Choosing the Best Surgeon for Hemorrhoid Treatment

Medically reviewed by: Gary H. Hoffman, MD

Choosing the right physician for your hemorrhoid treatment is an important decision. Not only do you need someone skilled and well-trained, but you need someone who can make you feel comfortable during exams and procedures. Most importantly, you need a doctor who can diagnose and treat your condition, taking into consideration your unique needs.

Some of the things to keep in mind when choosing a proctologist or surgeon for your hemorrhoid treatment include:

Choose a Hemorrhoid Specialist

If your hemorrhoids respond to a change in diet and over-the-counter treatments, your primary care physician will probably have enough experience in treating the annoying condition to ensure you have the information you need to heal quickly. If the hemorrhoids don’t respond to this type of conservative treatment though, you will want to consider talking to a specialist about your options.

A proctologist, sometimes known as a colon and rectal specialist, deals with hemorrhoids every day. Thanks to their training and experience, they can diagnose your condition, grade, and treat your hemorrhoids more effectively. They can also often offer more effective treatments to stop rectal bleeding and shrink inflamed hemorrhoidal tissues, often based on the latest research. These treatments are usually less invasive and are not as painful as conventional treatments.

If your condition requires surgery, you will definitely want to consult with a colon and rectal surgeon. General surgeons may only do a few hemorrhoidectomies a year, while a specialist may do many each week. The learning curve, especially when it comes to cutting-edge techniques, is steep. A general surgeon may not get enough practice to be competent at performing  these specialized procedures, in some cases.

Experience Is Key

If you hope to pursue a less invasive option than a traditional open hemorrhoidectomy, choosing a specialist with experience performing these cutting-edge procedures is key. While PPH is a minimally invasive procedure for hemorrhoids, it requires a high level of skill and experience to perform properly and minimize the risk of complications.

For example, our surgeons perform Procedure for Prolapse and Hemorrhoids, or PPH, on a regular basis. Dr. Gary Hoffman not only conducted research that proves the advantages of this procedure over a more traditional hemorrhoidectomy, he also continues to work on further streamlining the procedure and advancing the instrumentation used.

Even if you do not end up undergoing PPH, you want a doctor who has the experience to understand the best options based on your unique symptoms. When a doctor does not see a condition regularly, they have a much higher risk of misdiagnosis, prescribing the wrong treatment, or missing warning signs of complications.

A colorectal surgeon will have extensive experience with hemorrhoids, as is required for them to obtain board certification. This means you get a higher level of care for your condition, from routine screenings to diagnosis to in-office treatments to surgery, when necessary.

Find a Good Doctor

Not only do you want to find an experienced doctor, you want to find a good doctor. In many cases, the personality of a colon and rectal surgeon and how comfortable they make discussing these topics is as important as their training.

While colon and rectal surgeons have advanced training in diagnosing and treating hemorrhoids and other colorectal issues, they also need to have a bedside manner that helps you relax and feel at ease explaining your symptoms. They need to make it as easy as possible on you to undergo routine screenings, as well as non-surgical and surgical treatments.

We recommend starting by asking your friends and family for a recommendation. You doctor may also have good advice about specialists. Lastly, keep researching online. Read reviews and learn more about individual physicians and practices through their websites.

Talk to Us to Learn More

At Los Angeles Colon & Rectal Surgical Associates, our surgeons pioneered the use of less invasive hemorrhoid treatments that significantly reduce postoperative pain. We focus on using the latest advances to effectively treat hemorrhoids and other perirectal and perianal conditions. We also offer preventative and diagnostic support, in additional to routine screenings. Call (310)273-2310 today to schedule your confidential consultation.

What If Treating Hemorrhoids at Home Doesn’t Work?

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August 6, 2015 by
Benjamin Krevsky, MD, MPH

Hemorrhoids are swollen veins in the anal canal. Of course, everyone has veins in this area, but when they become enlarged they can bleed, itch and cause pain.

Hemorrhoids can be located internally, externally or sometimes both. While rarely a serious condition, hemorrhoids certainly cause a lot of discomfort and concern. I previously discussed treatments you can do at home to get relief. These treatments included hydration, fiber, sitz baths, soothing wipes, ointments, creams, suppositories and more. But what do you do when this does not solve the problem?

