What If Treating Hemorrhoids at Home Doesn’t Work?

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Posted
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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4 Signs Your Hemorrhoids Warrant a Doctor’s Visit

Hemorrhoids are fairly common, especially among people ages 45 to 75. And most hemorrhoid symptoms, such as mild itching or mild pain, can usually be treated at home with over-the-counter remedies.

But there are times when a trip to the doctor is warranted — and many people do seek medical help, whether for more specific medication or, in some cases, simple hemorrhoid surgery. According to the latest statistics for digestive diseases from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 1.1 million people received outpatient care for hemorrhoids in 2009, and 266,000 people were hospitalized for treatment in 2010. While severe complications of hemorrhoids are quite rare, it’s important to know when to see your doctor.

“Anytime you have bleeding, feel a lump in the anus, or have rectal pain, you should see a doctor to make sure you don’t have a more serious cause of the symptoms,” says Aline J. Charabaty-Pishvaian, MD, associate professor of medicine and director of the center for inflammatory bowel disease at MedStar Georgetown University Hospital in Washington, DC.

Even a less serious situation can prompt a call to your doctor. If you’ve been trying to treat hemorrhoids on your own, for instance, yet the hemorrhoid symptoms linger, a doctor visit makes sense.

“If you have already been diagnosed with hemorrhoids and your symptoms are not improving with fiber supplements, an increase in water intake, over-the-counter pain relievers, or a warm bath, then schedule an appointment,” Dr. Charabaty-Pishvaian says.

In most cases, you can see a general practitioner or your family physician about your hemorrhoid symptoms. If complications arise, you may be referred to a specialist, such as a gastroenterologist or a proctologist.

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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 [blood clotting], 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.

Though hemorrhoids are thought of as a minor health problem, you shouldn’t let that notion keep you from getting them examined. The ultimate goal is hemorrhoid relief, and for many people, that means an office visit.

Read more: Hemorrhoids: What to Know

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90,000 which doctor to contact. Expert advice.

Each disease has its own symptoms and causes. Naturally, you can not do without a doctor who is engaged in the prevention of the disease and its treatment. Which specialist should I contact if hemorrhoids appear?

Proctologist deals with all problems related to disorders in the rectum. If symptoms of the disease occur, he conducts the necessary studies and then prescribes the appropriate treatment. Fortunately, this disease does not always require surgical intervention, especially if it is detected in the early stages of development.

What are hemorrhoids?

Hemorrhoids are inflammation and swelling of the veins in the lower rectum and anus. This is due to circulatory disorders or other adverse factors. Sometimes the walls of these blood vessels stretch so much that the veins swell, especially during the process of defecation. About half of adults have experienced symptoms of hemorrhoids at least once by their 50th birthday.

Hemorrhoids are divided into internal and external. Internal hemorrhoids develop inside the rectum, or directly near the anus. External hemorrhoids develop outside the anus. The most frequent and unpleasant is the external process due to severe pain and difficulty in sitting. Most types of hemorrhoids are fairly easy to treat. Meanwhile, it is considered one of the most common causes of rectal bleeding.

What are the symptoms of hemorrhoids?

Depending on the type of hemorrhoids, they can cause different symptoms. Some of them are pronounced, others are hard to notice right away. For example, internal hemorrhoids are so deep inside the rectum that you usually cannot see or feel them. It does not cause pain because there are few nerve endings inside the rectum. Symptoms of internal hemorrhoids include:

• blood on feces, on toilet paper after wiping, or in the toilet bowl;
• soft tissue protruding beyond the anus (prolapse).

It can cause pain and discomfort when you have a bowel movement. You may see prolapsed hemorrhoids as moist bumps that are pinker than the surrounding area. They usually return inside the rectum on their own. Even if they don’t, they can often be neatly put back into place.
External hemorrhoids are located under the skin around the anus, where there are many more nerves that are sensitive to pain. Because of this, it is easier to detect, and the symptoms of external hemorrhoids are more serious and bothersome. You will feel obvious discomfort when sitting and lying down, and you will also be more sensitive to any touch to the affected area. Symptoms of external hemorrhoids include:
pain

• bleeding
• itching
• swelling

A blood clot inside an inflamed vein can turn external hemorrhoids into a thrombosed form. Usually the color of the veins around the anus turns purple or blue, a serious inflammatory process occurs. This is called thrombosis or thrombosed hemorrhoids. You may notice symptoms such as:

• severe pain
• constant itching
• bleeding

Although hemorrhoids are quite painful, they are not life threatening and often go away on their own without treatment. The exception is thrombosis during inflammation, which can lead to blockage of the veins and the occurrence of anal bleeding. If the disease appears frequently, you may develop symptoms of anemia, such as weakness and pale skin due to blood loss. Be careful and always see a doctor if you experience severe discomfort, pain, or excessive bleeding.

What causes hemorrhoids?

