Who should you consult for hemorrhoid treatment. How are hemorrhoids diagnosed and managed. What are the signs that indicate a need for professional medical intervention for hemorrhoids. When do hemorrhoid symptoms warrant a doctor’s visit.

Understanding Hemorrhoids: Types and Prevalence

Hemorrhoids are a common medical condition, particularly among individuals aged 45 to 75. They occur when veins in the anal area or lower rectum become swollen and inflamed. While the exact cause remains unclear, certain risk factors and conditions contribute to their development.

There are two main types of hemorrhoids:

• External hemorrhoids: These arise from the anal canal
• Internal hemorrhoids: These originate from the rectum, just above the anal canal

According to statistics from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), hemorrhoids are a significant health concern. In 2009, approximately 1.1 million people received outpatient care for hemorrhoids, while in 2010, 266,000 individuals were hospitalized for treatment.

Recognizing Hemorrhoid Symptoms and When to Seek Help

Most hemorrhoid symptoms, such as mild itching or pain, can often be managed at home with over-the-counter remedies. However, certain signs indicate the need for professional medical attention. Dr. Aline J. Charabaty-Pishvaian, associate professor of medicine and director of the center for inflammatory bowel disease at MedStar Georgetown University Hospital, advises seeking medical help in the following situations:

• Presence of bleeding
• Feeling a lump in the anus
• Experiencing rectal pain
• Persistent symptoms despite self-treatment

These symptoms may indicate more serious underlying conditions that require proper diagnosis and treatment.

When to Call Your Doctor

Consider contacting your healthcare provider if:

1. You’re experiencing any type of rectal bleeding
2. The hemorrhoids are causing pain or discomfort
3. Problems persist despite using over-the-counter hemorrhoid creams
4. You’re passing maroon or tarry-colored stools, which may indicate bleeding

In cases of large amounts of rectal bleeding accompanied by dizziness or faintness, seek emergency medical care immediately.

Diagnosing Hemorrhoids: What to Expect

When visiting a healthcare provider for hemorrhoid concerns, you can typically consult a general practitioner or family physician. They will likely perform a physical examination and may use various diagnostic techniques to assess the condition.

Common Diagnostic Procedures

• Visual inspection of the anal area
• Digital rectal examination
• Anoscopy: Examination of the anal canal using a small, hollow tube
• Sigmoidoscopy or colonoscopy: For cases requiring further investigation

In some instances, you may be referred to a specialist such as a gastroenterologist or proctologist for more complex cases or if complications arise.

Treatment Options for Hemorrhoids

Treatment for hemorrhoids varies depending on the severity of symptoms and the type of hemorrhoids present. Options range from conservative home remedies to medical interventions and, in some cases, surgical procedures.

Conservative Treatments

• Increasing fiber intake through diet or supplements
• Enhancing water consumption
• Using over-the-counter pain relievers
• Taking warm baths (sitz baths)
• Applying topical hemorrhoid creams or ointments

Medical Interventions

For more severe cases, medical professionals may recommend:

• Rubber band ligation
• Sclerotherapy
• Infrared coagulation
• Prescription-strength medications

Surgical Options

In rare cases where conservative treatments and medical interventions are ineffective, surgical procedures may be considered:

• Hemorrhoidectomy
• Stapled hemorrhoidopexy
• Doppler-guided hemorrhoid artery ligation

Preventing Hemorrhoids: Lifestyle Modifications

While not all cases of hemorrhoids can be prevented, certain lifestyle changes can reduce the risk of developing them or experiencing recurrences:

• Maintaining a high-fiber diet
• Staying adequately hydrated
• Exercising regularly
• Avoiding prolonged sitting or straining during bowel movements
• Managing weight

These modifications can help improve overall digestive health and reduce the likelihood of hemorrhoid formation.

Complications of Untreated Hemorrhoids

While severe complications from hemorrhoids are rare, leaving them untreated can lead to various issues. Dr. Cuckoo Choudhary, associate professor of gastroenterology at Thomas Jefferson University, notes that both internal and external hemorrhoids can cause problems if left unaddressed.

