Sitting Pretty: Answers to 4 Questions About Hemorrhoids

How to make the best treatment decision

Rubber bands

You have hemorrhoids, even if you don’t know it. In fact, we all have hemorrhoids as a part of our normal blood vessel anatomy.

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Hemorrhoids, in the more typical and negative sense of the word, happen when these normal vessels in the anal area become swollen or inflamed. If this happens, you may have pain, itching, tissue poking out of the rectum and rectal bleeding. How you treat those symptoms depends on exactly what’s causing them, so start by asking your doctor the following questions.

1. Is it really a hemorrhoid?

Most people who have pain, irritation or anything out of the ordinary in the anal region assume it’s a hemorrhoid. But don’t reach for the medicated cream or pads just yet. Many other conditions have similar symptoms; you might have an anal fissure, anal warts, an infection, anal cancer in serious cases, or even just a cut. A doctor needs to rule those things out to determine what treatment you need.

“We typically try conservative options first and save surgery for severe cases.”

Brooke Gurland, MD

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Department of Colorectal Surgery

2. How serious is it?

Time and treatments may help answer this question. We typically try conservative options first and save surgery for severe cases. Mild cases might respond to over-the-counter creams, warm sitz baths and dietary changes to relieve constipation, for example.

We also have simple, in-office treatments for internal hemorrhoids. You may have heard of “rubber band” ligation. In this procedure, we place little rubber bands on the hemorrhoids to cut off the blood supply. Without blood, the hemorrhoids shrink and fall off.

3. What’s my biggest concern: external or internal symptoms?

If your symptoms include internal itching, bleeding and a bulge that comes and goes with bowel movements, an internal hemorrhoid is the likely culprit. However, some people are more bothered by external hemorrhoids, which can swell, cause itching and be unsightly. Visible bumps and tags are common, for example.

Here’s why I bring that up: Internal hemorrhoids respond best to most treatments. Even when we do trim away an external tag, you may still see bumps and bulges from time to time. It’s all about your expectations: We can treat your internal hemorrhoids and ease your symptoms. We can also shrink your external hemorrhoids, but we can’t make them perfectly smooth. Doing so could cause other conditions, because a little extra skin is necessary for passing bowel movements.

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4. If I need surgery, what are my options?

If your hemorrhoids don’t respond to conservative treatments, you have options. And they’ve gotten better over the years.

A traditional hemorrhoidectomy involves cutting out the hemorrhoid tissue. That means it can be painful, especially during recovery. But there are less painful options available. One is hemorrhoid stapling, in which a surgeon uses a special stapler to cut off the blood supply to the hemorrhoid. Similarly, in hemorrhoid artery ligation, surgeons use a Doppler machine to pinpoint the hemorrhoidal arteries and cut off their blood supply.

A hemorrhoidectomy can help fix some of those external cosmetic issues, but the other two surgeries focus more on the internal hemorrhoids. That’s why you should ask your doctor all of these questions before pursuing the treatment that’s right for you.

Brooke Gurland, MD

Brooke Gurland, MD

Brooke Gurland, MD, is a surgeon with the Department of Colorectal Surgery at Cleveland Clinic.
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