What are the medical options for treating hemorrhoids. How do doctors diagnose and treat hemorrhoids when over-the-counter remedies don’t work. When should you see a doctor about hemorrhoid symptoms.

Understanding Hemorrhoids: Causes and Symptoms

Hemorrhoids are swollen veins in the anal canal that can cause discomfort, bleeding, itching, and pain. While everyone has veins in this area, they become problematic when enlarged. Hemorrhoids can be internal, external, or both. Although rarely serious, they can significantly impact quality of life.

What causes hemorrhoids to develop? Common factors include:

• Straining during bowel movements
• Chronic constipation or diarrhea
• Sitting for long periods on the toilet
• Pregnancy and childbirth
• Obesity
• Low-fiber diet

Are hemorrhoids always visible? Not necessarily. Internal hemorrhoids often go unnoticed until they bleed, while external hemorrhoids are more easily seen and felt as swollen lumps around the anus.

When Home Treatments Fall Short: Recognizing the Need for Medical Intervention

Many people find relief from hemorrhoid symptoms through home remedies like sitz baths, over-the-counter creams, and lifestyle changes. However, these methods don’t always provide sufficient relief. When should you consider seeking medical help?

Key indicators that it’s time to see a doctor include:

• Persistent bleeding during bowel movements
• Severe pain that doesn’t improve with home treatments
• Hemorrhoids that don’t respond to over-the-counter remedies after a week
• Large, painful external hemorrhoids
• Any signs of infection, such as fever or pus

Is it ever an emergency? Yes, if you experience heavy bleeding or sudden, severe pain, seek immediate medical attention as these could indicate a more serious condition.

Medical Evaluation: What to Expect When You See a Doctor for Hemorrhoids

When you visit a healthcare provider for hemorrhoid concerns, they will typically perform a thorough evaluation to confirm the diagnosis and rule out other potential issues. What does this examination usually involve?

1. Medical history review: Your doctor will ask about your symptoms, diet, bowel habits, and any previous treatments you’ve tried.
2. Visual examination: An external inspection of the anal area to check for visible hemorrhoids or other abnormalities.
3. Digital rectal exam: The doctor may gently insert a gloved, lubricated finger into the rectum to feel for internal hemorrhoids or other masses.
4. Anoscopy: A hollow, lighted tube may be used to view the anal canal and lower rectum more clearly.

In some cases, additional tests like colonoscopy might be recommended to rule out other conditions, especially if there’s bleeding or you’re over 40.

Prescription Treatments: Stepping Up from Over-the-Counter Options

When home remedies and over-the-counter treatments prove ineffective, doctors may prescribe stronger medications. How do these differ from what you can buy without a prescription?

Prescription treatments often include:

• Higher-strength corticosteroid creams to reduce inflammation
• Prescription-strength pain relievers
• Combination products containing anesthetics and anti-inflammatory agents
• Oral medications like Vasculera to help shrink hemorrhoids

Are prescription treatments always more effective? While they often provide stronger relief, individual responses can vary. Your doctor will work with you to find the most effective solution for your specific case.

Minimally Invasive Procedures: Office-Based Treatments for Hemorrhoids

When medications alone don’t provide sufficient relief, several minimally invasive procedures can be performed in a doctor’s office or outpatient setting. What are some of these options?

Rubber Band Ligation

This common treatment involves placing tiny rubber bands around internal hemorrhoids to cut off their blood supply. How is it performed? The doctor uses a special tool to apply the bands, which causes the hemorrhoid to shrink and fall off within a week or two. Multiple treatments may be needed for complete relief.

Infrared Coagulation

In this procedure, a device is used to direct infrared light onto the hemorrhoid, causing it to coagulate and shrink. What are the advantages of this method? It’s quick, relatively painless, and has a fast recovery time. However, it may be less effective for larger hemorrhoids.

Sclerotherapy

This involves injecting a chemical solution into the hemorrhoid to shrink it. How does it work? The solution causes the hemorrhoid to scar and close off, eventually shrinking it. This method is often used for small to medium-sized internal hemorrhoids.

Do these procedures require anesthesia? Most can be performed with local anesthesia or mild sedation, allowing patients to return home the same day.

Advanced Surgical Options: When Conservative Treatments Aren’t Enough

For severe or recurring hemorrhoids that don’t respond to other treatments, surgical intervention may be necessary. What are some of the more advanced surgical options available?

Hemorrhoidectomy

This traditional surgical approach involves removing the hemorrhoids entirely. How is it performed? Under general anesthesia, the surgeon cuts out the problematic tissue. While effective, it typically requires a longer recovery period and may cause more post-operative pain than other methods.

Stapled Hemorrhoidopexy

Also known as PPH (Procedure for Prolapse and Hemorrhoids), this technique uses a special stapling device to reposition and secure hemorrhoid tissue. What are its benefits? It often results in less post-operative pain and a quicker return to normal activities compared to traditional hemorrhoidectomy.

