Hemorrhoids: When to Consider Surgery or Medication

Hemorrhoid issues?

Doctor, about a month ago, I noticed some bright red blood when I went to the bathroom, but the amount was small.
I mentioned this to my traditional Chinese medicine doctor when I was taking allergy medication.
After taking the medicine for two weeks, the bleeding stopped.
There was a small growth near my anus that disappeared, but it has flattened and is still there.
Recently, I have noticed a little light-colored blood a few times when wiping after using the bathroom.
Should I consider surgery for this, or can it be treated with topical medication?

Ms. A, 10~19 year old female. Ask Date: 2016/04/16

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase hemorrhoid suppositories at the pharmacy for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and hydration should be sufficient.
The small lump outside the anus is likely a small external hemorrhoid, which generally does not pose a health risk but will not completely disappear.
If removal of the external hemorrhoid is desired, surgical intervention is the only option.

Reply Date: 2016/04/16

More Info

Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, bleeding, and pain. They can be classified into two types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. The symptoms you described, including bright red blood during bowel movements and the presence of a lump or mass around the anal area, are common indicators of hemorrhoids.

In your case, the fact that you experienced bleeding during bowel movements, which has since decreased after taking herbal medication, suggests that your condition may not be severe. The lump you mentioned that has flattened could be a thrombosed external hemorrhoid or a skin tag that sometimes forms after a hemorrhoid has healed. While the absence of bleeding is a positive sign, the occasional light bleeding you mentioned when wiping could indicate that the hemorrhoids are still present and may require further attention.

When considering whether to pursue surgery or medication for hemorrhoids, several factors come into play:
1. Severity of Symptoms: If your symptoms are mild and manageable, conservative treatments such as dietary changes, over-the-counter topical treatments, and warm baths may be sufficient. Increasing fiber intake and hydration can help soften stools and reduce straining during bowel movements, which is crucial in managing hemorrhoids.

2. Duration of Symptoms: If your symptoms persist despite conservative management for several weeks, it may be time to consult a healthcare professional. Persistent symptoms can indicate the need for more aggressive treatment options.

3. Response to Treatment: Since you have already seen some improvement with herbal medication, it may be worth continuing with conservative management for a little longer. However, if the bleeding resumes or worsens, or if you experience significant pain or discomfort, it would be advisable to seek medical evaluation.

4. Surgical Options: Surgery is typically considered when hemorrhoids are severe, recurrent, or do not respond to conservative treatments. Common surgical procedures include rubber band ligation, sclerotherapy, and hemorrhoidectomy. These procedures can effectively remove or reduce the size of hemorrhoids, but they come with risks and recovery time.

5. Consultation with a Specialist: Given your symptoms and history, it would be prudent to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination, possibly including a digital rectal exam or anoscopy, to assess the extent of your hemorrhoids and recommend the best course of action.

In summary, while your symptoms may not currently warrant surgery, ongoing monitoring and conservative management are essential. If you experience any changes in your symptoms, such as increased bleeding, pain, or changes in bowel habits, do not hesitate to seek medical advice. Early intervention can prevent complications and improve your quality of life.

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