When Should You Go to the Doctor for Hemorrhoids?

Again, before assuming that your condition is hemorrhoids, it’s a good idea to see your doctor for an examination. After all, it’s difficult to take a look for yourself. If there is any bleeding, severe pain or fecal incontinence (loss of bowel control), you should definitely see the doctor. A large amount of bleeding or the sudden onset of severe pain means you should seek medical treatment immediately.

What Kind of Doctor Treats Hemorrhoids?

In most cases, you can see a primary care physician about your hemorrhoid symptoms. But if there are complications, your doctor may refer you to a specialist, such as a gastroenterologist or a proctologist (surgeon).

How Do Doctors Treat Hemorrhoids?

Doctors can treat hemorrhoids by prescribing medications or by performing minor surgery to major surgery. Here are several treatment options:

Prescription Ointments, Creams and Suppositories

These usually contain an emollient (medication to soften and soothe the skin). In addition, there may be an anesthetic (for example, pramoxine) and/or steroid (hydrocortisone). Prescription strength medications often work better than their over-the-counter cousins. But sometimes not so much.

An oral tablet called Vasculera comes with some prescription treatment kits (Analpram advanced kit) and also helps reduce the size of hemorrhoids.

Rubber Band Ligation

In this common treatment, the doctor applies miniature rubber bands to the internal hemorrhoids. This causes them to shrink up, stop bleeding and pull back inside. There are several different techniques for performing the procedure.

In one form, (CRH O’Regan) single bands are applied once a week for several weeks. This is done as an outpatient in the doctor’s office. Multiple bands can also be placed right after a colonoscopy or other endoscopic procedure while you are still sedated. This would be done in an outpatient surgery center or hospital procedure room. Bands can also be placed without another procedure.

Depending on the doctor and your individual situation, it could be with or without sedation. While rubber band ligation works for most patients, it doesn’t work all the time. Also, there are some potential complications – bleeding, pain and infection. Recovery can range from a day or 2 to 6 weeks.

Infrared Coagulation

In this procedure, hot light is applied to the base of the hemorrhoid to seal it off. This is usually done in a surgery center but can be done in the office.

The advantages include:

• High success rate in small or medium hemorrhoids
• Very rapid recovery
• Very low risk of any complications

Usually, your recovery is complete as soon as the procedure is finished. There may be a second treatment required if the first treatment does not work.

Laser Treatment

Actually, laser treatment is not done any more. It was similar in principle to infrared coagulation, but the equipment is much more complicated and expensive.

Bipolar Therapy

This uses electrical energy to cauterize the hemorrhoids. While it is effective, it can be a painful treatment.

Radiofrequency Hemorrhoid Ligation

This method uses a probe to grasp the hemorrhoid and then cauterize it using high frequency electricity (HETTM) . Experience with this technique is limited.

Doppler Ligation

In the operating room, a surgeon uses a special ultrasound probe in the rectum to find the arteries supplying the hemorrhoids. Then a suture is placed around each artery to cut off the blood flow.

This is performed in the operating room and requires special equipment not commonly available. Recovery is quick and painless for most people.

Surgical Hemorrhoidectomy

This involves cutting out the hemorrhoids with a scalpel or cutting through the wall of the rectum and stapling the area shut again. This is true surgery and has a recovery period of several weeks. It can be very painful post-operatively and infection is often a problem.

However, this treatment works for the worst hemorrhoids, works when the other treatments fail, and has the longest period before the hemorrhoids come back.

Is It Common for Hemorrhoids to Reoccur?

Yes! Sometimes it takes a year or two, sometimes longer, but they can come back again after any treatment. They can even come back after surgery, but usually not for a long time.

How Do You Decide Which Hemorrhoid Therapy Is Best for You?

Everybody’s situation is different. Discuss the options with your gastroenterologist or surgeon. If they only offer one kind of treatment, they may not be selecting the best one for your hemorrhoids.

In the meantime, if you have more questions or feel your condition is urgent, contact your Temple physician or healthcare provider.

