Hemorrhoids: Types, Treatment Options, and Surgical Considerations

Follow-up Inquiry #187406

Dear Dr.
Chang,
Thank you very much for your response to my inquiry in “#187406 Consultation.” I have generally understood your explanations.
I would like to ask Dr.
Chang the following questions:
Q1.
Recently, I have been treating my hemorrhoid with warm baths and the "Hiyu Zhi" ointment.
The hemorrhoid, which is shaped like a half-sphere, has significantly reduced in size and is now retracted into the anal canal.
I can only feel it when I forcefully open the anal opening.
Could you please advise whether this half-spherical hemorrhoid is classified as an external hemorrhoid, internal hemorrhoid, or a mixed hemorrhoid?
Q2.
Regarding your response: “The thrombosed hemorrhoid can be absorbed, but the prolapsed soft tissue will not disappear.
It can be reduced with medication and sitz baths, but to completely remove it, surgical excision is the only option.” In your opinion, do you think it is advisable to actively pursue surgical excision of the prolapsed hemorrhoidal tissue? Or do you believe that as long as the hemorrhoidal tissue is not swollen, thrombosed, painful, itchy, or bleeding, and does not interfere with daily life, it is better to coexist with it?
Q3.
If I choose to coexist with the hemorrhoidal tissue without surgical excision, will leaving the hemorrhoidal tissue in and around the anus for an extended period lead to proliferation or malignant transformation (such as becoming a tumor) due to "friction or other factors"? Are there any clinical cases of this nature?
Q4.
The half-spherical hemorrhoid I have is approximately 1 centimeter in size.
In your opinion, is this type (half-spherical) and size of hemorrhoid suitable for treatment with "rubber band ligation"?
Thank you, Dr.
Chang.

Axiang, 40~49 year old female. Ask Date: 2022/10/11

Dr. Zhang Shuhao reply Surgery

1.
It should be internal hemorrhoids.
2.
If there are no symptoms, no treatment is necessary.
3.
It will not change to malignant.
4.
It is possible.

Reply Date: 2022/10/11

More Info

Understanding hemorrhoids is crucial for effective management and treatment. Hemorrhoids are swollen veins in the lower rectum and anus, and they can be classified into two main types: internal and external hemorrhoids. Internal hemorrhoids occur inside the rectum and are usually not visible, while external hemorrhoids develop under the skin around the anus and can be felt or seen. There are also mixed hemorrhoids, which contain both internal and external components.

Q1: Classification of Hemorrhoids
Based on your description, if the hemorrhoid is currently retracted into the anal canal but can still be felt with pressure, it is likely an internal hemorrhoid. Internal hemorrhoids can sometimes protrude during bowel movements but may retract afterward. If it were an external hemorrhoid, it would typically remain visible and palpable outside the anal opening. Therefore, your situation suggests it is primarily an internal hemorrhoid, possibly with some external components if you can feel it with pressure.

Q2: Surgical Considerations
Regarding the management of your hemorrhoid, the decision to proceed with surgical intervention depends on several factors. If the hemorrhoid is not causing significant discomfort, bleeding, or impacting your daily life, conservative management—such as topical treatments, warm baths, and dietary modifications—may be sufficient. However, if the hemorrhoid is causing persistent symptoms or if there is a risk of complications (like thrombosis or significant prolapse), surgical options may be warranted. Surgical removal is often recommended for persistent or severe cases, especially if the hemorrhoids are prolapsed and not responding to conservative measures.

Q3: Risks of Leaving Hemorrhoids Untreated
Leaving hemorrhoids untreated can lead to complications, but the risk of malignant transformation (cancer) from hemorrhoids is extremely low. However, chronic irritation from friction or straining can lead to other issues, such as anal fissures or skin tags. In rare cases, chronic irritation could contribute to changes in the tissue, but this is not common. Regular monitoring and maintaining good bowel habits can help mitigate these risks.

Q4: Rubber Band Ligation Suitability
Rubber band ligation is a common and effective treatment for internal hemorrhoids, particularly those that are symptomatic and have not responded to conservative treatments. Given that your hemorrhoid is approximately 1 cm in size and has shown improvement with conservative measures, it may be a suitable candidate for this procedure. The ligation works by cutting off the blood supply to the hemorrhoid, causing it to shrink and eventually fall off. However, a thorough evaluation by a healthcare provider is essential to determine the best course of action based on your specific condition.

Conclusion
In summary, your current situation with the hemorrhoid appears to be manageable with conservative treatment, but ongoing monitoring is essential. If symptoms persist or worsen, discussing surgical options with your healthcare provider would be prudent. Maintaining a healthy diet, staying hydrated, and avoiding straining during bowel movements can help prevent further issues. Always consult with a healthcare professional for personalized advice and treatment options tailored to your specific needs.

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