Managing Internal Hemorrhoids: Symptoms and Treatment Options

Rubber band ligation for internal hemorrhoids?

Hello Dr.
Ke: I have a question.
I had internal hemorrhoids before becoming pregnant, and they became worse after giving birth.
I have had one treatment already.
Recently, during bowel movements, I have had to push a lump back in, but occasionally it pops out when I strain, and I feel a significant foreign body sensation.
On March 8, I had another procedure done, and six days later, a painful pink lump appeared that is difficult to push back in.
I didn't have this issue the first time, and this time, the sutures were noticeably painful, and there was a small amount of bleeding during bowel movements.
Could this be a thrombosed external hemorrhoid? I also experienced painful hemorrhoids during pregnancy, which I remember improved after a few days.
The doctor who treated me has always said my hemorrhoids are not severe.
Dr.
Ke, how should I manage this situation? Thank you for your explanation.

EVA, 30~39 year old female. Ask Date: 2022/03/15

Dr. Ke Fangxu reply Surgery

Hemorrhoid ligation can sometimes cause pain due to variations in depth and size.
It is often necessary to conduct a physical examination to determine the severity of a thrombosed external hemorrhoid, as well as to assess the impact on daily activities.
If the hemorrhoids do not require extensive treatment and there is no significant bleeding, they are generally considered to be non-severe and do not necessitate highly invasive treatments.

Reply Date: 2022/03/15

More Info

Managing internal hemorrhoids can be a complex issue, especially when symptoms worsen or new symptoms arise. Based on your description, it seems you have a history of internal hemorrhoids that have become more problematic after childbirth. You mentioned experiencing significant discomfort, the need to push hemorrhoids back, and occasional bleeding during bowel movements. These symptoms can indicate a progression in the severity of your condition, and it's essential to address them appropriately.

Understanding Symptoms
1. Bleeding: The presence of blood during bowel movements is a common symptom of hemorrhoids. However, the color and amount of blood can provide insight into the severity of the condition. Bright red blood typically indicates that the bleeding is coming from the lower rectum, which is common with hemorrhoids. Dark red or maroon blood may suggest a more serious issue, potentially requiring further investigation.

2. Pain and Discomfort: The feeling of a "bulging" hemorrhoid, especially if it is painful and difficult to push back, can indicate thrombosis (blood clot formation) in the hemorrhoid. This can lead to significant pain and swelling, and may require different management strategies.

3. Changes in Bowel Habits: If you are experiencing changes in your bowel habits, such as straining or constipation, this can exacerbate hemorrhoid symptoms. It's crucial to maintain a diet high in fiber and stay hydrated to promote regular bowel movements.

Treatment Options
1. Conservative Management: For mild to moderate symptoms, conservative treatment options are often effective. These include:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements.

- Hydration: Drinking plenty of water can aid in digestion and prevent constipation.

- Sitz Baths: Soaking in warm water can relieve discomfort and promote healing.

- Over-the-Counter Medications: Topical treatments, such as creams or ointments containing hydrocortisone, can reduce inflammation and itching.

2. Medical Interventions: If conservative measures fail, or if you experience severe symptoms such as significant pain or persistent bleeding, further medical intervention may be necessary. Options include:
- Rubber Band Ligation: This is a common procedure for treating internal hemorrhoids. It involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off.

- Sclerotherapy: This involves injecting a solution into the hemorrhoid to shrink it.

- Infrared Coagulation: This technique uses infrared light to coagulate the tissue and reduce the size of the hemorrhoid.

3. Surgical Options: In cases where hemorrhoids are severe or recurrent, surgical options may be considered. Hemorrhoidectomy is a surgical procedure to remove hemorrhoids and is typically reserved for more severe cases.

When to Seek Help
Given your symptoms, especially the pain and difficulty with the hemorrhoid, it is advisable to consult with a healthcare professional, preferably a colorectal specialist. They can perform a thorough examination to determine the exact nature of your condition and recommend the most appropriate treatment. If you experience any of the following, seek immediate medical attention:
- Severe pain that does not improve with over-the-counter medications.

- Significant bleeding that does not stop after a few minutes.

- Signs of infection, such as fever or increased swelling.

Conclusion
Managing internal hemorrhoids effectively requires a combination of lifestyle modifications, medical treatments, and potentially surgical interventions. Given your history and current symptoms, it is crucial to have a comprehensive evaluation by a healthcare provider to tailor a treatment plan that addresses your specific needs. Early intervention can help prevent complications and improve your quality of life.

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