Do I Need Medical Treatment for My Hemorrhoids?

You have hemorrhoids. They’re annoying, sometimes painful, and they just don’t seem to want to go away.  At what point do you need medical treatment for hemorrhoids?

For most, hemorrhoids are small and tend to disappear on their own. For others, the presence of chronic hemorrhoids may require more than home-based remedies for relief as well as safety.

In most cases, hemorrhoids are formed by straining to complete a bowel movement.  This straining elevates venous blood and abdominal pressure, preventing the blood from draining from anal veins.  Veins have thinner walls than arteries and are more prone to leakage or rupture. A mass of bulging or dilated veins in anal tissues are called hemorrhoids.

Your doctor will be able to determine the severity or need for medical treatment through a variety of methods such as:

  • visual examination
  • a digital rectal exam
  • diagnostics such as anoscopy
  • a flexible or rigid proctosigmoidoscopy
  • colonoscopy

Such methods are effective in diagnosing internal hemorrhoids as well as to look for signs of bowel disease or other problems of the lower digestive tract.

How Does the Doctor Determine Appropriate Treatment for Hemorrhoids?

In order to determine whether medical treatment is required for one or more hemorrhoids, a physician will first obtain a complete medical history. During a physical examination, the doctor will check externally for any signs of swelling or lumps.

An internal hemorrhoid that has protruded through the anus is called a prolapsed or external hemorrhoid. Often, these hemorrhoids are visible and may also bleed. Prolapsed or external hemorrhoids often develop blood clots, which causes pain or  leakage of blood into the stool or mucus that surrounds the stool.

The physician will also observe for any signs of anal fissures or tears around the anus that may contribute to bleeding, pain, and itching.

While no one looks forward to a digital rectal exam, it serves a purpose in ascertaining muscle tone of the anus, which is required for healthy defecation.

Hemorrhoids Aren’t That Bad, Are They?

Most consider hemorrhoids embarrassing; but serious? They can be, especially serious if one or more hemorrhoids ruptures, contributing to bleeding. Left unchecked, bleeding hemorrhoids can contribute to development of anemia or other complications.

Low-grade or mild internal hemorrhoids are typically – and effectively – treated with over-the-counter medications and nonsurgical remedies. Others may require medical treatment and even surgery, especially in cases where serious or high-grade internal hemorrhoids failed to respond to other treatments.

Medical Treatments for Hemorrhoids

In the case of mild and occasional internal or small external hemorrhoids, a physician may recommend over-the-counter remedies such as hemorrhoid creams to relieve itching, minor pain and swelling.  If symptoms don’t resolve within a week or cause any side effects, you are encouraged to contact your physician for further treatment options.

A prolapsed or bleeding internal hemorrhoid may call for more focused treatment on an outpatient basis. Several medical treatments for a chronically bleeding internal hemorrhoid or a severe prolapsed hemorrhoid include:

  • Electrocoagulation – this technology utilizes a tool that transmits an electric current to painlessly cut off blood supply to the hemorrhoid. This shrinks the hemorrhoid and prompts development of scar tissue.
  • Infrared photocoagulation – similar to electrocoagulation, infrared photocoagulation is a tool that aims infrared light directly onto an internal hemorrhoid. The heat cuts off blood supply. The hemorrhoid shrinks and prompts the development of scar tissue.
  • Rubber band ligation – this procedure is common in the treatment of a prolapsed internal or bleeding hemorrhoid.  A type of rubber band is applied to the base of the hemorrhoid, cutting off blood supply. The hemorrhoid is starved of blood and oxygen, and will eventually shrink and fall off.
  • Sclerotherapy – this treatment option is an injection of a solution into an internal hemorrhoid.  Again, scar tissue is formed, cuts off blood and oxygen supply, which in turn, shrinks the hemorrhoid.

Large, external hemorrhoids or even severe prolapsed internal hemorrhoids that refuse to respond to other treatments may be removed in a process called a hemorrhoidectomy. The procedure is performed while the patient is sedated during the removal of the hemorrhoid via a number of incisions made in the hemorrhoid.  The vein inside the hemorrhoid is tied off and the hemorrhoid removed. Surgical tools for this procedure can involve lasers, cauterizing tools, or a scalpel.

Another option is called a Procedure for Prolapse and Hemorrhoids, or PPH, or stapled hemorrhoidopexy. This non-incisional procedure involves the use of a device fitted with a circular stapler.  The doctor will elevate the hemorrhoid and literally staple it to the lining of the anal canal, while at the same time removing a part of the hemorrhoid.

Yet another procedure is known as a Doppler guided hemorrhoidectomy, which is approach via a visual scope that helps the physician locate hemorrhoidal arteries for removal.

In The End…

Nearly all hemorrhoid procedures are performed on an outpatient basis. If you believe you may be suffering from internal or external hemorrhoids, consult with your physician regarding treatment options.