Transanal Hemorrhoidal Dearterialization (THD)

This newer technique uses Doppler ultrasound to locate and tie off the arteries feeding the hemorrhoids. How does it compare to other surgeries? THD typically causes less pain and has a faster recovery time, but may not be suitable for all types of hemorrhoids.

Are these surgeries always successful? While surgical treatments have high success rates, there’s always a small risk of recurrence or complications. Your surgeon will discuss the best option for your specific case.

Recovery and Follow-up: What to Expect After Hemorrhoid Treatment

The recovery process after hemorrhoid treatment can vary significantly depending on the procedure. What should patients anticipate during their recovery period?

For minimally invasive procedures like rubber band ligation or infrared coagulation:

• Mild discomfort for 1-2 days
• Possible light bleeding
• Return to normal activities within 24-48 hours

For surgical procedures like hemorrhoidectomy:

• More significant pain, managed with medication
• Restricted activities for 1-2 weeks
• Full recovery in 2-4 weeks

How can patients support their recovery? Following post-procedure instructions carefully, maintaining good hygiene, and gradually increasing fiber intake can all contribute to a smoother recovery process.

Preventing Recurrence: Long-Term Strategies for Hemorrhoid Management

After successful treatment, preventing hemorrhoid recurrence becomes a priority. What lifestyle changes can help maintain anal health and prevent future problems?

1. Dietary modifications: Increasing fiber intake and staying well-hydrated to promote softer stools.
2. Bathroom habits: Avoiding straining and limiting time spent on the toilet.
3. Exercise: Regular physical activity to promote healthy bowel function.
4. Weight management: Maintaining a healthy weight to reduce pressure on the anal area.
5. Prompt treatment: Addressing any new symptoms quickly to prevent worsening.

Can hemorrhoids be prevented entirely? While it’s not always possible to prevent hemorrhoids completely, especially in cases of genetic predisposition or certain medical conditions, these strategies can significantly reduce the risk of recurrence for many individuals.

By understanding the range of treatment options available and adopting healthy lifestyle practices, most people can find effective relief from hemorrhoid symptoms and improve their overall quality of life. If you’re struggling with persistent hemorrhoid issues, don’t hesitate to consult with a healthcare provider to explore the best treatment plan for your individual needs.

What If Treating Hemorrhoids at Home Doesn’t Work?

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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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How to Treat, When to See a Doctor

Hemorrhoids That Won’t Go Away: How to Treat, When to See a Doctor

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Medically reviewed by Saurabh Sethi, M. D., MPH — By Scott Frothingham on October 7, 2019

Even without treatment, the symptoms of small hemorrhoids might clear up in just a few days. Chronic hemorrhoids, however, can last weeks with regular symptom flare-ups.

Keep reading to learn how to treat hemorrhoids that won’t go away and when to see a doctor.

Hemorrhoids are swollen veins around your lower rectum and anus. These veins can swell to the point that they bulge and become irritated. There are two main types of hemorrhoids:

• Internal hemorrhoids. These occur in the small arterial branches inside the rectum. They’re typically not felt or seen, but they may bleed.
• External hemorrhoids. These occur in the veins under the skin outside of the anal opening. Like internal hemorrhoids, external hemorrhoids can bleed, but because there are more nerves in the area, they tend to create discomfort.

Conditions commonly associated with chronic hemorrhoids include the following:

• A prolapsed hemorrhoid is an internal hemorrhoid that gets bigger and bulges outside the anal sphincter.
• A strangulated hemorrhoid is a prolapsed hemorrhoid with the blood supply cut off by the muscles around your anus.
• A thrombosed hemorrhoid is a clot (thrombus) that forms after blood pools in an external hemorrhoid.

If you have hemorrhoids, you’re not alone. The National Institute of Diabetes and Digestive and Kidney Diseases estimates hemorrhoids affect about 5 percent of Americans and about 50 percent of adults over 50 years old.

If you have hemorrhoids that just won’t go away or keep reappearing, see your doctor.

Following diagnosis, your doctor might recommend treating chronic hemorrhoids with lifestyle changes, including:

• incorporating more high-fiber foods in your diet
• increasing your daily consumption of water and other nonalcoholic beverages
• limiting your time sitting on the toilet
• avoiding straining during bowel movements
• avoiding heavy lifting

Your doctor may also recommend some more involved or more medicinal steps to incorporate in self-treatment, such as using:

• over-the-counter (OTC) pain relievers, like ibuprofen (Advil), acetaminophen (Tylenol), naproxen (Aleve), or aspirin
• OTC topical treatments, such as a cream containing hydrocortisone or a pad with a numbing agent or witch hazel
• a stool softener or fiber supplement, such as methylcellulose (Citrucel) or psyllium (Metamucil)
• a sitz bath

If self-care isn’t effective in relieving your symptoms, your doctor may recommend one of a variety of procedures.

