Do You Need Surgery for Painless Hemorrhoids? Your Options

Do hemorrhoids require surgery if they are not painful?

Three years ago, I had an internal hemorrhoid removed, but soon after, a new hemorrhoid developed.
It would retract each time, so I didn't pay much attention to it.
However, a little over a month ago, the hemorrhoid became painful for several days and then suddenly protruded, unable to retract, and it was very painful.
Currently, I am abroad, and due to the pandemic, the doctor is only able to provide a consultation over the phone, so I am unsure whether this is an external or internal hemorrhoid.
I have been doing warm sitz baths and applying medication daily, and the hemorrhoid has reduced slightly in size and is no longer painful.
However, the lump is oval-shaped and approximately 1 cm in diameter, and it feels hard.
Could this be a thrombosed external hemorrhoid? If it is not painful, is surgery still necessary? Additionally, since I am planning to conceive, will sexual activity worsen the hemorrhoid condition? Thank you.

Ms. Huang, 30~39 year old female. Ask Date: 2022/02/10

Dr. Zhang Shuhao reply Surgery

If there is a protrusion during bowel movements, it is likely an internal hemorrhoid (most cases are mixed hemorrhoids with both internal and external components, but your internal hemorrhoid symptoms are more pronounced).
Once it cannot be reduced, it indicates progression to grade IV hemorrhoids, which may lead to severe swelling and incarceration at the anal opening.
If soaking and applying medication do not improve the condition, surgical intervention may be necessary.
Conservative treatment can alleviate symptoms but is prone to recurrence.
The lump is composed of hemorrhoidal tissue along with a portion of an old thrombus.
General sexual activity will not have an impact, but the progression of pregnancy can exacerbate hemorrhoid symptoms.
Therefore, it is recommended to undergo hemorrhoid surgery before pregnancy to avoid complications in the later stages of pregnancy.

Reply Date: 2022/02/10

More Info

When it comes to managing hemorrhoids, particularly after experiencing a painful episode, understanding your options is crucial. Hemorrhoids can be classified into two main types: internal and external. Internal hemorrhoids are located inside the rectum and are usually not visible, while external hemorrhoids are located under the skin around the anus and can be seen and felt. Based on your description, it sounds like you may be dealing with an external hemorrhoid, possibly complicated by thrombosis, which can occur when a blood clot forms within the hemorrhoid, leading to increased pain and swelling.

Given that you have experienced significant pain and the hemorrhoid has become prominent and hard, it is possible that you are dealing with a thrombosed external hemorrhoid. These can be quite uncomfortable and may require intervention, especially if they do not resolve on their own. However, if the pain has subsided and the hemorrhoid is no longer causing discomfort, surgical intervention may not be immediately necessary.

In general, the treatment for hemorrhoids can vary based on the severity of symptoms. For mild cases, conservative management is often recommended. This includes:
1. Warm Sitz Baths: Continuing with warm water sitz baths can help soothe the area and promote healing.

2. Topical Treatments: Over-the-counter creams or ointments can provide relief from itching and discomfort.

3. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements, which can exacerbate hemorrhoids.

4. Hydration: Drinking plenty of water is essential to prevent constipation.

If the hemorrhoid remains asymptomatic, you may not need surgery. However, if it becomes painful again or if you experience bleeding, it would be wise to consult a healthcare provider for a thorough evaluation. In some cases, procedures such as rubber band ligation, sclerotherapy, or surgical excision may be recommended, especially for persistent or severe cases.

Regarding your concern about pregnancy and sexual activity, it is important to note that while pregnancy can increase the risk of developing hemorrhoids due to hormonal changes and increased pressure on the pelvic area, engaging in sexual activity does not inherently worsen hemorrhoid conditions. However, if you experience discomfort during intercourse, it may be advisable to avoid certain positions or consult with a healthcare provider for personalized advice.

In conclusion, while surgery is an option for hemorrhoids, it is not always necessary, especially if symptoms are manageable. Monitoring your condition and maintaining a healthy lifestyle can significantly improve your situation. If you have any concerns about your symptoms or if they worsen, seeking medical advice, even through telehealth, is recommended to ensure appropriate care.

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