Don’t assume that a clinic claiming to specialize in hemorrhoid treatment is staffed with board certified colon rectal surgeons. Here at CRS, our experienced team of board certified colon rectal surgeons provides hemorrhoid patients with the best quality care for this common medical problem.

Because rectal bleeding is often the result of factors other than hemorrhoids, it is best to consult with a board certified specialist to determine the best treatment program for anal rectal problems.

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What are hemorrhoids?

Hemorrhoids are a normal part of the human anatomy. Everybody has them. When people refer to hemorrhoids, they’re actually referring to inflamed hemorrhoids, a condition in which the veins around the anus or lower rectum are swollen and inflamed.

There are several factors that contribute to forming symptomatic hemorrhoids, though the most common is straining to move stool. Other factors include pregnancy, aging, chronic constipation, or diarrhea.  Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

About half of the population experience hemorrhoid problems by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

FAQ and Common Myths

“Bleeding with bowel movements is probably just a hemorrhoid.”
Although rectal bleeding can commonly come from hemorrhoids, there are many other things that can cause rectal bleeding such as cancer, polyps, anal fissures, and anal fistulas.

“Rectal pain is probably just a hemorrhoid.”
Don’t assume that any rectal symptom is just a hemorrhoid. There are many other problems that people can have of their anorectal area. Over the counter hemorrhoid creams will most often prove to be ineffective if your problem is something other than a hemorrhoid.

Are hemorrhoid treatments all painful?
There are a variety of different treatments for hemorrhoids depending on the severity and type of hemorrhoid someone has. Some treatments can be surprisingly painless while other procedures remain a painful operation. It’s important to be evaluated by a colorectal surgeon to determine what options you may have available for treatment.

What can I do to prevent hemorrhoids?
Eating a healthy high fiber diet leading to normal healthy bowel movements can help prevent hemorrhoids. Avoid straining with bowel movements. It is also important not to spend too much time on the toilet (no reading, no phone games, no texting while on the toilet)

What are the symptoms of hemorrhoids?

Many other anorectal problems, including fissures, fistulas, and abscesses have similar symptoms to hemorrhoids and are incorrectly referred to as hemorrhoids. The most common symptom of internal hemorrhoids is bright red blood covering the stool, visible on toilet paper or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, where it becomes irritated and painful. This is known as a protruding hemorrhoid.

Hemorrhoids usually are not dangerous or life threatening. In most cases, their symptoms will go away within a few days. In fact, not everyone who has hemorrhoids even experiences symptoms.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

How are hemorrhoids diagnosed?

Any time bleeding from the rectum or blood in the stool occurs, you need to get a thorough evaluation and proper diagnosis. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

We will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, we may recommend a sigmoidoscopy or colonoscopy, diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

What Is the treatment for hemorrhoids?

Preventing the recurrence of hemorrhoids requires relieving the pressure of straining due to constipation or diarrhea. The most effective method to relieve constipation is increasing the amount of fiber and fluids in your diet. Eating the right amount of fiber and drinking six to eight glasses of fluid (not alcohol) result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. A reduction in straining also helps prevent the hemorrhoids from protruding.

Good sources of fiber are fruits, vegetables, and whole grains. In addition, we may recommend a bulk stool softener or a fiber supplement.

Medical treatment of hemorrhoids is aimed initially at relieving symptoms and includes:

  • Tub baths several times a day in plain, warm water for about 10 minutes
  • Application of a hemorroidal cream or suppository to the affected area for a limited time

In-Office/Outpatient Interventions

Over half a million people are treated for symptomatic hemorrhoids each year. The vast majority of them will not require surgery. However, when dietary modifications, topical ointments, soaking in warm water, and office based treatments aren’t successful, hemorrhoids must be treated surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. There are three methods we commonly employ during an office or hospital visit:

Infrared coagulation

Infrared Coagulation (commonly referred to by patients – incorrectly – as “laser” surgery) is an office-based procedure used on bleeding hemorrhoids that don’t protrude. An a probe is used to provide infrared heat directly to the internal hemorrhoids. Infrared Coagulation (IRC) is relatively painless and causes the hemorrhoids to shrivel up.

Elastic band ligation

Elastic Band Ligation is another commonly employed, office-based procedure used primarily on patients with bleeding internal hemorrhoids. (Prolapse of hemorrhoidal tissue is more commonly referred to as “piles” and is a common condition, particularly in people over 50.) An anoscope is used to identify the “piles” and a specialized instrument is used to apply a small rubber band that strangulates the hemorrhoid tissue and makes the hemorrhoid eventually fall off. This is often a relatively painless procedure.

Excision of Thrombosed Hemorrhoid

Occasionally external hemorrhoids will cause acute pain when a blood clot develops inside of that tissue producing a large painful lump on the outside of your anus. In the office, we are able to inject local numbing medicine so that we can excise and extract the blood clot. Extracting the blood clot will help alleviate your pain more quickly.

Surgical Interventions

When the hemorrhoids require more aggressive treatment, there are a variety of surgical treatments available:

Traditional hemorrhoidectomy

Traditional hemorrhoidectomy involves removing internal and external hemorrhoids generally from 3 areas surrounding your anus. The tissues are removed and the remaining defects are sutured close. This procedure works well but is often reserved for severe hemorrhoids because there is often a great deal of postoperative pain associated with this procedure.

Stapled Hemorrhoidectomy

PPH (Procedure for Prolapse and Hemorrhoids) is another option for patients who cannot be treated in the office as an alternative to traditional surgery. PPH was developed in the early 90s and employs a circular stapling device. The prolapsed tissue is pulled into the device, allowing the excess tissue to be removed while, at the same time, stapling the remaining tissue. This restores the hemorrhoidal tissue back to its original anatomical position. The benefits of PPH, compared to conventional surgical techniques, include less postoperative pain and a quicker return to normal activities.

THD Hemorrhoid Procedure

THD uses a doppler to locate the terminating branches of the hemorrhoidal arteries. Once the artery is located the surgeon uses an absorbable suture to ligate or “tie-off” the arterial blood flow. This eventual results in shrinking of the hemorrhoid tissue. This is done without excision of tissue. If necessary the surgeon will perform a hemorrhoidopexy to repair the prolapse. Again, this is done with suture and no excision of tissue. This repair restores and “lifts” the tissue back to its anatomical position. Because there is no excision and occurs in areas with less pain fibers, there is less pain associated with this procedure.