Potential Complications

• Persistent bleeding, potentially leading to anemia
• Thrombosis in external hemorrhoids, causing severe pain
• Strangulation of hemorrhoids
• Infection
• Difficulty with hygiene

Recognizing these potential complications underscores the importance of seeking timely medical attention when hemorrhoid symptoms persist or worsen.

The Link Between Hemorrhoids and Gut Health

Recent research has highlighted the interconnection between hemorrhoids and overall gut health. The gut microbiome, comprising trillions of bacteria in the digestive tract, plays a crucial role in maintaining digestive health and potentially influencing hemorrhoid development.

How Gut Health Affects Hemorrhoids

• Balanced gut flora aids in proper digestion and regular bowel movements
• A healthy gut may reduce inflammation, potentially decreasing hemorrhoid risk
• Certain gut bacteria produce short-chain fatty acids that support colon health

Maintaining a healthy gut through diet and lifestyle choices may contribute to reducing the risk of hemorrhoids and alleviating symptoms in existing cases.

Dietary Considerations for Gut Health and Hemorrhoid Prevention

Incorporating certain foods into your diet can promote gut health and potentially reduce the risk of hemorrhoids:

• Probiotic-rich foods: Yogurt, kefir, sauerkraut
• Prebiotic foods: Garlic, onions, leeks, asparagus
• High-fiber foods: Whole grains, fruits, vegetables, legumes
• Fermented foods: Kimchi, kombucha, miso

These dietary choices can help maintain a healthy gut microbiome and support overall digestive health, potentially reducing the risk of hemorrhoid development.

Hemorrhoids in Special Populations

While hemorrhoids can affect anyone, certain populations may be at higher risk or require special considerations in treatment and management.

Pregnancy and Hemorrhoids

Pregnant women are particularly susceptible to hemorrhoids due to increased pressure on the pelvic area and hormonal changes. Management typically focuses on conservative treatments and lifestyle modifications, as many medical interventions may not be suitable during pregnancy.

Hemorrhoids in Older Adults

As muscle tone decreases with age, older adults may be more prone to hemorrhoid development. Treatment approaches may need to be tailored to account for other health conditions and medications common in this population.

Hemorrhoids in Individuals with Chronic Conditions

People with chronic conditions such as inflammatory bowel disease or chronic constipation may experience more frequent or severe hemorrhoids. Management often involves addressing the underlying condition in addition to treating the hemorrhoids themselves.

Emerging Treatments and Research in Hemorrhoid Management

The field of hemorrhoid treatment continues to evolve, with ongoing research into new and improved management strategies.

Promising Developments

• Minimally invasive surgical techniques
• Advanced topical treatments with enhanced efficacy
• Targeted probiotic therapies for gut health and hemorrhoid prevention
• Novel devices for improved hemorrhoid ligation and removal

These emerging treatments aim to provide more effective, less invasive options for hemorrhoid management, potentially reducing recovery time and improving outcomes for patients.

Ongoing Clinical Trials

Several clinical trials are currently underway to evaluate new treatments and interventions for hemorrhoids. These studies investigate various aspects, including:

• New pharmaceutical compounds for symptom relief
• Innovative surgical techniques
• The role of dietary interventions in hemorrhoid prevention and treatment
• The efficacy of combination therapies

As research progresses, it is anticipated that new and improved options for hemorrhoid management will become available, offering hope for those who struggle with this common condition.

In conclusion, while hemorrhoids are a prevalent and often uncomfortable condition, understanding the symptoms, knowing when to seek medical help, and exploring various treatment options can significantly improve outcomes. By staying informed about the latest developments in hemorrhoid management and maintaining good overall digestive health, individuals can take proactive steps to prevent and manage this common ailment effectively.

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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Hemorrhoid Symptoms and Diagnosis: Internal and External Hemorrhoids

Hemorrhoids occur when veins in the skin around the anus or in the lower rectum get swollen and inflamed. It’s not exactly clear what causes people to get hemorrhoids, but there are some common, accepted risk factors and conditions that lead to their development.

Aging can decrease muscle tone in the area, weakening the tissue and causing hemorrhoids to bulge, while obesity and pregnancy can increase the risk for hemorrhoids due to increased pressure on tissue in the area. (1)

Repeated straining to make a bowel movement, as well as constipation, are also associated with hemorrhoids.

