Hemorrhoids: Diagnosis And Treatment Options
TIMOTHY MOTT, MD, Naval Hospital Pensacola, Pensacola, Florida
KELLY LATIMER, MD, MPH, U.S. Naval Hospital Sigonella, Catania, Italy
CHAD EDWARDS, MD, Hamilton Medical Center, Dalton, Georgia
Am Fam Physician. 2018 Feb 1 97:172-179.
Patient information: A handout on hemorrhoids is available.
Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium . The anus is approximately 4 cm long in adults, with the dentate line located roughly at the midpoint.2 Hemorrhoids developing above the dentate line are internal. They are painless because they are viscerally innervated. External hemorrhoids develop below the dentate line and can become painful when swollen. The extent of prolapse of internal hemorrhoids can be graded on a scale from I to IV, which guides effective treatment . This grading system is incomplete, however, because it focuses exclusively on the extent of prolapse and does not consider other clinical factors, such as size and number of hemorrhoids, amount of pain and bleeding, and patient comorbidities and preferences.3
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Increasing fiber intake is an effective first-line, non-surgical treatment for hemorrhoids.
What Are The Signs That You Need To See A Doctor For Hemorrhoids
Hemorrhoids can be misdiagnosed easily if a person tries to self-diagnose the disease. Most people cant recognize the disease, especially in the earlier stages of internal hemorrhoids when the swollen and inflamed veins are not visible externally. Hence, it is important that you go and see a doctor about your hemorrhoids. Here are four signs that indicate that your hemorrhoids need medical intervention at the earliest.
1. Rectal Bleeding
Bleeding during the bowels is the first sign you will notice if you have hemorrhoids. Both internal and external hemorrhoids bleed even in the early stages. Over time, the bleeding will become more severe and it could lead to mild to moderate anemia. However, rectal bleeding can be a sign of other underlying conditions too. Hence, you should never ignore this sign and get diagnosed right away. Only a professional doctor will be able to diagnose the disease accurately.
2. Bulge from Anus
Hemorrhoids start bulging out from the anus when it reaches the prolapsed stage. If the bulge prolapses during bowel movements and you have to push it back inside, it is time to see a doctor. Prolapsed hemorrhoids will only become worse over time and it increases the risk of strangulation of the hemorrhoidal mass. Thats why early treatment is necessary to prevent the condition from getting worse.
3. Feeling of Fullness
4. Long-lasting Discomfort & Irritation
Can They Remove Hemorrhoids During A Colonoscopy
Hemorrhoids are swollen veins, and doctors can immediately distinguish between them, anal fissures, colon polyps, or colon cancer. Colon polyps are growths in the lining of your colon that can be an indication you could be at risk from colon cancer. They can be quickly and easily removed during a colonoscopy.
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When Is It Time To See Your Doctor
While most people think of hemorrhoids as a minor problem, they can be very painful, explains Dr. Buzas. Knowing when to treat conditions such as hemorrhoids on your own and when its better to seek help can help you avoid unnecessary complications.If youre experiencing any of the following situations related to your hemorrhoids, make an appointment to see your doctor:
- You experience rectal bleeding or see bright red blood on your toilet paper.
- You have pain and discomfort in your rectum or anus.
- Youve tried over-the-counter remedies for more than one week without relieving your symptoms.
- You have bowel movements that are maroon or dark like tar in color, which can be a sign of bleeding.
If your rectal bleeding wont stop and you feel dizzy or faint, you should consider it a medical emergency that warrants a trip to the emergency room.When you see your doctor for hemorrhoids, youll first discuss your symptoms. Be sure to answer any questions directly and honestly, to get the best diagnosis. Your doctor will then examine you for external hemorrhoids, internal hemorrhoids and other potential issues.
Getting your hemorrhoids checked out is no different than and as important as getting a routine colonoscopy, Pap test, mammogram or prostate exam, Dr. Buzas notes. Theres no reason to be reluctant or delay your care.
How Are Haemorrhoids Diagnosed
Diagnosis of haemorrhoids usually involves an examination of the anal passage to look for any swollen blood vessels. Your doctor may conduct one of the following tests.
- Digital rectal examination, where your doctor puts on gloves and places a lubricated finger inside the back passage to gently feel for any abnormalities. This is likely to be uncomfortable but will probably not be painful.
- Proctoscopy, where your doctor examines the inside of the rectum using a proctoscope to look for any swelling or other symptoms. Again, this may be uncomfortable but will probably not be painful.
There is no need to feel embarrassed about these tests haemorrhoids are a common problem and your doctor is used to diagnosing and treating them.
In some cases, your doctor may refer you to a surgeon who can assess your haemorrhoids and recommend a treatment.
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What Can My Doctor Do For Hemorrhoids
There are many ways that hemorrhoids can be handled and treated. These options vary depending on the condition, severity and location of the hemorrhoids. Below are methods that may be employed to treat your hemorrhoids.
