When Should You Go to the Doctor for Hemorrhoids?

You should see your doctor if you experience either of the following:

• Bleeding from the rectum, which may be a sign of a more serious medical condition
• Severe or recurrent pain

If you have hemorrhoids, you should see your doctor if you experience bleeding from the rectum, which may be a sign of a more serious medical condition or severe or recurrent pain from the hemorrhoids.

If you’re dealing with painful or bleeding hemorrhoids, you’re not alone. About one in 20 Americans have hemorrhoids, and that includes half of all adults over age 50.

Hemorrhoids develop around the anus or in the walls of the lower rectum. The rectum is the last part of the digestive tract. It’s 6 to 8 inches long and holds solid waste before it leaves the body. The anus is the opening of the rectum.

Hemorrhoids can be uncomfortable, but there are treatments available. To determine what kind of treatment you need, a doctor will look at what kind of hemorrhoids you have and what your symptoms are.

There are two types of hemorrhoids: internal and external.

• External hemorrhoids are completely visible on the outside of the body. They develop near the opening of the anus and can become painful when they swell.
• Internal hemorrhoids develop inside the anus or rectum. Most of the time, you can’t see these from outside the body. Internal hemorrhoids may prolapse, which means that part of hemorrhoid grows outside of the anal opening. Prolapsed internal hemorrhoids may be painful.

Internal and external hemorrhoids cause slightly different symptoms.

External hemorrhoid symptoms

External hemorrhoids can cause:

• Itching near the anus
• Aching or pain, particularly when sitting
• Tender, hard lumps near the anus

If you strain while moving your bowels or rub too much around your anus, you may make the symptoms of external hemorrhoids worse. Symptoms usually get better within a few days.

Internal hemorrhoid symptoms

Internal hemorrhoids may cause:

• Bleeding that is visible on your stool, in the toilet bowl, or on the toilet paper after you move your bowels
• Painful tissue around the anus

Pain from internal hemorrhoids usually happens when hemorrhoid has prolapsed. Fully-internal hemorrhoids may be painless but still, cause bleeding.

Hemorrhoids develop when the blood vessels in the rectum and anus swell or bulge. This can happen for a variety of reasons, including:

• Straining during bowel movements
• Sitting on the toilet for extended periods
• Frequent diarrhea or constipation
• Weakened anal and rectal tissue due to aging
• Frequent heavy lifting
• Pregnancy

If you have external hemorrhoids only, your doctor may be able to diagnose them by looking at them and touching them with gloved fingers.

To diagnose internal hemorrhoids, the doctor will need to feel and look at the inside of the anus and rectum. They’ll feel for growths using a lubricated, gloved finger. They’ll also use a special instrument to see inside the rectum.  

If the doctor suspects that hemorrhoids may not be the cause of your discomfort, they may order a procedure called a colonoscopy. This involves a small viewing tube that lets the doctor see your intestine.

Treatments for hemorrhoids range from at-home therapies to outpatient surgeries.

At-home treatments

• Some people choose to treat hemorrhoids at home by:
• Eating high-fiber foods
• Taking stool softeners or fiber supplements
• Staying hydrated
• Avoiding sitting on the toilet for long periods
• Taking over-the-counter pain relievers like ibuprofen, acetaminophen, or naproxen
• Sitting in warm water to relieve pain 

In-office treatments

If your hemorrhoids don’t respond to at-home treatments, your doctor might suggest treating them during an office visit or at a local medical center.

In-office procedures treat hemorrhoids by creating scar tissue, which cuts off hemorrhoids’ blood supply. Possibilities include:

• Sclerotherapy, which uses an injected solution
• Infrared photocoagulation, which uses infrared light that generates heat
• Electrocoagulation, which uses an electric current

Another option is the rubber band ligation. During this procedure, a doctor cuts off the blood supply to hemorrhoid using a special rubber band tied around the hemorrhoid’s base.

The outside of hemorrhoid then shrivels and falls off. Scar tissue forms in the remaining part of hemorrhoid and shrinks it.

Outpatient or hospital treatments

Rarely, hemorrhoids will need surgery to remove. This usually happens if less invasive procedures haven’t been successful. There are two basic types of hemorrhoid surgeries.

A hemorrhoidectomy involves a doctor cutting away external hemorrhoids and internal hemorrhoids that have fallen out of the anus. Doctors perform this procedure under anesthesia.

Hemorrhoid stapling uses a special surgical tool to block blood flow to internal hemorrhoids. It has a shorter recovery time than hemorrhoidectomy, but hemorrhoids are more likely to come back.