Chronic Hemorrhoids: When to Seek Specialized Medical Care?

Recurrent hemorrhoids?

In the past three years, I have undergone approximately 20 to 30 rubber band ligation procedures at a general clinic, as well as one thrombectomy.
The frequency of these procedures has filled my medical record.
Currently, I have a large internal hemorrhoid and experience swelling around the anal area after bowel movements.
I exercise daily, so the swelling subsides shortly after applying medication.
When I consulted the physician, they mentioned that since there is no pain or persistent swelling, performing a flap procedure to completely remove the hemorrhoid would be a significant undertaking with a low cost-benefit ratio.
They advised that if my condition worsens, we could reassess the situation.
I would like to ask if it is advisable to seek treatment at a regional hospital given my current condition.
The discomfort is affecting my mood and straining family relationships, so I would like to gather multiple medical opinions.
Below is a link to an image of the swelling after bowel movements: https://imgur.com/hiuFTWC.

Xiao Zhang, 30~39 year old female. Ask Date: 2019/02/12

Dr. Ke Fangxu reply Surgery

If hemorrhoid treatment has not shown significant improvement after three years, then surgical removal may be the most effective solution to your problem.
Generally, surgery is not necessary unless there is significant bleeding or severe pain.
Based on the photos you provided, the swelling appears to be mild.
In such cases, I usually consider the patient's expectations regarding treatment outcomes and allow them to choose their preferred treatment method.
Both topical medications and surgery are suitable options.
Surgery is likely not as complicated as some "famous doctors" may suggest.

Reply Date: 2019/02/12

More Info

Chronic hemorrhoids can significantly impact a person's quality of life, and it is understandable that you are seeking specialized medical care given your ongoing symptoms and previous treatments. Based on your description, it seems that you have undergone multiple rubber band ligation procedures and one thrombectomy, which indicates a persistent issue with hemorrhoids that has not fully resolved despite these interventions.

When considering whether to seek specialized medical care, there are several factors to take into account:
1. Severity of Symptoms: You mentioned that you have a large internal hemorrhoid and experience swelling around the anus after bowel movements. While you currently do not have pain or persistent swelling, the presence of a large hemorrhoid and the swelling you experience can indicate that the condition is not improving. If these symptoms worsen or if you begin to experience pain, bleeding, or changes in bowel habits, it would be prudent to seek medical attention.

2. Impact on Quality of Life: Chronic hemorrhoids can lead to discomfort, embarrassment, and emotional distress. If your symptoms are affecting your mood or family relationships, this is a valid reason to pursue further medical evaluation. Quality of life is an important consideration in managing any chronic condition.

3. Previous Treatments: Given that you have had multiple treatments without complete resolution, it may be time to consider more definitive surgical options. While your current physician has suggested that the risks may outweigh the benefits of further surgery at this time, a second opinion from a colorectal surgeon could provide additional insights. They may offer alternative treatment options, such as a hemorrhoidectomy, which could provide a more permanent solution.

4. Potential Complications: Chronic hemorrhoids can lead to complications such as thrombosis, infection, or even anemia from chronic blood loss. If you notice any signs of complications, such as increased pain, fever, or significant changes in your bowel habits, you should seek immediate medical care.

5. Specialized Care: If you are considering a visit to a larger regional hospital, it may be beneficial to consult with a colorectal specialist. These specialists have extensive training in the management of complex hemorrhoidal disease and can offer a comprehensive evaluation of your condition. They can also discuss the risks and benefits of various treatment options, including surgical interventions.

In summary, while your current physician may not see an immediate need for further intervention, your ongoing symptoms and their impact on your life warrant a thorough evaluation by a specialist. Seeking a second opinion can provide you with more options and help you make an informed decision about your treatment moving forward. It is important to advocate for your health and well-being, especially when chronic conditions are affecting your quality of life.

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