Dealing with Hemorrhoids: Can They Resolve Without Surgery?

Q: Dealing with Hemorrhoids: Can They Resolve Without Surgery?

Dear John： Based on your description, it is likely an acute episode of external hemorrhoids, which typically remain outside. <br>Therefore, there is no need to repeatedly push it back in, as this may lead to increased inflammation and prolong the healing process. <br>Usually, it

What should I do if hemorrhoids cannot be pushed back in?

Hello Dr.
Hou, I am currently studying in Italy and will return to Taiwan in July next year.
I have been experiencing hemorrhoids for about three to four years.
I have a history of hepatitis B, and sometimes I notice bleeding after having a bowel movement.
Last Friday, after a particularly hard and large stool, I noticed a ring-like protrusion.
I didn't pay much attention to it and even had two glasses of red wine that night.
By the next day, the pain intensified and lasted for two days.
I have been lying on my side in bed or taking warm baths.
I bought a topical ointment and suppositories from the pharmacy, but they haven't been very effective.
However, I felt much better yesterday (Monday) and today I am no longer in pain, but the hemorrhoid still won't retract.
I went to the hospital, and they attempted to reduce it, but it still protrudes.
The doctor suggested surgery for today, but I am hesitant about undergoing the procedure.
Is it possible for my condition to resolve without surgery? Will it retract on its own? What can I do to help it return, and what should I be aware of? Thank you, John.

Yuehan, 20~29 year old female. Ask Date: 2008/07/30

Dr. Hou Yongji reply Surgery

Dear John: Based on your description, it is likely an acute episode of external hemorrhoids, which typically remain outside.
Therefore, there is no need to repeatedly push it back in, as this may lead to increased inflammation and prolong the healing process.
Usually, it will resolve naturally within 3 to 4 weeks.
However, I must remind you that the diagnosis of anal hemorrhoids requires not only a medical history but also visual inspection, palpation, and possibly endoscopic examination.
Thus, this diagnosis may not be entirely accurate, and you should seek treatment from a colorectal specialist as soon as possible.
Thank you.

Reply Date: 2008/07/30

More Info

Dealing with hemorrhoids can be a challenging experience, especially when they become painful or protrude. Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, bleeding, and other symptoms. The good news is that many cases of hemorrhoids can resolve without the need for surgical intervention, especially if they are managed properly.

In your situation, it sounds like you have been experiencing symptoms for several years, and the recent episode of pain and protrusion may indicate that your hemorrhoids have become more aggravated. The fact that you have been using topical treatments and warm baths is a good start, as these methods can help alleviate discomfort and promote healing. However, it is important to understand that while some hemorrhoids may shrink on their own, others may require more intensive treatment.

Here are some key points to consider regarding your condition:
1. Self-Care Measures: Continue with warm sitz baths, which can help soothe the area and reduce inflammation. Over-the-counter topical treatments, such as creams or ointments containing hydrocortisone, can also provide relief. Increasing your fiber intake through diet or supplements can help soften stools and reduce straining during bowel movements, which is crucial for preventing further irritation of the hemorrhoids.

2. Observation: If your symptoms have improved and you are no longer in pain, it may be reasonable to monitor the situation for a little while longer. Many hemorrhoids can resolve with conservative management, especially if you are able to avoid straining during bowel movements.

3. Prolapsed Hemorrhoids: If the hemorrhoid is protruding (prolapsed), it may sometimes retract on its own, especially if you are able to relax the anal sphincter and gently push it back in. However, this can be uncomfortable and may not always be successful. If the hemorrhoid remains outside and is causing significant discomfort, it may be necessary to consider medical intervention.

4. Consultation with a Specialist: Since you have been advised to consider surgery, it is important to weigh the risks and benefits. Surgical options, such as hemorrhoidectomy or rubber band ligation, are typically reserved for severe cases or when conservative measures fail. Discuss your concerns with a colorectal surgeon, who can provide you with a comprehensive evaluation and help you understand the potential outcomes of surgery versus continued conservative management.

5. When to Seek Immediate Help: If you experience severe pain, significant bleeding, or any signs of infection (such as fever or pus), it is important to seek medical attention promptly. These symptoms may indicate complications that require immediate treatment.

In summary, while many hemorrhoids can resolve without surgery, it is essential to manage your symptoms effectively and monitor your condition closely. If you continue to experience discomfort or if your symptoms worsen, do not hesitate to seek further medical advice. Remember, maintaining a healthy diet, staying hydrated, and avoiding straining during bowel movements are key factors in managing hemorrhoids effectively.

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