To schedule an appointment, please call 800-TEMPLE-MED (800-836-7536) or request an appointment online.

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What does a proctologist treat and how to prepare for an examination? Indications for visiting a doctor at the MEDSI Clinic

A proctologist is a specialist who treats diseases of the rectum, large intestine and anus. You should contact this doctor immediately after the first signs of the disease are detected. MEDSI clinics employ experienced specialists who provide support to patients with a variety of proctological problems.

Proctologist specialization

A proctologist treats infectious, parasitic, congenital, inflammatory and oncological diseases of the intestine, colon and surrounding tissues. The specialist examines patients and collects anamnesis. You can also get medical advice from a professional.

Doctors have a therapeutic or surgical profile. Doctors of the first type carry out only conservative therapy, the second – surgical interventions.

What diseases does the doctor treat in women?

A proctologist treats:

• Hemorrhoids. This disease occurs due to varicose veins in the rectum and leads to the development of hemorrhoids that protrude from the anus, causing discomfort, bleeding and pain
• Anal fissures. This pathology occurs as a result of damage to the walls of the rectum
• Polyps in the colon. This pathology belongs to the category of benign formations and is hereditary in nature
• Paraproctitis. These diseases lead to inflammation of the perirectal tissues and the formation of fistulas
• Worm infestations
• Cancers

Women should consult a doctor when the first signs of any of the listed pathologies are detected.

These include:

• Constipation or fecal incontinence
• Pain in the anus
• Anal bleeding
• Discharge from anus mucus and pus
• Bloating

What diseases does it treat in men?

In men, proctologists treat the same diseases as in women.

You should consult a specialist for hemorrhoids, anal fissures, polyps, proctitis and paraproctitis. It is important to understand that only with timely diagnosis, diagnosis and treatment, one can count on the rapid elimination of not only the symptoms of diseases, but also their causes. Turning to a doctor in the early stages of the development of pathology, the patient receives adequate conservative therapy, which avoids the need for surgical intervention.

How to prepare for the examination?

Preparing for a proctologist examination is quite simple. You don’t have to go on a special diet or do cleansing enemas.

Follow these guidelines:

• It is recommended to have a bowel movement before going to the doctor. If necessary, you can take a laxative. This will allow the specialist to make a preliminary diagnosis
• One day before the appointment with the proctologist, you should exclude from the diet products that stimulate increased gas formation
• Immediately before going to the doctor, perform standard hygiene procedures (washing with soap)
• Try to calm down and not worry. There is nothing terrible and shameful in the examination by a proctologist. Doctor doing his job

How is the inspection?

An examination by a proctologist takes place in several stages:

• History taking and listening to patient complaints
• Primary examination. It is carried out by palpation. The organs are palpated by the doctor through the abdominal wall and through the anus. Such an examination allows you to assess the condition of the anal canal and closely located parts of the intestine. Diagnosis by palpation makes it possible to detect pathological formations and damage to the walls
• Anoscopy. To conduct this examination, an anoscope is used – a special device in the form of a hollow tube with a light tip and an adapter, which allows you to perform a visual examination of the walls of the rectum. For diagnosis, the patient lies on his side and pulls his legs to his stomach. The device is inserted into the anus and allows the doctor to see all the changes. In addition, during anoscopy, biopsy material is taken
• Sigmoidoscopy. This examination is carried out using a sigmoidoscope. Diagnosis is aimed at assessing the rectum and sigmoid colon, as well as the condition of the mucous membranes at a depth of up to 40 cm. The sigmoidoscope is a fiber optic tube with a lighting device. For diagnosis, the patient is asked to kneel and elbows. This ensures that the tool penetrates to the desired depth
• Colonoscopy. Such an examination belongs to the category of endoscopic and is one of the most informative. With such a diagnosis, tumors, ulcerative colitis and Crohn’s disease can be detected. The procedure can be not only diagnostic, but also therapeutic. Colonoscopy is also prescribed to stop bleeding, remove small benign tumors and remove foreign bodies from the rectum. Colonoscopy can be performed under anesthesia
• Laboratory studies. Patients often donate blood and feces

If dangerous pathologies are suspected, the following is additionally prescribed:

• Computed tomography
• Intestinal ozonation
• ultrasound
• Colon hydrotherapy

Proctologist examination of children

If your child complains of pain during bowel movements, experiences other problems of a proctological nature, you should immediately register him with a doctor. As a rule, the diagnosis of diseases in children is carried out using the palpation technique. Instrumental methods are not used because of the too small size of the rectum. Additionally, the doctor prescribes ultrasound, CT and other examinations that are non-invasive.

