Large Hemorrhoids: Symptoms, Treatments, and Surgical Options

Hemorrhoids are too large?

Hello Doctor, my mother (63) has been experiencing rectal bleeding.
She visited a colorectal specialist yesterday, who diagnosed her with large internal and external hemorrhoids.
The doctor mentioned that due to the size of the external hemorrhoids, surgery would have to be traditional, while the internal hemorrhoids could be treated with laser.
The doctor also stated that traditional surgery would be very painful and could take up to a month for recovery.
We have decided to start with conservative treatment, which includes oral medication, suppositories, and ointment for the hemorrhoids.
I would like to ask if hemorrhoids can cause a constant urge to have a bowel movement? My mother has been getting up three to four times at night to use the bathroom (this has been happening for three consecutive days).
Last month, she had a colonoscopy, and the doctor found rectal ulcers with bleeding, but the biopsy results were normal.
Thank you for your assistance.

Niming, 60~69 year old female. Ask Date: 2024/03/06

Dr. Zhang Shuhao reply Surgery

Hemorrhoids can lead to an increased frequency of bowel movements primarily because they cause discomfort in the anal area, stimulating the nerves around the rectum and anus, which creates a sensation of needing to defecate, even if there is not always stool present.
If the hemorrhoids have become large enough to cause significant symptoms that affect quality of life, surgical intervention should be considered.
Based on the situation you described, traditional surgery may be more appropriate, but the specific surgical approach should be determined based on the physician's recommendations and the individual condition of the patient.

Reply Date: 2024/03/06

More Info

Hemorrhoids, commonly referred to as piles, are swollen veins in the lower rectum and anus that can cause discomfort, bleeding, and other symptoms. Your mother’s situation, involving both internal and external hemorrhoids, is not uncommon, especially in individuals over the age of 50. The symptoms she is experiencing, such as rectal bleeding and the urge to have bowel movements frequently, can indeed be associated with hemorrhoids, particularly if they are large and inflamed.

Symptoms of Hemorrhoids
The symptoms of hemorrhoids can vary depending on whether they are internal or external. Common symptoms include:
1. Bleeding: Bright red blood may appear on toilet paper or in the toilet bowl after a bowel movement.

2. Pain and Discomfort: External hemorrhoids can be painful, especially when sitting or during bowel movements.

3. Itching: The area around the anus may become itchy or irritated.

4. Swelling: External hemorrhoids may cause swelling around the anus.

5. Feeling of Fullness: Some patients report a sensation of fullness or the urge to have a bowel movement, even after having one.

Treatment Options
1. Conservative Management: This is often the first line of treatment for hemorrhoids and includes:
- Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements.

- Hydration: Drinking plenty of fluids can also help prevent constipation.

- Over-the-Counter Medications: Topical creams, ointments, and suppositories can provide relief from itching and pain.

- Sitz Baths: Soaking in warm water can help soothe the area.

2. Minimally Invasive Procedures: If conservative treatments do not provide relief, there are several minimally invasive options:
- Rubber Band Ligation: A band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink.

- Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it.

- Infrared Coagulation: A device is used to apply infrared light to the hemorrhoid, causing it to shrink.

3. Surgical Options: In cases where hemorrhoids are large or do not respond to other treatments, surgery may be necessary. The two main surgical options are:
- Hemorrhoidectomy: This is the traditional surgical removal of hemorrhoids. It is effective but can be painful and requires a longer recovery time, often up to a month.

- Stapled Hemorrhoidopexy: This procedure involves using a stapling device to reposition the hemorrhoids and cut off their blood supply. It is less painful than a hemorrhoidectomy and has a shorter recovery time.

Urgency and Frequency of Bowel Movements
Regarding your mother’s frequent urge to have bowel movements, this can be attributed to several factors:
- Irritation: Hemorrhoids can cause irritation in the rectal area, leading to a sensation of needing to go.

- Rectal Ulcers: The presence of rectal ulcers, as noted in her previous colonoscopy, can also contribute to discomfort and the urge to defecate.

- Anxiety or Stress: Sometimes, the anxiety associated with pain or discomfort can lead to increased frequency of bowel movements.

Conclusion
It is crucial for your mother to follow up with her healthcare provider regarding her symptoms and treatment options. If conservative management does not alleviate her symptoms, discussing the potential for surgical intervention may be necessary. Additionally, monitoring her bowel habits and ensuring she maintains a high-fiber diet can help manage her symptoms effectively. If her symptoms worsen or if she experiences significant pain or additional bleeding, seeking immediate medical attention is advisable.

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