Hemorrhoids that are not painful but cause persistent bleeding during bowel movements, with difficulty in stopping the bleeding and slow wound healing?
I have both internal and external hemorrhoids.
The hemorrhoids are not painful, but I have been experiencing long-term bleeding during bowel movements that is difficult to stop.
The bleeding occurs only during bowel movements (a significant amount), and it stops shortly after wiping.
However, sometimes when I exert too much pressure while passing gas or during bowel movements, I experience bleeding again, which can be quite severe, resembling a toilet bowl full of blood.
Once, I bled so much that I became anemic, and my hemoglobin level dropped to 5.
The doctor recommended a blood transfusion but did not suggest surgery, stating that my bleeding is difficult to control and that the risks of surgery are high.
I have been considering my options since then.
It has been over two years since I first consulted a doctor (at Cathay General Hospital).
The treatment has mainly consisted of topical medications, hemostatic agents, and iron supplements, along with a few sessions of infrared coagulation therapy.
However, the bleeding recurs after a short period.
Many people have advised me that as long as it does not affect my daily life, surgery may not be necessary, and that surgery could potentially worsen the situation since my wounds are slow to heal.
I do not experience pain from the hemorrhoids, but I am concerned about the ongoing bleeding and the risk of anemia.
Given that my treatment has only involved topical medications and infrared coagulation, I am wondering if I should consider surgery.
However, I am also worried that surgery might lead to more severe complications or uncontrollable bleeding, especially since my wounds do not heal easily.
What should I do?
Chen Xiaoyu, 30~39 year old female. Ask Date: 2018/02/23
Dr. Ke Fangxu reply Surgery
What are the reasons for wounds not healing easily? Could it be due to autoimmune diseases or other hematological disorders? If hemorrhoidal bleeding is severe enough to cause anemia, surgical treatment is necessary.
If there are other conditions causing coagulopathy, those should be properly treated to correct the coagulation issues; otherwise, hemorrhoid surgery would only address the symptoms rather than the underlying problem.
Reply Date: 2018/02/23
More Info
Managing painless hemorrhoids, especially when they lead to chronic bleeding, can be a challenging situation. It’s important to understand the nature of your symptoms and the potential treatment options available. Hemorrhoids, whether internal or external, can cause significant discomfort and complications, particularly when they result in substantial blood loss.
In your case, it seems that you are experiencing significant bleeding during bowel movements, which has led to anemia. A hemoglobin level of 5 is critically low and indicates that you have been losing a considerable amount of blood. This situation is concerning, as chronic blood loss can lead to severe health issues, including heart problems and fatigue due to anemia.
The fact that your hemorrhoids are painless is somewhat atypical, as many patients experience discomfort or pain. However, painless hemorrhoids can still cause significant bleeding, especially if they are thrombosed or if there is significant straining during bowel movements. The bleeding you describe, particularly if it fills the toilet bowl, suggests that the hemorrhoids may be quite large or that there is significant vascular engorgement.
You mentioned that you have tried various treatments, including topical medications, iron supplements, and rubber band ligation (a form of minimally invasive treatment). While these treatments can be effective for some patients, they may not be sufficient for others, especially if the bleeding persists or worsens.
When considering surgery, it’s essential to weigh the risks and benefits. Surgical options for hemorrhoids include hemorrhoidectomy (removal of the hemorrhoids) and other minimally invasive procedures. While surgery can provide a definitive solution to the problem, it does come with risks, such as infection, pain, and complications related to healing, especially if you have a history of poor wound healing.
Given your situation, here are some considerations:
1. Consult a Specialist: If you haven’t already, it may be beneficial to see a colorectal surgeon who specializes in hemorrhoid treatment. They can provide a thorough evaluation and discuss the most appropriate surgical options based on your specific condition.
2. Evaluate Non-Surgical Options: If surgery is deemed too risky, you might want to explore other non-surgical interventions. These could include more aggressive medical management, dietary changes to promote softer stools, or additional procedures like sclerotherapy or infrared coagulation.
3. Monitor Your Symptoms: Keep a close eye on your symptoms. If you experience increased bleeding, pain, or any other concerning symptoms, seek medical attention promptly.
4. Consider Your Quality of Life: If the bleeding significantly impacts your quality of life or leads to recurrent anemia, surgery may be the best option despite the risks. It’s crucial to have an open discussion with your healthcare provider about your fears and concerns regarding surgery.
5. Lifestyle Modifications: Incorporating a high-fiber diet, staying hydrated, and avoiding straining during bowel movements can help manage symptoms and reduce the risk of exacerbating your hemorrhoids.
In conclusion, while surgery for hemorrhoids can be daunting, it may be necessary if conservative treatments fail and if you continue to experience significant bleeding. A thorough discussion with a colorectal specialist can help you make an informed decision that balances the risks of surgery against the ongoing issues caused by your hemorrhoids. Remember, your health and well-being should always come first, and addressing the underlying cause of your symptoms is crucial.
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