Hemorrhoids are not only acquired problems with veins, but also bad heredity. You can improve your position if you moderate heavy lifting, watch your diet and physical activity. A sedentary lifestyle, snacking on sandwiches and not having enough liquids in the diet is harmful to the body. Mindfulness of your body will give you long-term health and can prevent the risk of relapse.

Obese people with thrombosis or varicose veins are at increased risk. You fall into this group during pregnancy, as during this period our organs and systems malfunction. The enlargement of the uterus does not contribute to the health of the colon, as it presses on it, as a result of which the intestines swell slightly. To prevent this, it is important to constantly monitor your diet and catch the slightest discomfort during bowel movements.

Contrary to popular belief, hemorrhoids do not arise from constant sitting, but from a standing lifestyle. When you stand, the muscles tense up too much and, without the opportunity to relax, can provoke inflammatory processes. Anal intercourse can provoke the development of hemorrhoids. Be attentive and careful, and if you feel discomfort, it is better to stop any interaction.

Hemorrhoids can be passed genetically from parent to child. If any of your relatives have vein problems or had hemorrhoids, you are at increased risk. True, this does not mean that the disease will manifest itself in you without fail, some may not experience any problems in their entire lives.

How are hemorrhoids diagnosed?

Diagnosis of hemorrhoids usually does not cause many problems. An experienced specialist can identify the disease in you just by conducting a visual examination. If it seems to him that the problem may be more serious and a simple examination is not enough, the doctor may palpate your colon by inserting a finger into the anus. This procedure is not too painful, but it helps to determine at what stage the inflammatory process inside the intestine is now.

In addition, sigmoidoscopy may be prescribed. It is needed for a detailed examination of your anus for damage or the presence of blood clots in the hemorrhoids. For this procedure, a very small fiber optic camera is placed inside the intestine. With it, the doctor can see the full scale of the problem and, if necessary, adjust the treatment.

What are the treatment options for hemorrhoids?

Hemorrhoids can be treated at home or in the doctor’s office. Often simple cases are treated at home by relieving pain and relieving inflammation. To alleviate the pain syndrome, warm baths are recommended in the evenings. The water should not be hot, somewhere around 40 degrees. It is recommended to take a bath for 10-15 minutes, you can add natural herbs to it, such as chamomile and calendula. Using a cold compress can also help reduce swelling in hemorrhoids.

Suppositories, ointments and creams based on plant extracts and medicines help relieve pain and reduce inflammation. A variety of candles for the treatment of hemorrhoids can be found in all pharmacies and online stores. They are convenient to use, so you can remove the first symptoms even while sitting at work.

Another long-term remedy for the prevention and treatment of hemorrhoids can be foods rich in fiber. You can use it in its pure form in order to improve digestion and facilitate the process of defecation. One of the most common dietary supplements is psyllium.

If prone to hemorrhoids, observe special hygiene rules. Washing your anus daily with warm water without the use of soap or other harsh parabens will help. Also, avoid using dry or rough toilet paper after a bowel movement, prefer cleansing or soft paper tissues.

Medical intervention

In case of advanced hemorrhoids or frequent recurrences that can lead to heavy bleeding, the doctor may recommend surgery. One of the procedures for the treatment of hemorrhoids is the ligation of inflamed nodes and deprivation of their blood circulation. Swelling and inflammation gradually subsides, and you return to normal faster. This procedure should be performed only by a qualified medical professional, so as not to cause even more harm to the body.

There are several other techniques for treating hemorrhoids, such as hemorrhoidectomy. For some of them, surgical intervention is performed with a scalpel, for others – with a laser or ultrasound. When removing the tissue of hemorrhoids, the supply vessels are either cauterized or sutured. This helps to eliminate the symptoms of the disease and prevent future recurrences. The procedure is performed under epidural anesthesia, which makes it as painless as possible.

Hemorrhoid Prevention

To prevent hemorrhoids from getting worse, try the following tips:

1. Eat more fiber. This helps food pass through your body more easily. A good way to get it is to include plant foods in your diet: vegetables, fruits, whole grains, nuts, seeds, and legumes. Try to get 20 to 35 grams of dietary fiber per day.
2. Use fiber supplements. Over-the-counter supplements can help soften stools if you don’t get enough fiber from food. Start with a small amount and gradually increase the dosage until the desired effect is achieved.
3. Drink water. This may seem like very simple advice to you, but drinking enough water will help you avoid hard stools and constipation. You will be less tense during a bowel movement and will not provoke inflammation in the anus.
4. Exercise. Physical activity, such as walking for half an hour every day, keeps your cardiovascular and digestive systems working.
5. Don’t wait too long. Doctors recommend using the toilet as soon as you feel the urge. Too long retention of feces can adversely affect the condition of the anus and colon. Refrain from sitting on the toilet for long periods and don’t push too hard. It would be ideal to let the bowel movements pass by themselves when the stomach notifies you of such a need.
6. Maintain a healthy weight. Obesity adversely affects the state of the whole organism. Extra pounds do not contribute to your physical activity, and also lead to high cholesterol. Which in turn increases the risk of thrombosis.

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