Internal Hemorrhoids: When to Seek Treatment

Internal mole ligation

Hello, doctor.
I have two internal hemorrhoids that often cause significant bleeding during bowel movements, which can last for several months at a time.
After each bleeding episode, there is a period of no bleeding.
I previously consulted a colorectal surgeon who mentioned that a ligation procedure could be performed.
Now that the pandemic is easing, I would like to go to the hospital for hemorrhoid ligation, but currently, the hemorrhoids are not bleeding.
Can the doctor determine which internal hemorrhoid is causing the bleeding, or should I wait until there is bleeding again before seeking treatment? Thank you.

Xiao Chen, 30~39 year old female. Ask Date: 2021/08/08

Dr. Ke Fangxu reply Surgery

Hemorrhoid ligation does not necessarily need to be performed during active bleeding; however, it is easier to observe the bleeding point and assess treatment efficacy when bleeding is present.
If there is no bleeding, ligating the larger internal hemorrhoids can also be an effective approach.

Reply Date: 2021/08/08

More Info

When it comes to internal hemorrhoids, understanding when to seek treatment is crucial for managing symptoms and preventing complications. Internal hemorrhoids are swollen veins located inside the rectum, and they can cause a variety of symptoms, including painless rectal bleeding, discomfort, and sometimes prolapse (when the hemorrhoid protrudes outside the anus).

In your case, you mentioned experiencing significant bleeding during bowel movements that can last for months, followed by periods of no bleeding. This pattern of bleeding is concerning and warrants further evaluation. While it is possible for a doctor to identify the source of bleeding during an examination, it can be challenging to pinpoint which specific hemorrhoid is causing the issue if there is no active bleeding at the time of the visit.

Here are some key points to consider regarding your situation:
1. Timing of Treatment: While it may seem logical to wait until the bleeding resumes to seek treatment, it is generally advisable to consult with a healthcare provider sooner rather than later. Persistent bleeding, even if it stops temporarily, can indicate underlying issues that need to be addressed. Additionally, if you have already been advised about the possibility of ligation (a procedure where rubber bands are placed around the base of the hemorrhoid to cut off blood supply), it is worth discussing this option with your doctor, even if you are not currently experiencing bleeding.

2. Diagnosis: During a physical examination, a healthcare provider can assess the condition of your hemorrhoids. They may perform a digital rectal exam or use an anoscope to visualize the internal hemorrhoids directly. If you are not actively bleeding, the doctor may still be able to evaluate the size and condition of the hemorrhoids and determine the best course of action.

3. Symptoms and Complications: If you experience additional symptoms such as pain, itching, or changes in bowel habits, it is essential to report these to your healthcare provider. Complications from untreated hemorrhoids can include thrombosis (formation of a blood clot), infection, or anemia due to chronic blood loss.

4. Lifestyle Modifications: In addition to medical treatments, lifestyle changes can help manage symptoms. Increasing fiber intake, staying hydrated, and avoiding straining during bowel movements can reduce the frequency and severity of hemorrhoid flare-ups.

5. Follow-Up: If you decide to wait until the bleeding resumes before seeking treatment, ensure you have a plan in place for follow-up care. Keeping a record of your symptoms, including the frequency and duration of bleeding episodes, can provide valuable information to your healthcare provider.

In summary, while it may be tempting to wait for active bleeding to seek treatment, it is advisable to consult with your healthcare provider now. They can evaluate your condition, discuss treatment options, and help you manage your symptoms effectively. Early intervention can prevent complications and improve your quality of life. If you have any concerns or questions about your symptoms, do not hesitate to reach out to a healthcare professional for guidance.

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