Hemorrhoids are generally not dangerous or life-threatening, but they may be painful.

Common Hemorrhoid Symptoms to Watch For

The following signs and symptoms may indicate hemorrhoids:

• Bright red blood on toilet paper, in stool, or in the toilet bowl after a bowel movement
• Anal itching
• Pain around the anus, especially while sitting
• Pain during bowel movements
• One or more hard, painful lumps around the anus

If you have any symptoms of hemorrhoids, try to avoid excessive straining, rubbing, or cleaning around the anus.

Doing these things can make any irritation and itching worse, and can sometimes lead to bleeding.

Internal Hemorrhoids vs. External Hemorrhoids

There are two main types of hemorrhoids:

Internal Hemorrhoids These hemorrhoids develop inside the lower rectum. Internal hemorrhoids usually don’t hurt, but they often bleed painlessly, resulting in bright red blood you might notice when you go to the bathroom and wipe.

Most of the time, internal hemorrhoids are not visible to the naked eye. But in some cases, internal hemorrhoids may protrude through the anus, which is known as becoming prolapsed. When this happens, they will usually shrink back inside the rectum on their own. Protruding hemorrhoids can become irritated and itchy, and patients may find it difficult to clean themselves after a bowel movement.

Internal hemorrhoids are categorized by how prolapsed they are, which helps determine how they should be treated.

Grade 1 hemorrhoids means there is no prolapse. A prolapse that goes back in by itself is categorized as grade 2. Prolapse that needs to be pushed back in by the patient is considered grade 3. Grade 4 is when the prolapse can’t be pushed back in. (2)

External Hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. They can be itchy or painful, and may feel lumpy.

External hemorrhoids are called thrombosed hemorrhoids when a blood clot develops within the hemorrhoid. The increased pressure can be very painful, especially within the first 48 hours after it develops. (1)

Thrombosed hemorrhoids tend to be bluish in color due to the clot. Sometimes the blood clot will go away on its own, but because the clot has stretched the skin, it may result in an anal skin tag — excess skin left when the blood clot in a thrombosed hemorrhoid is absorbed by the body. Skin tags do not require removal, but if it’s particularly bothersome to a patient, excision is an option. (1)

If a thrombosed hemorrhoid has been present for longer than two days, the pain has often peaked and you might try home treatments while waiting for the clot to clear up on its own. When the clot first forms, it can be very painful; if you make it to your doctor’s office during this time, an in-office surgical procedure, involving local anesthesia and excision of the hemorrhoidal tissue, may be available. (2)

RELATED: 8 Myths You’ve Been Told About Hemorrhoids

How Hemorrhoids Are Diagnosed by Your Doctor

See your doctor if you think you might have hemorrhoids, especially if you notice bleeding from your anus or rectum, or have bloody stools. Your doctor will want to rule out more serious problems that can cause bleeding from the anus or rectum, such as cancer.

Hemorrhoid symptoms may also be similar to those of other anal and rectal problems, including anal fissures, abscesses, warts, and polyps.

Your doctor will ask about your medical history and will ask you to describe your symptoms. Questions about your eating habits, toilet habits, and enema and laxative use are likely to come up. (3)

Your doctor will also perform a physical exam to look for lumps or swelling, prolapsed internal hemorrhoids, external hemorrhoids, skin irritation, skin tags, and anal fissures, which are small tears in the anus that can result in itching and bleeding. (3) This will involve a visual examination of the area.

Your doctor may also perform a rectal exam to diagnose internal hemorrhoids, check the muscle tone of your anus, and check for blood in the stool. This is done with a gloved, lubricated finger (called a digital rectal examination) and a tool called an anoscope.

An anoscope is a type of endoscope — a hollow, lighted tube that is inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum. This procedure is performed in the doctor’s office and doesn’t require anesthesia. (3)

Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are over age 40.

These tests may include:

Colonoscopy After you’re sedated with medicine, your doctor uses a thin, flexible tube called a colonoscope to look at the inner lining of your colon.

A colonoscopy can help discover ulcers, polyps, tumors, and other areas of inflammation or bleeding.

Sigmoidoscopy This procedure is similar to a colonoscopy, but it uses a shorter tube called a sigmoidoscope to examine the lining of the rectum and the sigmoid colon (the lower part of the colon).