Who treats colitis – proctologist or gastroenterologist?

Proctologists are involved in the treatment of colitis, as well as other diseases of the lower digestive tract. They carry out both an initial examination and consultations, as well as a complete diagnosis, and further therapy. If necessary, an additional examination by a gastroenterologist is prescribed. If the situation is complex and confusing, doctors consult and decide on the treatment of pathology together.

Benefits of visiting a proctologist at MEDSI

• Use of the latest European diagnostic and treatment protocols
• Minimization of psychological uncertainty, feelings of fear and anxiety in patients
• Experienced doctors with many years of experience. Our proctologists in Moscow regularly improve their skills, undergo internships in the world’s leading clinics
• Using a range of modern diagnostic methods: laboratory tests, endoscopy of the anal canal and rectum. MRI of the pelvic and abdominal organs
• The use of minimally invasive endoscopic and surgical intervention techniques for the treatment of diseases of the large intestine, anal canal and perineum: sclerotherapy, infrared photocoagulation, node removal, laser operations
• Lack of queues and the possibility of making an appointment with a doctor at a convenient time

To make an appointment with a proctologist, just call: +7 ((495) 152-47-53.

Do not delay treatment, contact a doctor right now:

• Proctologist appointment

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Contents

• Principles of development of hemorrhoids
• Symptoms of disease
• Which doctor should I contact
• Why it is important to see a doctor

Show all

Hemorrhoids is the most common proctological disease: today almost 12% of the total adult population suffers from it, which is a lot, it occurs equally often in men and women. ¹ Nevertheless, even if the disease brings serious discomfort in everyday life, not everyone goes to the doctor: someone is embarrassed, and someone is afraid that the examination or treatment may be painful.

In the article we will tell you why it is important to consult a specialist with this disease, which doctor treats hemorrhoids and what the main symptoms look like.

Principles of development of hemorrhoids

But what causes hemorrhoids to develop and how does it happen? This disease is a hypertrophy of the cavernous veins of the rectal plexus of the rectum. In simple words, this is varicose veins of the rectum and anus, accompanied by inflammation, bleeding and soreness. The main predisposing factors are a sedentary lifestyle, heavy physical labor, frequent and prolonged constipation, pregnancy, certain eating habits, and much more. The leading role in the development of hemorrhoids is played by:

• hemodynamic factor . It is based on the excess of arterial blood inflow over venous outflow through the cavernous veins. Because of this, nodes are formed;

• muscular dystrophic factor . In this case, the dystrophy of the muscles and ligaments located in the anal canal plays a role. They hold internal hemorrhoids above the anorectal line. If their work is disturbed, hemorrhoids increase in size, shift, and eventually fall out of the anal canal.

Hemorrhoids can be external and internal, depending on which veins are affected: located inside the anal canal or outside, under the skin around the anus. ^{1, 2}

The disease develops gradually, has several stages and degrees of severity: if at first it causes a minimum of discomfort, then in the future, if there is no treatment, the symptoms may intensify.

Symptoms of the disease

Let’s analyze what symptoms should be a mandatory reason to see a doctor. So, for hemorrhoids, depending on the form and degree, I can be characterized by:

• bleeding from the rectum during defecation . The amount of blood can be different: someone notices very few drops on toilet paper, and for someone, every trip to the toilet causes profuse bleeding. Treatment is required in both cases – you should not take the problem lightly if there is little blood;

• prolapsed hemorrhoids . In the early stages, they enter the anal canal on their own, then this can only be done manually, and in the later stages this becomes impossible;

• pain, itching or any discomfort in the anus . They can be caused both by prolapse of internal nodes, and by inflammation of external ones, thrombosis. ^{1, 2}

You should not ignore these signs – if at least one of them appears, you need to consult a doctor.

