Hemorrhoids: Symptoms, Diagnosis, and Treatment Options

Anal issues

I'm sorry to ask the doctor, but I have internal hemorrhoids.
Two weeks ago, my stool was a bit hard, and I felt something unusual in my anus.
There was a small amount of blood on the toilet paper.
I used a suppository, which helped a bit, but then it became swollen again.
I went back to see the doctor, who initially said it looked like a fistula, but then asked if I had any discharge.
I said no, and he mentioned that it might just be an enlarged internal hemorrhoid.
What are the chances that I have a fistula? I usually go to the bathroom on time and wash with clean water.
The doctor prescribed a suppository, a venous relaxant, and an ointment, which have helped reduce the swelling.
However, I'm a bit worried because I've heard that a fistula requires surgical treatment.
The doctor only examined me visually and did not perform a digital examination.
How is a fistula diagnosed?

Jerry, 20~29 year old female. Ask Date: 2016/01/01

Dr. Ke Fangxu reply Surgery

Anal fistulas can indeed only be definitively treated through surgical intervention.
However, based on your description, it seems more likely that you may be dealing with hemorrhoids.
In addition to a lump, an anal fistula would also present a hard, tubular structure connecting to the anal canal.
A thorough examination by a trained physician would provide a more accurate diagnosis.

Reply Date: 2016/01/01

More Info

Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding during bowel movements. They are classified into two types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. Understanding the symptoms, diagnosis, and treatment options for hemorrhoids is crucial for effective management and relief.

Symptoms of Hemorrhoids
The primary symptoms of hemorrhoids include:
1. Bleeding: This is often the most noticeable symptom. Bright red blood may appear on toilet paper after wiping or in the toilet bowl after a bowel movement. This bleeding is typically painless, especially in the case of internal hemorrhoids.

2. Pain or Discomfort: While internal hemorrhoids usually do not cause pain, external hemorrhoids can be painful, especially if a blood clot forms (thrombosed hemorrhoid).

3. Itching or Irritation: The area around the anus may become itchy or irritated due to inflammation.

4. Swelling: Swelling around the anus may occur, particularly with external hemorrhoids.

5. Prolapse: Internal hemorrhoids can protrude through the anal opening, especially during bowel movements, leading to a feeling of fullness or discomfort.

Diagnosis of Hemorrhoids
Diagnosis typically involves a physical examination and a review of symptoms. A healthcare provider may perform a visual inspection of the anal area. In some cases, a digital rectal exam may be necessary to assess the internal structures. If there is a concern about other conditions, such as anal fissures or colorectal cancer, additional tests may be recommended, including:
- Anoscopy: A small tube is inserted into the anus to visualize the lower rectum and anal canal.

- Sigmoidoscopy or Colonoscopy: These procedures allow for a more comprehensive examination of the lower gastrointestinal tract.

Treatment Options for Hemorrhoids
Treatment for hemorrhoids depends on the severity of the symptoms and the type of hemorrhoids present. Options include:
1. Lifestyle Modifications: Increasing fiber intake through diet or supplements can help soften stools and reduce straining during bowel movements. Staying hydrated and exercising regularly can also promote bowel health.

2. Over-the-Counter Medications: Topical treatments, such as creams or ointments containing hydrocortisone, can relieve itching and inflammation. Oral pain relievers like acetaminophen or ibuprofen may also help alleviate discomfort.

3. Minimally Invasive Procedures: If symptoms persist despite conservative treatment, several minimally invasive procedures can be performed:
- Rubber Band Ligation: A rubber band is placed around the base of the hemorrhoid to cut off blood supply, causing it to shrink and fall off.

- 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 clot and shrink.

4. Surgical Options: In cases of severe or recurrent hemorrhoids, surgical intervention may be necessary. Hemorrhoidectomy, the surgical removal of hemorrhoids, is considered the most effective treatment for severe cases.

Concerns About Fistulas
Regarding your concern about a possible anal fistula, it is important to note that a fistula is an abnormal connection between the anal canal and the skin surrounding the anus. Symptoms may include persistent drainage of pus or blood, pain, and swelling. Diagnosis typically involves a physical examination and possibly imaging studies.

If your doctor suspects a fistula, they may perform a more thorough examination, including a digital rectal exam or an endoscopic evaluation. If confirmed, treatment usually involves surgical intervention to close the fistula and prevent further complications.

Conclusion
In summary, while hemorrhoids can be uncomfortable and concerning, they are generally manageable with appropriate treatment. It is essential to maintain open communication with your healthcare provider, follow their recommendations, and seek further evaluation if symptoms persist or worsen. If you have any additional concerns or questions, do not hesitate to reach out to your healthcare provider for personalized advice and treatment options.

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