Barium Enema X-ray This is a special type of X-ray of the colon and rectum in which your doctor inserts a liquid solution containing barium sulfate into the rectum. The solution helps highlight specific areas in the colon for your doctor to examine in the X-ray images.

RELATED: 4 Signs Your Hemorrhoids Warrant a Doctor’s Visit

Additional reporting by Deborah Shapiro.

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If you have hemorrhoids which doctor will help you?

/ Home / Articles / First aid for hemorrhoids

Hemorrhoids are a fairly common disease among adult men and women, especially sedentary work contributes to it. The problem is so delicate that many are embarrassed to go to the clinic with it, to find out which doctor you need to book a consultation with. However, this is wrong behavior: if hemorrhoids are not treated, they become chronic. The exacerbation of the disease is caused by the transfer of heavy objects, the period of pregnancy, and malnutrition. If you do not treat hemorrhoids, then you will have to eliminate the problem with the help of surgical operations. Therefore, we recommend that at the initial manifestations of hemorrhoids, contact a specialist – a proctologist or coloproctologist.

Which doctor treats hemorrhoids?

Hemorrhoids is a pathology of the lowest part of digestion – the rectum. Proctologists are engaged in the diagnosis and treatment of this part of the organ. According to the modern classification of specialties – coloproctologist. These specialists deal with all problems that are associated with the colon, anus and perineum. Hemorrhoids are diagnosed by an increase in nodes, they will be detected by a gynecologist who performs a routine examination of women and a urologist when examining men. Also, the young men can be informed about the first signs of the disease by a surgeon who examines them as part of a medical examination at the military registration and enlistment office. If symptoms are detected, then the patient is referred to a narrower specialist – a coloproctologist, they explain that a professional approach is important in treating the disease.

Most district-level hospitals have a proctologist on staff. If not, then you can make an appointment with a surgeon, since proctology is one of the areas of surgery, so such a doctor has a sufficient knowledge base and practice in this area. The surgeon in the district hospital (polyclinic) conducts an outpatient appointment free of charge. In addition, you can contact a private medical clinic, there are enough coloproctologists in such institutions. To get to a good specialist, you should ask if the clinic has a license, find out the doctor’s experience and category, read reviews about him. When making an appointment, it is necessary to clarify what is included in the examination, the doctor may additionally prescribe an instrumental examination (sigmoidoscopy, anoscopy), which are paid separately. It is important to clarify this not only in terms of finances, but also for proper preparation for the study.

In the case when there is bleeding from the anus, the pain is very strong, then you need to call an ambulance. Such a complication can be caused by infringement of the node or thrombosis. If medical care is not provided in time, this will lead to necrosis (tissue necrosis).

Proctologists and Coloproctologists

The exact name of medical specialties is approved by the List of the Ministry of Health. In state institutions, when applying for a job, they strictly monitor that the name of the specialty exactly matches the law. Previously, doctors who treated hemorrhoids were called “proctologists”. Since 2014 they have been referred to as “coloproctologists”. This is due to the fact that the field of study of pathology was slightly “expanded” – to the entire large intestine.

Depending on the place of work and the characteristics of the medical profile, coloproctologists can be:

1. Therapists. In this case, the coloproctologist is engaged in therapeutic (drug) treatment of the disease, as well as the treatment of Crohn’s disease, colitis, elimination of infections and parasites that have settled in the intestines.
2. Surgeons. Coloproctologists of this direction practice minimally invasive methods of treating hemorrhoids, and also perform operations to remove tumors, hemorrhoidal cones, polyps using special endoscopic devices.

A coloproctologist-therapist for the treatment of hemorrhoids prescribes medications, prescribes drugs for oral and topical use, paints a diet that must be followed. Doctors of this specialization usually work in polyclinics, conduct outpatient appointments.

A coloproctologist-surgeon is a doctor who is consulted in cases where treatment with various home methods has not yielded results, hemorrhoids have entered an advanced stage, complications have appeared (a crack in the intestinal wall), bleeding begins, prolapse or infringement of hemorrhoids occurs. All this requires surgical intervention.

