Hemorrhoids: Symptoms, Treatments, and When to See a Specialist

Hemorrhoid issues

Hello Doctor: Before this year's Lunar New Year, around January 24, I started experiencing a sharp pain in my buttocks (anus) and noticed some blood when wiping.
I visited a general clinic on January 29, and the doctor diagnosed it as external hemorrhoids.
They prescribed an ointment and oral medication for me.
Since I was going abroad in February, the doctor advised me to avoid taking antibiotics if possible.
I only took the medication once on January 30 or 31; otherwise, I have been using the ointment and taking warm sitz baths.
During this period, I have seen significant improvement.
However, I have some concerns: 1.
Before and after the discomfort, my bowel movements have been normal, and I have not experienced constipation.
2.
When applying the ointment, I feel like there is more than one hemorrhoid.
3.
Recently, I have noticed intermittent bleeding, which is quite concerning! Should I see a colorectal surgeon? I am worried about whether I might need surgery.

air, 40~49 year old female. Ask Date: 2020/02/12

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, shorten the time spent on bowel movements, and increase the intake of dietary fiber, which can be helpful.
Warm sitz baths should also help alleviate symptoms.
You can purchase over-the-counter hemorrhoidal suppositories, but it is best not to take stool softeners indiscriminately.
If bleeding persists, it is advisable to consult a physician for evaluation.
If necessary, a colonoscopy can be arranged.
Based on your description, there does not seem to be an indication for surgery unless the colonoscopy reveals other issues.

Reply Date: 2020/02/12

More Info

Hemorrhoids, commonly referred to as piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. They are classified into two types: external hemorrhoids, which occur under the skin around the anus, and internal hemorrhoids, which occur inside the rectum. Understanding the symptoms, treatments, and when to seek specialist care is crucial for managing this condition effectively.

Symptoms of Hemorrhoids
The symptoms of hemorrhoids can vary depending on their type and severity. Common symptoms include:
1. Pain or Discomfort: This is particularly noticeable during bowel movements or when sitting.

2. Bleeding: Bright red blood may appear on toilet paper, in the toilet bowl, or on the surface of stools. This can be alarming and is often a sign of hemorrhoids.

3. Itching or Irritation: The area around the anus may become itchy or irritated.

4. Swelling: You may notice a lump near the anus, which can be sensitive or painful.

5. Mucus Discharge: Some individuals may experience mucus discharge from the anus.

Treatments for Hemorrhoids
Treatment for hemorrhoids often depends on the severity of the symptoms. Here are some common approaches:
1. Over-the-Counter Remedies: Creams, ointments, and suppositories that contain hydrocortisone or witch hazel can help relieve itching and discomfort.

2. Pain Relief: Oral pain relievers such as acetaminophen or ibuprofen can help alleviate pain.

3. Warm Baths: Soaking in a warm bath several times a day can provide relief from pain and discomfort.

4. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help prevent constipation and reduce straining during bowel movements.

5. Sitz Baths: Sitting in warm water for 10-15 minutes can help soothe the area and promote healing.

6. Medical Procedures: If conservative treatments fail, procedures such as rubber band ligation, sclerotherapy, or surgical removal (hemorrhoidectomy) may be necessary.

When to See a Specialist
You should consider consulting a colorectal specialist if:
1. Persistent Symptoms: If your symptoms do not improve with home treatment after a week or two, it’s time to seek professional help.

2. Severe Bleeding: If you experience significant bleeding, especially if it is accompanied by pain or other concerning symptoms, you should see a doctor immediately.

3. Changes in Bowel Habits: If you notice changes in your bowel habits, such as diarrhea or constipation, or if you have new symptoms that concern you.

4. Lumps or Growths: If you notice lumps or growths around the anus that do not resolve, it’s essential to have them evaluated.

Concerns About Surgery
It’s understandable to be apprehensive about the possibility of surgery. However, many cases of hemorrhoids can be managed effectively with non-surgical treatments. Surgical intervention is typically reserved for severe cases that do not respond to other treatments. A colorectal specialist can provide a thorough evaluation and discuss the best treatment options based on your specific situation.

Conclusion
In your case, since you have experienced symptoms such as pain, bleeding, and the sensation of multiple lumps, it is advisable to follow up with a colorectal specialist. They can perform a thorough examination to confirm the diagnosis and rule out other potential issues, such as anal fissures or more serious conditions. Early intervention can help prevent complications and improve your quality of life. Remember, while hemorrhoids can be uncomfortable and distressing, they are a common condition, and effective treatments are available.

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