Hemorrhoids: Pain Management and Treatment Options Explained

Hemorrhoids

Hello Dr.
Hou, I have issues with external and internal hemorrhoids.
There is no bleeding, but I experience prolonged pain after bowel movements, especially during my menstrual period.
The pain feels like something hard is being pushed into my anus, and when I sit down, the pain radiates from my anus to my lower abdomen.
I consulted a clinic doctor who said I have grade II hemorrhoids progressing to grade III and recommended laser surgery (costing NT$20,000 out of pocket).
I would like to ask Dr.
Hou: 1.
Can hemorrhoids be this painful? I also have adenomyosis, and I’ve heard that this condition can cause post-defecation pain as well.
Which condition is actually causing the pain? 2.
Is surgery or laser treatment the only way to cure this? Which hospitals in Tainan perform these procedures, and are they covered by health insurance?

jj, 20~29 year old female. Ask Date: 2002/11/26

Dr. Hou Yongji reply Surgery

1.
Typically, internal and external hemorrhoids are distinguished by the physiological anal dentate line, which is significant because the dentate line serves as a boundary for pain sensation nerves.
Therefore, it can generally be said that internal hemorrhoids are more likely to cause bleeding, while external hemorrhoids are more likely to cause pain.
If your pain occurs only during bowel movements, it is unlikely to be caused by external hemorrhoids, as pain from external hemorrhoids is usually persistent and lasts about a week.
2.
Currently, the National Health Insurance in Taiwan covers traditional surgical procedures for hemorrhoids, but it does not cover the latest anal sphincterotomy.
As for laser treatment, it is a new technology, and there is currently no coverage for laser surgery under the National Health Insurance.
Whether hemorrhoids should be treated with laser is subjective.
I am not familiar with the Tainan area, so I cannot provide recommendations.
3.
For basic information about hemorrhoids, you can visit our hospital's website.

Reply Date: 2002/11/26

More Info

Hemorrhoids, commonly referred to as piles, are swollen veins in the lower rectum and anus that can cause discomfort and pain, especially during bowel movements. Your symptoms of persistent pain after defecation, particularly during menstruation, are indeed consistent with hemorrhoids, especially if you have been diagnosed with grade II hemorrhoids, which can progress to grade III if left untreated.
1. Pain Associated with Hemorrhoids: Yes, hemorrhoids can be quite painful. The pain you describe, feeling like something hard is pressing against the anus, is typical for individuals with hemorrhoids. The pain can radiate to the lower abdomen, especially if there is significant swelling or if the hemorrhoids are thrombosed (i.e., contain a clot). Additionally, hormonal changes during your menstrual cycle can exacerbate the pain due to increased blood flow and swelling in the pelvic region, which may heighten the sensitivity of the area.

2. Differentiating Pain Sources: You mentioned having adenomyosis (子宮肌腺瘤), which can also cause pelvic pain and discomfort during menstruation. It is essential to differentiate whether your pain is primarily due to hemorrhoids or if it is related to your gynecological condition. Both conditions can coexist and contribute to your symptoms. A thorough evaluation by a healthcare provider, including a physical examination and possibly imaging studies, may be necessary to ascertain the primary source of your pain.

3. Treatment Options: For hemorrhoids, treatment options vary based on the severity of the condition. Conservative measures include dietary changes (increasing fiber intake), hydration, and topical treatments to alleviate discomfort. If these measures fail and the hemorrhoids are causing significant pain or complications, surgical options such as hemorrhoidectomy or laser treatment may be recommended.
- Surgical Options: Laser surgery is a minimally invasive option that can be effective for treating hemorrhoids. It typically results in less pain and quicker recovery compared to traditional surgery. However, the decision to proceed with surgery should be based on a comprehensive evaluation of your symptoms and overall health.

4. Insurance Coverage: Regarding insurance coverage, it is essential to check with your local health insurance provider in Taiwan to determine if the procedure is covered. Many hospitals in Tainan offer treatment for hemorrhoids, including laser surgery. It would be beneficial to consult with a colorectal surgeon or a gastroenterologist who can provide you with a list of reputable hospitals and their services.

In conclusion, while hemorrhoids can indeed cause significant pain, it is crucial to evaluate all potential sources of your discomfort. If you are considering surgical options, discussing this with a specialist who can provide personalized advice based on your medical history and current symptoms is advisable. Additionally, exploring non-surgical treatments and lifestyle modifications may provide relief and improve your quality of life.

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