In-office procedures

Your doctor may suggest:

• Rubber band ligation. Also called hemorrhoid banding, this procedure is used for prolapsing or bleeding hemorrhoids. Your doctor places a special rubber band around the base of the hemorrhoid to cut off its blood supply. In about a week, the banded section will shrivel and fall off.
• Electrocoagulation. Your doctor uses a special tool to deliver an electric current that shrinks a hemorrhoid by cutting off its blood supply. It’s commonly used for internal hemorrhoids.
• Infrared photocoagulation. Your doctor uses a tool that delivers infrared light to shrink a hemorrhoid by cutting off its blood supply. It’s typically used for internal hemorrhoids.
• Sclerotherapy. Your doctor injects a solution that shrinks a hemorrhoid by cutting off its blood supply. It’s typically used for internal hemorrhoids.

Hospital procedures

Your doctor may suggest:

• Hemorrhoidopexy. A surgeon uses a special stapling tool to remove internal hemorrhoid tissue, pulling a prolapsed hemorrhoid back into your anus. This procedure is also called hemorrhoid stapling.
• Hemorrhoidectomy. A surgeon surgically removes prolapsed hemorrhoids or large external hemorrhoids.

If you have hemorrhoids that won’t go away, see your doctor. They can recommend a variety of treatments, ranging from diet and lifestyle changes to procedures.

It’s important you see your doctor if:

• You’re experiencing discomfort in your anal area or have bleeding during bowel movements.
• You have hemorrhoids that don’t improve after a week of self-care.
• You have a lot of rectal bleeding and feel dizzy or lightheaded.

Don’t assume that rectal bleeding is hemorrhoids. It can also be a symptom of other diseases, including anal cancer and colorectal cancer.

Last medically reviewed on October 7, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• American Society of Colon and Rectal Surgeons. (n.d.). Hemorrhoids: Expanded version.
  fascrs.org/patients/disease-condition/hemorrhoids-expanded-version
• Cleveland Clinic. (2016). Hemorrhoids. 
  my.clevelandclinic.org/health/diseases/15120-hemorrhoids
• Harvard Health Publishing. (2019). Hemorrhoids and what to do about them. 
  health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
• Mayo Clinic Staff. (2019). Hemorrhoids.
  mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268
• National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Hemorrhoids.  
  niddk.nih.gov/health-information/digestive-diseases/hemorrhoids

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Oct 7, 2019

Written By

Scott Frothingham

Edited By

Elizabeth Donovan

Medically Reviewed By

Saurabh Sethi, MD, MPH

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Medically reviewed by Saurabh Sethi, M.D., MPH — By Scott Frothingham on October 7, 2019

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When does Botox start to work and why does it not work? Interestingly, long before this, this drug was widely used in medicine to correct strabismus, torticollis and some other diseases. Therefore, Botox is a fairly well-studied substance.

How it works

Botulinum toxin is designed to block neuromuscular impulse transmission to the muscle from the brain, while not changing the very structure of muscles or nerves. The drug is administered subcutaneously. Botox partially paralyzes the muscles, as a result of which they stop contracting and stretching the skin. As a result, a person acquires a face without wrinkles, but with the preservation of her facial expressions.

Why Botox might not work?

The lack of results from the injection of the drug can be due to several reasons:

Injection of the drug into the wrong muscle

To obtain a successful result, it is extremely important to determine the location of the muscle and its strength.

Incorrectly calculated dosage

Thus, too low a dosage of the agent will not make it possible to achieve the desired result.

Wrong choice of drug

Botox is commonly referred to as any drug containing botulinum toxin A. There is no significant difference between the drugs, but there is a difference in duration, degree of purification, volume. For example, the Xeomin drug is considered weaker than Botox and Dysport, and if it is administered to a client after these two designated drugs, there may be no effect. It is also not recommended to mix different drugs and administer them without waiting for the complete withdrawal of the previous one.

Doctor’s incompetence

Lack of experience, incorrect assessment of the state of tissues can lead to errors, which will negatively affect the effect of the drug.

Expired

Botulinum toxin preparations are highly sensitive to storage temperature – they can be found undiluted in the refrigerator or in the freezer. This storage regime should be observed from the manufacturer’s packaging until the dilution of botulinum toxin in the clinic with saline. However, unforeseen things can happen – improper transportation, power outages – and the effectiveness of the drug will immediately decrease significantly. This applies to all drugs except Xeomin.

Incorrect dilution of the drug

It is necessary to carefully dilute botulinum toxin with saline. With too rapid introduction of saline into the drug, a large number of bubbles and foam appear. This leads to a significant decrease in the effect of the drug.