Internal hemorrhoids may be injected with a solution that causes a scar to be formed and close off the hemorrhoids. This procedure will only hurt a little but is usually very effective.
2. Cauterization or Coagulation
This method is a painless method of burning off, removing and sealing the end of the hemorrhoids with an electric probe, infrared light or laser beam.
The Coagulation method allows the hemorrhoid to close and shrink and is most effective for treating prolapsed hemorrhoids.
3. Rubber band ligation
Rubber band ligations are also mostly employed in cases of prolapsed hemorrhoids as well as protruding internal hemorrhoids that have been pushed outside .
In this treatment, the doctor will put a small rubber band around the hemorrhoid to cut off blood supply to the tissues therein.
Rubber band ligations will usually cause the hemorrhoid to dry up, shrink in size and fall due to the unavailability of blood.
4. Surgery or Hemorrhoidectomy
For large internal or external hemorrhoids that keep on worsening and bring excruciating discomfort to the patient, a surgical procedure may be required to remove the hemorrhoids or a newer technique using staples may be applied.
Most of these medical treatments are effective in treating hemorrhoids.
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.
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Who To Consult For Hemorrhoid Treatment
Usually, your family doctor or primary care provider can help to manage and control hemorrhoid symptoms. The doctor will suggest home remedies and conservative treatment methods if the symptoms are mild. If advanced treatment is required, the doctor will refer you to a colorectal surgeon or general surgeon. They are the specialists in treating hemorrhoids both surgically and non-surgically.
The doctor will diagnose the disease thoroughly and determine the most appropriate treatment method for you.
Should I See A Gastroenterologist Or Proctologist For Hemorrhoids
Hemorrhoids, commonly called piles, are swollen, inflamed veins around the anus or the lower part of the rectum . They may be felt as tiny lumps in and around the anus. Hemorrhoids may often get better on their own within a few days, but some may need medications and even surgery to go away.
Both gastroenterologists and proctologists can provide you treatment for hemorrhoids. Whether you should visit a gastroenterologist or proctologist depends on the type and severity of hemorrhoids you have. Hemorrhoids are of two main types:
- External hemorrhoids: They form under the skin around the anus.
- Internal hemorrhoids: They form in the lining of the anus and lower rectum.
Talk to a general physician to understand which doctor you need for hemorrhoid management.
A gastroenterologist is a doctor trained in the branch of internal medicine that focuses on the disorders of the gut, gallbladder, liver, bile ducts, and pancreas. A gastroenterologist can diagnose hemorrhoids, provide medications, and advise lifestyle modifications. They can also do certain procedures, such as endoscopy and hemorrhoid banding .
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How Do Doctors Check For Hemorrhoids
There are many methods for diagnosing hemorrhoids. Your Doctor may be able to tell that you have an external hemorrhoid by simply looking while internal hemorrhoids can be diagnosed by using a few procedures to examine your rectum and anal canal.
One of the ways of checking for internal hemorrhoids is by digital examination .
In this procedure, your doctor will put some medical gloves on and insert a lubricated finger into your rectum.
Your doctor will then proceed to see if there is anything unusual such as lump and growths and the result from this examination will suggest if there is need for further testing.
A visual inspection may be needed in some cases as internal hemorrhoids are often very soft. During a visual exam, an anoscope, sigmidoscope or proctoscope may be used.
There Are Two Types Of Hemorrhoids:
- Internal Hemorrhoids
- External Hemorrhoids
Internal hemorrhoids develop inside of the anal cavity. It is impossible to see this type of hemorrhoid, unlike external hemorrhoids which are visible in the mirror as they develop outside of the anal sphincter. In some situations, it is possible to feel the presence of an internal hemorrhoid just inside the anal cavity, but you cant always depend on this.
If you have never had hemorrhoids before, then you may have a few questions as to the specifics of the condition. Here is a quick guide to how to determine whether or not you have hemorrhoids with answers to a couple of frequently asked questions.
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What Kind Of Doctor Do I Need To See For My Hemorrhoids
A number of medical practitioners and doctors are all experienced and qualified to manage your hemorrhoids.
You may speak to the following types of medical professionals or doctors for hemorrhoids:
- General Practicioner
- General Surgeon
For Pregnant mothers who are prone to experiencing hemorrhoids in their third trimester, a Gynecologist may be the best person to visit considering these hemorrhoids are most likely present due to the increased pressure of pregnancy on the rectal and anal muscles.
Hemorrhoids during pregnancy can be very difficult to deal with. If you are pregnant with hemorrhoids, worry not, our hemorrhoids during pregnancy guide will help you manage your hemorrhoids in the best possible way.
Depending on the treatment, surgery may or may not be required.
A Colorectal surgeon or Proctologist may be required in severe cases that require operating on your hemorrhoids.
Most of these procedures can be performed in the doctors office to help shrink or remove the hemorrhoids.
Laser hemorrhoid surgery is also an option for your hemorrhoids, and you will want to make sure you choose an experienced hemorrhoid doctor when opting for laser hemorrhoid surgery.
