Hemorrhoids: Symptoms, Diagnosis, and Treatment Options

Hemorrhoid issues

Hello Dr.
Chang, I consulted you yesterday regarding the sharp pain and itching after bowel movements, along with a discharge of slightly yellow fluid.
Today, I visited the outpatient clinic, and the doctor performed a digital examination, stating that it does not seem to be an issue of anal fissures.
They also asked if I wanted to undergo a colonoscopy, but I had one done in March of last year with no issues.
The doctor prescribed eczema cream, Gentamicin ointment, and Dexamethasone enteric-coated tablets.
However, I am still experiencing sharp pain and itching after bowel movements, and I continue to have a slight yellow discharge.
The area around my anus, where I previously had hemorrhoids, has become more swollen, and I need to frequently change my pads throughout the day.
Should I consider seeking an examination with an anoscope? Thank you for your assistance.

Jun, 40~49 year old female. Ask Date: 2023/02/22

Dr. Zhang Shuhao reply Surgery

If you had a colonoscopy last year, there is no need to repeat it this year.
You can start with the medications prescribed by your doctor, and also perform warm sitz baths, reduce the use of irritating bathing products, and increase your intake of fluids and dietary fiber.
Generally, colorectal clinics have the capability to perform anal and rigid sigmoidoscopy examinations.
You can monitor your condition for a while, and if there is no improvement, consider consulting other specialists.

Reply Date: 2023/02/22

More Info

Understanding hemorrhoids is crucial for anyone experiencing symptoms related to this common condition. Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. They can be classified into two types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus.

Symptoms of Hemorrhoids
The symptoms of hemorrhoids can vary depending on their type and severity. Common symptoms include:
1. Pain or Discomfort: This is often felt during bowel movements or when sitting. The pain can be sharp and may be accompanied by itching.

2. Bleeding: Bright red blood may appear on toilet paper after wiping or in the toilet bowl. This is typically associated with external hemorrhoids.

3. Swelling: The area around the anus may appear swollen or bulging, especially in the case of external hemorrhoids.

4. Itching: The anal area may feel itchy or irritated, which can lead to discomfort and further complications if scratched.

Diagnosis
Diagnosis of hemorrhoids typically involves a physical examination. A healthcare provider may perform a digital rectal exam to assess the condition of the anal area. If necessary, they may recommend further diagnostic procedures such as:
- Anoscopy: A procedure that allows the doctor to examine the anal canal and lower rectum using a small tube with a light.

- Sigmoidoscopy or Colonoscopy: These procedures are used to examine the entire colon and rectum, especially if there are concerns about other conditions such as colorectal cancer.

Treatment Options
Treatment for hemorrhoids can vary based on the severity of the symptoms and the type of hemorrhoids present. Here are some common treatment options:
1. Lifestyle Changes: Increasing fiber intake through diet or supplements can help soften stools and reduce straining during bowel movements. Staying hydrated and exercising regularly can also be beneficial.

2. Topical Treatments: Over-the-counter creams and ointments can provide relief from itching and discomfort. Your doctor may prescribe medications, such as hydrocortisone creams or topical anesthetics, to reduce inflammation and pain.

3. Sitz Baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help alleviate discomfort and promote healing.

4. Minimally Invasive Procedures: If conservative treatments do not provide relief, your doctor may recommend procedures such as rubber band ligation, sclerotherapy, or infrared coagulation to treat hemorrhoids.

5. Surgical Options: In severe cases, surgical intervention may be necessary. Hemorrhoidectomy (surgical removal of hemorrhoids) or stapled hemorrhoidopexy (a procedure that uses staples to remove hemorrhoids) are options for persistent or severe hemorrhoids.

When to Seek Further Evaluation
If you are experiencing persistent symptoms such as severe pain, significant bleeding, or if your symptoms do not improve with conservative treatment, it is essential to consult a healthcare provider. Given your situation, where you have experienced persistent pain and discharge, it may be advisable to seek further evaluation, possibly including an examination with an anoscope or other diagnostic tools to rule out other conditions.

In conclusion, while hemorrhoids are a common issue, understanding their symptoms, diagnosis, and treatment options can help manage the condition effectively. If you have concerns about your symptoms or the effectiveness of your current treatment, discussing them with your healthcare provider is crucial for appropriate management and relief.

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