Which doctor should I contact

Hemorrhoids are a pathology of the rectum. Proctologists or coloproctologists are engaged in the diagnosis and treatment of such diseases. Today, these two terms denote the same specialty: officially it is called “coloproctology”. Such specialists treat diseases of the large intestine, including the rectum, pelvic muscles and sacrum.

As part of the first visit, the doctor conducts an examination, so you will need to prepare for visiting the clinic – exactly how, you will be told in detail during the appointment.

Diagnosis proceeds as follows:

• the patient tells the doctor about when the first symptoms of the disease appeared, how it proceeded, what worries now;

• then an examination is carried out, a digital examination of the anal canal, and also in most cases anoscopy or sigmoidoscopy – examination of the rectum using a special device;

• in the future, a colonoscopy, laboratory tests may be prescribed.

All this will make it possible to make a diagnosis, determine the stage of hemorrhoids, its severity and prescribe the right treatment. At the first stages, it is usually conservative, it allows you to stop the symptoms of acute hemorrhoids, reduce the likelihood of complications and exacerbations. Mandatory correction of the diet and diet. In the early stages, this is enough to completely get rid of the symptoms. But if a person went to the doctor too late, it is not always possible to avoid surgical intervention. For treatment, minimally invasive methods or hemorrhoidectomy can be used – a full-fledged operation involving surgical excision of hemorrhoids. ³

As part of the conservative treatment of hemorrhoids, drugs in the form of rectal suppositories are actively used. Natalsid ^® belongs to such means.

This is a medicine whose main active ingredient is sodium alginate, which is obtained from brown seaweed. The herbal preparation can be used in the treatment of chronic bleeding hemorrhoids, chronic anal fissures in the epithelization stage and other proctological pathologies.

One of the main features: Natalside ^® is approved for use during pregnancy and lactation. ⁴

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Why it is important to see a doctor

Many are embarrassed to go to the doctor with such a delicate problem, and in vain. There are several good reasons to see a specialist if you have symptoms that are characteristic of hemorrhoids.

• The sooner the diagnosis is made, the easier the treatment process will be . If in the early stages it is possible to confine oneself to conservative therapy and changing the diet, then, in the later stages, it will no longer be possible to do without surgical intervention. Hemorrhoidectomy requires a fairly long recovery, the postoperative period is associated with unpleasant sensations, so it is better to consult a doctor as soon as possible to avoid this.

• These symptoms may be characteristic of other diseases . Hemorrhoids are not the only pathology that can cause bleeding during bowel movements or pain in the anus. And only a doctor can make a correct diagnosis and prescribe treatment. Do not try to take medication for hemorrhoids on your own or use folk remedies that have helped someone you know. It is possible that you have a completely different disease with similar symptoms.
• Hemorrhoids are fraught with complications . This is not a relatively harmless disease that can only cause discomfort. Many dangerous complications are possible: from the transition of the inflammatory process to the surrounding tissues to gangrene. ³
• Hemorrhoids severely impair quality of life . Constant soreness, bleeding, prolapsed nodes that cause discomfort – all this affects daily life. Performance decreases, nervousness, irritability appear. Is embarrassment worth such sacrifices? It is better to consult a doctor, undergo treatment and return to normal life.

Knowing which doctor is needed when symptoms of hemorrhoids appear, it is important to understand why it is so important to contact him in time. If you or your loved ones have signs of this disease, make an appointment with a proctologist.

References

1. Mayat K. E. Modern methods of treating hemorrhoids // Attending physician, 2008.
   URL: https://www.lvrach.ru/
2. Clinical recommendations of the Ministry of Health of Russia: Hemorrhoids, 2020.
   URL: https://cr.minzdrav.gov.ru/
3. Vorobyov G. I., Grateful L. A. Conservative therapy of hemorrhoids // BC, 2001.
   URL: https://www.rmj.ru/
4. Instructions for use of the medicinal product Natalside ^® .