrhoidectomy For Thrombosed External Hemorrhoids
THOMAS J. ZUBER, M.D., Saginaw Cooperative Hospital, Saginaw, Michigan
Am Fam Physician. 2002 Apr 15 65:1629-1632.
External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis with removal of the entire diseased hemorrhoidal plexus in one piece. Caution must be exercised to avoid cutting into the muscle sphincter below the hemorrhoidal vessels. Infection after suture closure is rare secondary to the rich vascular network in the anal area. Stool softeners must be prescribed postoperatively to help prevent tearing at the suture line. Training and experience in general and skin surgery are necessary before the physician attempts this procedure unsupervised.
External hemorrhoids often develop in healthy young persons and may suddenly become thrombosed. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. The thrombosis is slowly absorbed by the body during the course of several weeks. A resolving thrombosis may erode through the skin and produce bleeding or drainage.
The following are pictures of the stapled hemorrhoidectomy procedure.
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Hemorrhoids Treatment: Rubber Band Ligation
The principle of rubber band ligation is to encircle the base of the hemorrhoidal clump with a tight rubber band. The tissue cut off by the rubber band dies, and is replaced by an ulcer that heals with scarring.
A similar procedure was described in 460 BC by the Greek physician Hippocrates:
And hemorrhoids you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind and when the patient recovers, let him be put on a course of Hellebore.
Rubber band ligation can be used with first-, second-, and third-degree hemorrhoids, and may be more effective than sclerotherapy. Symptoms frequently recur several years later, but usually can be treated with further ligation.
The most common complication of ligation is pain. However, bleeding one or two weeks after ligation or bacterial infection in the tissues surrounding the hemorrhoids may occur.
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How To Fix External Hemorrhoids
The more painful of the two types of hemorrhoids, external hemorrhoids are small, rubbery bumps that form around the anal area.
They take formation when the veins underneath the skin in this area become irritated and inflame.
To fix external hemorrhoids, topical methods of treatment can be applied to these bumps to help encourage them to shrink.
Creams are one of the easiest ways to treat external hemorrhoids. Our best hemorrhoid cream guide can help you determine which cream you should pick.
Try an over the counter cream like Preparation H, which is formulated for hemorrhoids specifically, and can help reduce swelling and inflammation.
Hemorrhoid creams leave a soothing, calming effect on the external hemorrhoids, which can help alleviate the pain that they often cause.
Another method to fix external hemorrhoids is a sitz bath.
Taking a sitz bath where you submerge your anal area in warm water is proven to be effective. Not only does this method offer relief of the pain brought on by external hemorrhoids, but also keeps this area clean, and this is important in order to shrink your hemorrhoids.
You can find sitz baths at your local health care store. Some of these sitz baths are designed to fit over the toilet bowl. Using a regular sized tub is just as effective, as well.
How Do You Know If You Have Hemorrhoids
The most common symptoms of hemorrhoids are:
- Anal pain/painful bowel movements
- Rectal bleeding
- Itchiness
- Swelling around the anus
However, these symptoms could also be a sign of something more serious, like anal cancer or polyps. Hemorrhoids also have many symptoms in common with anal fissures, which occur when the skin around the anus is torn. Anal fissures tend to be much more painful than hemorrhoids, however.
Even if youre fairly certain youre dealing with hemorrhoids, its still a good idea to go see a doctor to rule out any serious conditions, especially if youre over the age of 50.
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Soak It Off In A Sitz Bath
A sitz bath comes from the German word sitzen, meaning sit, and it refers to a 10 to 15 minute soak in warm water that comes just up to your bottom and hips. Sitz baths can relieve irritation and itching as well as spasm of your anal sphincter muscles, says Dr. Thomas. Take a shallow soak in your bathtub or buy a small plastic tub from your pharmacy to give yourself a portable sitz bath two to three times a day.