Hemorrhoids: When to Seek Surgical Intervention

Hemorrhoid issues

Hello Dr.
Chang: I have had hemorrhoids since childhood due to constipation, but I only feel discomfort during times of staying up late or when I have a lot of heat in my body.
It usually resolves itself within a day or two.
Occasionally, I experience bleeding during bowel movements.
Recently, however, after sitting for long periods, I experienced severe pain that made it difficult to sit or stand.
It has not improved for five days, and I continue to have small amounts of bright red bleeding.
I have been hesitant to seek medical attention and found information online suggesting it might be a thrombosed external hemorrhoid.
Upon examining myself, I noticed one large and one small bleeding sore on the hemorrhoid (dark red and slightly moist).
After applying pressure, there was some bleeding, and the pain has improved somewhat.
However, I haven't seen many reports from others about having sores (holes) like this.
I would like to know if my current condition can heal on its own or if I need to see a surgeon for a procedure, and which type would be more suitable.
Although I feel embarrassed about seeking treatment for this condition, I really cannot endure another recurrence, so I thought I would consult first.
Thank you, Dr.
Chang.

Cai Cai, 30~39 year old female. Ask Date: 2022/11/12

Dr. Zhang Shuhao reply Surgery

General thrombosed hemorrhoids can easily rupture due to friction, leading to bleeding.
In such cases, warm sitz baths, along with topical ointments and oral anti-inflammatory pain relievers, can provide relief.
It is important to maintain good lifestyle habits to prevent recurrence.
However, you mentioned experiencing severe pain lasting for five days, which raises concerns about a more serious condition such as hemorrhoidal prolapse causing impaired blood circulation and potential ulceration on the surface.
In this situation, surgical intervention is recommended, as surgery can also reduce the chances of recurrence.

Reply Date: 2022/11/12

More Info

Understanding hemorrhoids and when to seek surgical intervention is crucial for managing this common condition effectively. Hemorrhoids, or piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. They can be classified into two main types: internal and external hemorrhoids. 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 seems you have been experiencing significant discomfort due to your hemorrhoids, particularly after a period of prolonged sitting and possibly due to constipation. The presence of pain, bleeding, and the observation of wounds on the hemorrhoids suggests that you may be dealing with thrombosed external hemorrhoids, which occur when a blood clot forms in an external hemorrhoid. This condition can be quite painful and may require medical intervention.

When to Seek Surgical Intervention
1. Severe Pain and Discomfort: If the pain is severe and persistent, as you described, it is a strong indicator that you should seek medical attention. While some discomfort is common with hemorrhoids, extreme pain, especially if it interferes with daily activities, warrants a visit to a healthcare provider.

2. Persistent Bleeding: You mentioned experiencing small amounts of bright red blood during bowel movements. While occasional bleeding can occur with hemorrhoids, persistent or heavy bleeding is concerning and should be evaluated by a physician to rule out other conditions.

3. Visible Wounds or Ulceration: The presence of wounds on the hemorrhoids, especially if they are dark red and moist, indicates that there may be a complication such as thrombosis or ulceration. This can lead to further issues if not treated appropriately.

4. Failure of Conservative Treatments: If you have tried home remedies, such as warm baths, over-the-counter topical treatments, and dietary changes (increasing fiber intake to alleviate constipation) without improvement, it may be time to consider surgical options.

Surgical Options
If surgical intervention is deemed necessary, there are several options available:
- Hemorrhoidectomy: This is a surgical procedure to remove hemorrhoids. It is typically recommended for severe cases, especially when other treatments have failed. Recovery can be painful, but it is effective for eliminating hemorrhoids.

- Minimally Invasive Procedures: Options such as rubber band ligation, sclerotherapy, or infrared coagulation can be performed in an outpatient setting. These procedures are less invasive and can be effective for treating smaller hemorrhoids.

Conclusion
Given your symptoms, it is advisable to consult a colorectal surgeon or a healthcare provider specializing in gastrointestinal issues. They can perform a thorough examination and recommend the most appropriate treatment based on the severity of your condition. While it may feel uncomfortable to discuss, seeking medical help is essential for your health and well-being. Early intervention can prevent complications and improve your quality of life significantly. Remember, hemorrhoids are a common issue, and healthcare professionals are accustomed to treating them. Don't hesitate to reach out for the help you need.

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