Both types of coloproctologists have enough knowledge and experience to diagnose hemorrhoids, determine the stage of the disease, and choose an effective treatment method. At the appointment, the doctor finds out how long ago the signs of the disease appeared, what provoked it and led to an exacerbation. At the consultation, the specialist necessarily examines the anus, performs palpation of the lower rectum, performs anoscopy, sigmoidoscopy. If there is a need, then such studies as irrigoscopy or colonoscopy are additionally assigned.

Based on the study, complaints and analyzes, an individual treatment regimen for the patient is selected, taking into account the age and presence of other diseases. The therapeutic process and its effectiveness are monitored. For stages I-III of the disease, treatment is carried out with the help of minisurgery (sclerotherapy for external hemorrhoids, the imposition of latex rings, ligation of blood vessels). Also, laser irradiation, cryotherapy, thermal coagulation can be used for treatment. After the procedures, the proctologist must prescribe a therapy that will prevent the development of exacerbations and maintain a positive result of treatment. To do this, the doctor explains to the patient the features of nutrition, hygiene, regimen.

Duties of a coloproctologist

A coloproctologist-surgeon not only treats hemorrhoids, but deals with the elimination of intestinal pathologies due to injuries, congenital diseases.

The doctor provides emergency or planned care in the presence of:

• hemorrhoids with complications;
• rectal fissures;
• intestinal polyps;
• paraproctitis;
• cysts and tumors.

The task of the doctor is to choose an effective method of treatment, taking into account the results of the diagnosis and the general health of the patient. The choice of the method of surgical intervention is based on the ratio of the level of risk and the prediction of the development of the disease. The coloproctologist explains to the patient the methods of preparing for surgery, removes structures, eliminates cracks, and restores the functionality of the intestine. After the operation, a diet, dressings, local procedures, and medications are prescribed.

The duties of a doctor of this specialization, in addition to receiving patients, include maintaining documentation, analyzing the effectiveness of their work, and improving their qualifications every 5 years. During retraining courses, the doctor gains knowledge about new therapeutic achievements and drugs, the possibilities of innovative diagnostic equipment.

Preparation for inspection

It is better to plan a trip to the coloproctologist on your day off, because you need to carefully prepare for the examination. Before taking it is desirable to perform a bowel cleansing.

A day before visiting a doctor, you need to exclude from the diet food that provokes gas formation:

• milk;
• legumes;
• all types of cabbage;
• fatty fish and meat dishes;
• sweet products;
• sparkling water, strong coffee and tea;
• pickles;
• any alcohol, including beer.

You should refrain from smoking. The night before, you need to do 2 cleansing enemas, in the morning one more. If the classic version of the enema is poorly tolerated, then rectal suppositories based on glycerin, Microlax microclysters, are suitable. They provide bowel cleansing in 20 minutes. You should go to the doctor on an empty stomach in case he prescribes a blood test.

How painful is the examination?

The doctor performs an examination taking into account the patient’s condition, his excitement. Therefore, he talks to the patient and tries to conduct the examination slowly and carefully. The palpation procedure is quite unpleasant, but for the most part it does not cause pain. If there is a hemorrhoidal blackened node outside, then the examination is not performed, its removal is immediately assigned.

Why is it important to see a doctor?

Hemorrhoids is a disease that causes discomfort and complicates life and work of a person due to such signs:

• pain during defecation;
• bleeding;
• itching, erosion, irritation, weeping skin around the anus;
• sensation as if there is something foreign in the anal canal.

If you do not start treating hemorrhoids, then this leads to the appearance of cracks and ruptures, inflammatory processes. Due to stagnation of blood, blood clots are formed, which worsen the nutrition of tissues, lead to necrosis. This provokes severe pain and general intoxication. If the thrombus is not removed in time along with the node, then bleeding occurs. It is joined by a bacterial infection that passes to the tissues of the rectum. This is fraught with sepsis, damage to neighboring organs.

Due to the shyness in the diagnosis and treatment, hemorrhoids quickly become neglected with complications. The longer you do not seek medical help, the more difficult it is to treat the disease, the risk of complications increases, the need for urgent surgery. A timely visit to the doctor allows you to stabilize the condition, prevent the transition of hemorrhoids to the painful stage 4.

September 22, 2020

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