Hemorrhoids: Symptoms, Treatments, and When to Seek Help

Hemorrhoid issues

Hello Doctor: A while ago, I experienced the following situation, but when I went to see a doctor, they said I had a small internal hemorrhoid and tied it off, but the issue still hasn't been resolved.
I'm not sure if the doctor missed something? (At that time, I didn't notice a small lump, so I only mentioned the area around the anus; later, I felt around several times before I found it...) Symptoms: There are small spots of blood on the toilet paper when wiping (very tiny blood spots), a feeling of something foreign, and pain (it's more painful when wiping, but I hardly feel anything otherwise).
Sometimes, I won't see blood for a while, but suddenly when I go to the bathroom more frequently or strain, it starts again.
I tried to feel it, and the location seems to be above the anus, a small lump (about 0.3 cm, not very sure), feeling smooth, not rough.

1.
I would like to ask you, Doctor, is this an internal hemorrhoid, external hemorrhoid, or a mixed hemorrhoid? Can external hemorrhoids also cause blood spots when wiping?
2.
Should I just buy an ointment (which type should I buy?) or is surgery necessary?
3.
If it is an external hemorrhoid, does it always require surgery to resolve? I've heard that it might cause the anus to become smaller or something like that?
4.
If surgery is needed, can I wait two months to go? Because it's currently the middle of the semester, and it seems inconvenient.

5.
After the rubber band ligation, I had difficulty urinating and couldn't do so for several hours; is this normal?
I have quite a few questions, and I appreciate your patience in answering them! (I'm feeling a bit anxious...)

Niming, 20~29 year old female. Ask Date: 2023/11/18

Dr. Zhang Shuhao reply Surgery

1.
Based on your description, it seems more like an external hemorrhoid.
Only internal hemorrhoids can be banded, and after banding, external hemorrhoids may become more pronounced due to impaired blood flow.
External hemorrhoids are associated with pain, and friction during swelling can easily lead to bleeding.

2.
If there is swelling and discomfort, you can purchase over-the-counter hemorrhoid ointments, such as those containing witch hazel, and perform warm sitz baths.
Additionally, increasing fluid intake to prevent constipation can help alleviate symptoms.
Surgery is only necessary when hemorrhoids frequently recur and significantly affect quality of life.
3.
To completely eliminate external hemorrhoids, surgical intervention is required; however, conservative treatments can also relieve symptoms.
Modern surgical techniques have advanced, resulting in fewer severe complications such as anal stenosis or incontinence.
4.
If conservative treatment is effective, surgery is not necessarily required.
5.
After undergoing rubber band ligation, the local tissue may swell, and a small number of individuals may experience difficulty urinating, but this will gradually improve.

Reply Date: 2023/11/18

More Info

Hemorrhoids, commonly referred to as piles, are swollen veins in the lower rectum and anus that can cause discomfort and bleeding. Understanding the symptoms, treatments, and when to seek medical help is crucial for managing this condition effectively.

Symptoms of Hemorrhoids
The symptoms of hemorrhoids can vary depending on whether they are internal or external:
1. Internal Hemorrhoids: These are located inside the rectum and usually do not cause pain. However, they can lead to bleeding during bowel movements, which may present as small blood spots on toilet paper or in the stool. You may also feel a sense of fullness or pressure in the rectum.

2. External Hemorrhoids: These are located under the skin around the anus and can cause pain, itching, and swelling. If a blood clot forms in an external hemorrhoid, it can lead to severe pain and a hard lump near the anus.

3. Mixed Hemorrhoids: This condition involves both internal and external hemorrhoids, leading to a combination of symptoms from both types.

In your case, the presence of blood on toilet paper, a feeling of discomfort, and the small lump you described suggest that you may be dealing with either internal or external hemorrhoids, or possibly a combination of both.

Treatment Options
1. Over-the-Counter Treatments: Many people find relief from symptoms using over-the-counter creams or ointments designed for hemorrhoids. Look for products containing hydrocortisone or witch hazel, which can help reduce inflammation and soothe the area.
2. Lifestyle Changes: Increasing fiber intake through diet or supplements can help soften stools and reduce straining during bowel movements, which is a common trigger for hemorrhoid flare-ups. Staying hydrated and engaging in regular physical activity can also be beneficial.

3. Medical Procedures: If conservative treatments do not provide relief, or if the hemorrhoids are particularly large or painful, medical procedures may be necessary. These can include rubber band ligation (the procedure you mentioned), sclerotherapy, or surgical removal of the hemorrhoids.

When to Seek Help
It is essential to consult a healthcare provider if:
- You experience significant pain or discomfort.

- There is persistent bleeding, especially if it is heavy.

- You notice changes in bowel habits or stool consistency.

- You have concerns about the size or appearance of the hemorrhoids.

Addressing Your Concerns
1. Type of Hemorrhoids: Based on your description, it is difficult to definitively classify your hemorrhoids without a physical examination. However, the symptoms you describe could indicate either internal or external hemorrhoids. External hemorrhoids can indeed cause bleeding when irritated.

2. Self-Medication: While over-the-counter treatments can be effective, it is advisable to consult with a healthcare provider before starting any new medication, especially if you are unsure about the diagnosis.

3. Surgical Options: Not all external hemorrhoids require surgery. Many can be managed with conservative treatments. Surgery is typically reserved for severe cases or when other treatments fail.

4. Timing for Surgery: If surgery is deemed necessary, it is generally advisable to proceed sooner rather than later, especially if symptoms are worsening. However, if you feel that you cannot manage it during the school term, discuss your situation with your healthcare provider to determine the best course of action.

5. Post-Procedure Concerns: Difficulty urinating after a procedure like rubber band ligation can occur due to swelling or discomfort. If this persists or worsens, it is important to contact your healthcare provider.

Conclusion
Managing hemorrhoids can be challenging, but understanding your symptoms and treatment options is the first step toward relief. If your symptoms persist or worsen, do not hesitate to seek medical advice. Remember, it’s essential to address any concerns you have with your healthcare provider to ensure you receive the appropriate care and support.

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