Hemorrhoids: When to Seek Treatment and Management Tips

Hemorrhoid issues

Doctor, I’ve heard that everyone has hemorrhoids to varying degrees, and asymptomatic hemorrhoids are considered normal physiological tissue.
I previously experienced constipation and anal fissures, but they were not severe enough to require treatment.
A few days ago, I noticed several lumps around my anal area, and I’ve been quite concerned and have wanted to touch or check them.
Although my bowel movements have been normal recently, the size and number of these lumps are hard for me to ignore.
Do hemorrhoids need treatment if they exceed a certain size or number, or can I just relax and manage to prevent flare-ups? Thank you.

Niming, 20~29 year old female. Ask Date: 2023/01/04

Dr. Ke Fangxu reply Surgery

If hemorrhoids are not accompanied by bleeding or pain, there is generally no reason for aggressive treatment.
Swelling is often related to prolonged bowel movements.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
Spicy and irritating foods should be temporarily avoided, and increasing dietary fiber can be beneficial.
Warm sitz baths may help improve symptoms.
If symptoms persist without improvement, it is advisable to consult a physician for evaluation.

Reply Date: 2023/01/04

More Info

Hemorrhoids, also known as piles, are a common condition that affects many individuals at some point in their lives. They are essentially swollen veins in the lower rectum and anus, and 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 or felt.

It's true that many people have hemorrhoids without experiencing any symptoms. In fact, asymptomatic hemorrhoids are often considered a normal anatomical variation. However, when symptoms do occur, they can include pain, discomfort, itching, swelling, and bleeding during bowel movements. The presence of "meatballs" or lumps around the anus, as you described, may indicate the presence of external hemorrhoids or possibly thrombosed hemorrhoids, which can be painful.

Given your history of constipation and anal fissures, it's important to monitor your symptoms closely. While not all hemorrhoids require treatment, there are certain situations where seeking medical advice is warranted. Here are some guidelines on when to seek treatment for hemorrhoids:
1. Persistent Symptoms: If you experience ongoing pain, discomfort, or bleeding that does not improve with home remedies, it is advisable to consult a healthcare provider. Persistent bleeding, especially if it is bright red and occurs during bowel movements, should not be ignored.

2. Increasing Size or Number: If you notice that the lumps around your anus are increasing in size or number, this could indicate worsening hemorrhoids or the development of new ones. A healthcare provider can assess the situation and recommend appropriate treatment options.

3. Severe Pain or Thrombosis: If you experience severe pain, especially if it is sudden and intense, it may indicate a thrombosed hemorrhoid, which occurs when a blood clot forms in an external hemorrhoid. This condition can be very painful and may require medical intervention.

4. Changes in Bowel Habits: If you notice changes in your bowel habits, such as diarrhea or constipation, or if you experience significant changes in the appearance of your stool, it is important to seek medical advice. These changes can sometimes be associated with other gastrointestinal issues.

5. Signs of Infection: If you notice signs of infection, such as fever, increased redness, swelling, or discharge from the hemorrhoidal area, you should seek medical attention promptly.

In terms of management, there are several strategies you can employ to alleviate symptoms and prevent exacerbation of hemorrhoids:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help prevent constipation and reduce straining during bowel movements. Staying well-hydrated is also crucial.

- Regular Exercise: Engaging in regular physical activity can promote healthy bowel function and reduce the risk of constipation.

- Avoid Straining: When using the bathroom, avoid straining or sitting for prolonged periods, as this can exacerbate hemorrhoids.

- Warm Baths: Soaking in a warm bath can provide relief from discomfort and help reduce swelling.

- Over-the-Counter Treatments: There are various over-the-counter creams and ointments available that can help relieve itching and discomfort associated with hemorrhoids.

- Medical Treatments: If conservative measures fail, medical treatments such as rubber band ligation, sclerotherapy, or surgical options may be considered.

In conclusion, while many individuals may have hemorrhoids without symptoms, it is important to be vigilant about any changes in your condition. If you have concerns about the size or number of hemorrhoids, or if you experience any troubling symptoms, it is best to consult with a healthcare provider for a thorough evaluation and personalized treatment recommendations. Remember, early intervention can often prevent more serious complications and improve your quality of life.

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