When To See The Doctor For Piles
Usually, piles heal on their own and dont require medical attention. But contact your doctor if you notice blood while youre passing a stool. Bright red blood generally comes from the lower digestive tract , while black or tarry-appearing blood comes from higher up in your body.
The most common reasons for bright blood in the stool are usually not serious, but sometimes it can indicate a more serious underlying illness. If your piles often reappear, dont heal on their own at home, or cause you severe pain, contact your doctor.
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Medical Treatment For Your Hemorrhoids
Dr. Rivas develops personalized hemorrhoid treatment plans after completing a thorough examination. The treatments we recommend may depend on the type of hemorrhoids, as well as your symptoms. Initially, we may suggest lifestyle changes to ease your pain, such as increasing your intake of fiber and water to improve bowel movements and sitz baths to alleviate pain and discomfort.
However, when at-home treatments fail, Dr. Rivas may suggest a procedure to destroy or remove your hemorrhoids, such as:
- Rubber band ligation
- Infrared, laser, or bipolar coagulation
When To See A Doctor About Your Hemorrhoids
A Centre of Excellence for Piles Treatment
It is understandable that people usually dont talk about hemorrhoids openly due to embarrassment. The same problem exists when a person thinks about seeing a doctor. Talking to a doctor about hemorrhoids may seem awkward, but it is important to open up about your problem to find the best solution. Seeing a doctor is usually recommended when piles symptoms appear and dont go away for more than a week. In most people, hemorrhoids resolve on their own. But if your condition doesnt improve within a week, you should immediately see a doctor for piles.
Even though hemorrhoids dont always require surgical treatment, consulting a doctor is essential to prevent the condition from advancing. The doctor will diagnose the disease and determine how serious it is. The treatment method is chosen according to the severity of the hemorrhoids. Read ahead to find out when and who you should see for hemorrhoids.
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Modify Your Daily Activities
- Avoid prolonged sitting or standing. Take frequent short walks.
- If possible, avoid lifting heavy objects frequently. If you must lift heavy objects, always exhale as you lift the object. Don’t hold your breath when you lift.
- If you are pregnant, sleeping on your side will lower pressure on the blood vessels in your pelvis. This can help keep hemorrhoids from becoming bigger.
Is Hemorrhoid Removal Surgery Painful
Minor or minimally invasive hemorrhoid removal surgery is usually not painful. These procedures typically involve the use of a local anesthetic, which numbs the affected area. More severe or persistent hemorrhoids might require removal that is more invasive, such as hemorrhoidectomy, although these are done less often.
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How Do I Get Rid Of These Annoying Hemorrhoids
We get it. No one wants to talk about things going on in the rear.
Hemorrhoids fall at the top of the list of topics you would never bring up in a casual conversation. However, we need to know how to deal with these kinds of problems. Sometimes, you have to look for answers, and that may mean asking some embarrassing questions.
First, its important to understand what hemorrhoids are and how they happen. When veins in the rectum or anus swell, they can begin to protrude. This can lead to bleeding and discomfort. Its a very common condition, especially for women who have just given birth.
Straining due to constipation during or after pregnancy can cause hemorrhoids. Other causes include lengthy periods of sitting on a toilet, obesity, anal intercourse, heavy lifting, and low-fiber diets.
Thats Great. Now, What Can I Do to Stop Hemorrhoids?
Most of the time, you can stop hemorrhoids on your own without help from a doctor. A warm bath or sitz bath can provide relief. Other options include applying Preparation H or witch hazel pads.
Even though this is a common medical condition, you should still monitor it closely and seek advice when needed. Its rare, but some women require surgery to take care of the problem. If you have questions or develop hemorrhoids that dont seem to go away, talk to your OB/GYN.
When To Seek Medical Care For Hemorrhoids
When to call the doctor
- Bleeding from the rectum or anus is never normal and although hemorrhoids are the most common reason to have blood in the stool, it should be discussed with your primary health-care professional. Other causes ofrectal bleeding exist and can be serious. Inflammatory bowel disease and cancers of the colon can present with rectal bleeding. Blood in the stool should never be ignored.
- Medical care should be sought urgently if a person is taking anticoagulation medications such as warfarin , dabigatran , rivaroxiban , apixaban , clopidogrel , prasugrel or enoxaparin .
- Individuals who have associated symptoms such as lightheadedness and weakness may have significant blood loss and may require more urgent care.
- Hemorrhoids do not cause abdominal pain should this pain be present with bleeding, medical care should be sought immediately.
- Prolapsed hemorrhoids that cannot be pushed back through the anus require medical care.
- Thrombosed external hemorrhoids may cause significant pain and medical care may be necessary to remove the clot.
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Can Hemorrhoids Be Removed
Hemorrhoidectomy is surgery to remove hemorrhoids. You will be given general anesthesia or spinal anesthesia so that you will not feel pain. Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed.