Hemorrhoids: Treatment Options and Concerns Explained

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Hello, Doctor.
A few days ago, I experienced sudden rectal bleeding while having a bowel movement.
Whenever I exert myself, bright red blood flows out.
For two consecutive days, oral and topical medications, as well as suppositories, have not been effective.
Although the bleeding has stopped, I still bleed whenever I try to use the restroom.
I have been wiping with tissue and can see the blood flowing from the anal opening, but my stools are soft (not well-formed) and I have bled three times.
I went to Chengda Hospital, and they said it was hemorrhoids and nothing to worry about.
Yesterday, I went to a clinic for sclerotherapy treatment (the doctor said my condition does not require surgery).
Today, during my first bowel movement, the initial stool was a reddish color resembling liver, and later, the stool had bloody mucus mixed in.
I was terrified; is this normal? When I called to ask the doctor, they said it was normal.
What is sclerotherapy? During my second bowel movement today, there was no bleeding.
Is this treatment temporary? I heard it could recur in six months.
Besides surgery, what other options are available? Last year, I had a flexible sigmoidoscopy at Chengda, and the doctor said the rectum appeared gray but there was nothing wrong, possibly due to long-term use of stool softeners or laxatives.
In February of this year, I also had a colonoscopy at Chengda, and the report was normal.
The rectum was also grayish-black, but there was a black spot that the doctor said was fine.
Although the reports are normal, I am still worried.
Can something bad develop in such a short time of six months? I am really concerned.
Thank you for your patient response.

qaz700510, 20~29 year old female. Ask Date: 2008/06/26

Dr. Hou Yongji reply Surgery

Dear Patient,
1.
The diagnosis and treatment of diseases typically require not only a medical history and symptom description but also physical examination, palpation, and even colonoscopy.
Based on your description, a definitive diagnosis cannot be made.
Please ensure that you communicate thoroughly with your physician during treatment or consultation to avoid any miscommunication that could lead to issues.
2.
The principle of sclerotherapy for hemorrhoids involves the injection of a sclerosing agent (usually phenol) above the bleeding vessels of the hemorrhoid (internal hemorrhoid), causing fibrosis of the surrounding tissue (hemorrhoidal vessels) to inhibit blood flow and prevent bleeding.
Therefore, this treatment is quite effective for internal hemorrhoid bleeding, but it should be tailored to the individual's condition and treatment circumstances.
3.
Please trust your physician and take the time to discuss your concerns with them.
This will be more beneficial.
Dr.
Hou Yong-ji

Reply Date: 2008/06/26

More Info

Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, bleeding, and pain. They are classified into two main types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. The symptoms can include bright red blood during bowel movements, itching, and discomfort.

Treatment Options for Hemorrhoids
1. Conservative Management: This includes dietary changes, such as increasing fiber intake to soften stools and reduce straining during bowel movements. Over-the-counter medications, such as topical creams and ointments, can help alleviate symptoms. Stool softeners may also be recommended to ease bowel movements.

2. Sclerotherapy (Hardening Agent Injection): This is the treatment you mentioned having undergone. Sclerotherapy involves injecting a solution into the hemorrhoid tissue, causing it to shrink and eventually disappear. This method is minimally invasive and can be effective for treating smaller hemorrhoids. It is generally considered a temporary solution, and while many patients experience relief, there is a possibility of recurrence, often within six months to a year.

3. Rubber Band Ligation: This procedure involves placing a small rubber band around the base of an internal hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within a week or so. This method is effective for larger internal hemorrhoids and has a lower recurrence rate compared to sclerotherapy.

4. Infrared Coagulation: This technique uses infrared light to coagulate the blood vessels supplying the hemorrhoid, leading to its shrinkage. It is a quick procedure that can be performed in a doctor's office.

5. Surgical Options: If other treatments fail, surgical options such as hemorrhoidectomy (removal of hemorrhoids) or stapled hemorrhoidopexy (stapling the hemorrhoids back into place) may be considered. These procedures are more invasive and typically reserved for severe cases.

Concerns and Considerations
- Bleeding: The presence of bright red blood during bowel movements is a common symptom of hemorrhoids. However, if the bleeding persists or is accompanied by significant pain, it is essential to seek medical attention to rule out other conditions, such as anal fissures or colorectal issues.

- Color of Stool: The appearance of your stool, particularly if it is mixed with blood or has a different color, can be alarming. The "pig liver" color you described may indicate the presence of blood, and while it can be a result of hemorrhoids, it is crucial to monitor this symptom closely. If it continues or worsens, further evaluation may be necessary.

- Anxiety About Findings: It is understandable to feel anxious about the findings from previous examinations, especially with the mention of a "black spot" in the rectum. While your doctor has reassured you that these findings are not concerning, it is essential to maintain regular follow-ups and communicate any new symptoms or changes.

- Recurrence: It is true that hemorrhoids can recur after treatment, especially if lifestyle factors contributing to their development are not addressed. Maintaining a high-fiber diet, staying hydrated, and avoiding prolonged sitting can help reduce the risk of recurrence.

Conclusion
In summary, while your recent treatment with sclerotherapy may provide temporary relief, it is essential to adopt preventive measures to minimize the risk of recurrence. If you experience any new or worsening symptoms, do not hesitate to consult your healthcare provider for further evaluation and management. Regular check-ups and open communication with your doctor can help alleviate your concerns and ensure that any potential issues are addressed promptly.

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