What to Expect If You Think You Have Hemorrhoids

Talk to your doctor about bleeding, swelling or itching in the anal area

Did you know that all human beings have hemorrhoids? They’re actually part of our normal blood vessel anatomy in the anal area.

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But in the sense that the word is typically used, hemorrhoids happen when these normal “vascular cushions” in the anal area become swollen or inflamed, colorectal surgeon Massarat Zutshi, MD, explains. If this happens, you may have tissue protruding from the rectum accompanied by rectal bleeding.

How you treat those symptoms depends on exactly what’s causing them, so start by talking with your doctor about these points.

Do you really have hemorrhoids?

Many people who experience pain, irritation or anything out of the ordinary in the anal region probably assume it’s a hemorrhoid. But don’t go reaching for the medicated cream or pads just yet. Many other conditions could be the culprit, including anal fissure, anal warts, an infection, anal cancer in serious cases, or even just a cut.

Work with a doctor to rule out those things and determine what treatment you need.

Is it internal or external hemorrhoids?

If your symptoms include internal itching, anal bleeding and a bulge that comes and goes with bowel movements, an internal hemorrhoid is the likely culprit.

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However, some people are more bothered by external hemorrhoids, which can cause swelling, itching and bleeding, and be unsightly. Visible bumps and tags are common with external hemorrhoids.

How serious are my hemorrhoids?

Treatment will depend on your symptoms, but typically, doctors will recommend conservative options first.

Mild or occasional rectal bleeding may respond to changes in dietary habits, like upping your dietary fiber and drinking more water, Dr. Zutshi says. For periodic anal irritation caused by inflamed hemorrhoids, over-the-counter skin protective creams and warm sitz baths may help.

There are also some simple, in-office treatments for mild, on-and-off bleeding from internal hemorrhoids. “Rubber band” ligation is a commonly used procedure that involves placing little rubber bands above a hemorrhoid to cut off the blood supply. The hemorrhoid then shrinks and falls off.

This procedure is usually only used on smaller hemorrhoids, Dr. Zutshi explains. But larger internal hemorrhoids can still be easily treated with minimally invasive surgery.

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If the issue is large internal and external hemorrhoids, a more invasive surgery might be necessary. However, if it’s only skin tags, which are residual hemorrhoid tags, these are usually not treated, Dr. Zutshi says, as trimming them off is very painful, and residual bulges may still persist.

Occasionally, external hemorrhoids become very painful when they develop a clot in them, she explains. This is called a thrombosed hemorrhoid. If you see your doctor within a few days of onset, the clots can be removed, Dr. Zutshi says. Otherwise it takes a few weeks for the swelling and pain to settle down.

If I need surgery to remove hemorrhoids, what are my options?

If your symptoms don’t respond to more conservative treatments, you have options.

Noninvasive options include:

  • Electrocoagulation, a minimally invasive procedure that can treat multiple hemorrhoids at the same time. This is also called the HET procedure.
  • Doppler-guided hemorrhoid arterial ligation, which uses a special attachment to pinpoint the hemorrhoidal vessels and cut off the blood supply. This procedure is performed under anesthesia.
  • A hemorrhoidectomy may be necessary for very large internal and external hemorrhoids or those that are acutely inflamed or thrombosed, Dr. Zutshi says. It involves cutting out the hemorrhoid tissue, which can be painful, especially during recovery. But there are less painful options available.
  • Hemorrhoid stapling, in which a surgeon uses a special stapler to cut off the blood supply to the hemorrhoid. This kind of hemorrhoidectomy is thought to be less painful.

Which treatment is best will depend on your symptoms and your expectations, Dr. Zutshi says, and those should be discussed with your doctor.

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