Improper storage after reconstitution

All diluted botulinum toxin preparations must be used within 24 hours and not stored in the refrigerator for several days. Sometimes an unused diluted drug is collected in syringes and put into freezers, and when the client arrives, it is taken out and thawed. However, re-freezing of the formulations is prohibited, because the effect of the drug practically disappears.

Body produces antibodies to the drug

This situation can happen for several reasons:

• short treatment interval;
• increased dosage;
• past botulism (food poisoning containing botulinum toxin).

Botox is an effective cosmetic procedure, but it is not able to remove static wrinkles. The drug is most effective when injected into the area of ​​the nasolabial folds, between the eyebrows, and the forehead.

An expert spoke about the dangers of using expired drugs

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02/16/2023

Often people do not keep track of the expiration date of medicines in the home medicine cabinet and take expired medicines.

How long is it permissible to take drugs after the expiration date? What medications should not be taken in such cases? How to store medicines correctly? And how to understand that the drugs were stored incorrectly? – told about it Ekaterina Terentyeva, general practitioner, head of the medical examination department, INVITRO group of companies.

What happens to drugs after the expiration date?

Over time, the drug is exposed to temperature, moisture, sunlight and other external factors that can lead to various chemical reactions of decomposition, oxidation, and so on. These chemical interactions entail a change in the physicochemical properties of the drug. In expired medicines, the chemical properties of the components of the drug change, their medicinal qualities are destroyed. Such drugs can become hazardous to human health.

Can medicines that have expired be used? For which drugs is this unacceptable?

The expiry date is the period of time the manufacturer of the drug guarantees its effectiveness, provided that the storage conditions are observed. After the expiration date, many drugs can be used without fear for their health, but not more than two months, provided they are properly stored. However, these recommendations do not apply to all dosage forms.

All ophthalmic preparations should definitely be discarded at the expiration date, since by this time the preservative usually stops working in them and bacteria begin to multiply in the drops. It is recommended to store a printed vial of tablets for no more than a year from the moment it is opened, otherwise the risk of getting gastrointestinal problems increases. In addition, some capsules / tablets, depending on their properties, may shrink or absorb water vapor from the air, which may affect the therapeutic effect of the drug. Expired solutions for injection should not be used, as they may form toxic substances. Also, do not use injection solutions if they have changed their color or a cloudy precipitate has appeared in them, even if the expiration date is preserved – this can be extremely dangerous. Separately, it must be said about vitamins, since these low molecular weight organic compounds decompose at a high rate and at the time of the expiration date they will contain very few active substances that have a therapeutic effect.

Preparations such as nitroglycerine, insulin and antibiotics in liquid form are strongly discouraged after the expiration date.

The effectiveness of some drugs may decrease dramatically as the end date approaches.

Liquid form preparations (solutions, suspensions) have a shorter shelf life than solid form preparations (tablets, powders, capsules).

What happens if you still use after the deadline? Are poisonings possible with such drugs?

It is better not to take the risk of taking the drug after the expiration date. This is especially true for anticonvulsants, drugs that stop attacks of ischemia and angina, anticoagulants, if there is a risk of thrombosis, bronchodilators and antispasmodics, cardiotonic and antiarrhythmic drugs, drugs to stabilize the function of the thyroid gland, sedatives and hypnotics, oral contraceptives, adrenaline, insulin, antibiotics and others.

Expired medicines may not be effective or cause irreparable harm to health due to changes in their chemical composition. The consequences of taking such drugs can be an allergic reaction, poisoning, increased infection, heart failure, visual disturbances and other consequences.

Please understand that if you use expired tablets, you are solely responsible for possible side effects. At the expiration date, the effect of the drugs may differ for the worse from that provided for by the instructions. Do not use tablets that have changed their color, shape, or texture.

What to do with medicines that do not have expired dates, but were stored incorrectly?

Proper storage of medicines ensures that you are taking the right quality medicines that have the maximum therapeutic effect on the body.

It is very important to store medicines at the correct temperature. Ideally, this should be the temperature indicated in the package for the drug, but minor deviations are possible. Most drug manufacturers try to make it easier to store them, so the acceptable temperature range is quite wide. At the same time, many drugs are designed for storage at room temperature from about 15 to 22 degrees Celsius, for some drugs the temperature may be even higher, but some of them must be stored in the refrigerator. If you do not follow the storage rules, the product will become unsuitable for use much earlier than indicated on the package.

Is it true that if the tablet crumbles / does not crumble, then this means that it has retained its medicinal properties?

In addition to expiration dates and requirements for storage conditions, all medicines have external characteristics: color, haze or gloss, density, size, consistency, which make it possible to determine whether the medicine has deteriorated.

Look out for cracked, crumbling or crumbling tablets. You need to check if the color specified in the annotation has changed. If the tablets have changed color or texture, they may be harmful to health.