Hemorrhoids – Diagnosis and Treatment
Diagnosis
Doctors usually spot external hemorrhoids just by looking at the area around the anus. Internal hemorrhoids, though, are trickier and need a closer look.
Here’s how doctors usually check for hemorrhoids:
- Digital Exam: The doctor puts on a glove and gently inserts a finger into the rectum to feel for any unusual lumps or bumps.
- Visual Tools: They might use an anoscope, proctoscope, or sigmoidoscope to get a better view inside the anal canal and rectum.
People often come in for these tests when they notice rectal bleeding, pain, itching, discomfort, swelling, or even prolapse. Chronic constipation and straining during bowel movements tend to make things worse.
If a hemorrhoid is swollen and painful from a blood clot (a thrombosed hemorrhoid), doctors can usually spot that during the exam too.
Sometimes, if symptoms look like they could be from something more serious—like colorectal cancer or inflammatory bowel disease—a full colonoscopy might be the next step.
In some cases, imaging tests like an endoscopic ultrasound or MRI may be used to rule out other conditions if symptoms persist despite treatment.
Treatment
Self-Care and Home-Based Approaches
Managing mild hemorrhoid symptoms at home isn’t too complicated.
Here are some steps people often try:
- Eating More Fiber: Adding more fiber—like fruits, veggies, and whole grains—makes stools softer and easier to pass. If you add fiber too quickly, it can cause some extra gas, so it’s smart to take it slow.
Topical Creams and Pads: Over-the-counter creams or suppositories with ingredients like hydrocortisone can help with pain and itching. Witch hazel pads or ointments with numbing medicine are also worth a try.
- Warm Baths or Sitz Baths: Sitting in warm water, either in a bathtub or a sitz bath that fits on the toilet, helps reduce swelling and soothes discomfort. Most people do this for about 10 to 15 minutes, a couple of times a day.
- Pain Relievers: Medications like acetaminophen, aspirin, or ibuprofen can take the edge off pain. It’s best not to use these for long stretches unless your doctor says it’s okay.
| Home Remedy | Benefit | Notes |
|---|---|---|
| High-fiber diet | Softer stools; less straining | Add slowly to prevent bloating |
| Hemorrhoid creams | Relieves pain and itching | Short-term use only |
| Sitz/warm baths | Reduces swelling and discomfort | 10-15 minutes, 2-3 times daily |
| Pain medicine | Temporary pain relief | Use as directed |
If things don’t improve in a week, or if there’s a lot of pain or bleeding, it’s time to check in with a doctor.
Over-the-Counter and Prescription Medicines
When symptoms are mild, some products can help and you don’t need a prescription for them.
Creams, pads, and suppositories often include ingredients like witch hazel, hydrocortisone (a steroid), or lidocaine (a numbing agent). These can take down pain and itching.
Don’t use hydrocortisone creams for more than a week at a time—they can thin the skin if you do. If symptoms keep going, ask your healthcare provider about how long it’s safe to use them.
Types of Medicines
- Hemorrhoid Creams and Ointments: These help with external symptoms like itching and soreness.
- Suppositories: For internal hemorrhoids, especially if there’s pain or swelling inside the rectum.
- Stool Softeners: These make it easier to go to the bathroom without straining, which helps healing and can keep flare-ups from coming back.
Quick Relief for Clotted External Hemorrhoids
If a painful clot forms in an external hemorrhoid, a provider might do a quick removal called a thrombectomy. They numb the area, open it up, and remove the clotted blood.
This gives fast relief, especially if it’s done within 72 hours after the clot shows up. Most people feel a lot better right away, though there might be a bit of soreness for a few days.
Less Invasive Techniques
When home care isn’t enough or if bleeding and pain just won’t quit, a healthcare provider may recommend minimally invasive treatments.
These don’t usually need anesthesia and can often be done right in the office or clinic.
Common Office Treatments
| Procedure | Main Use | What to Expect | Side Effects |
|---|---|---|---|
| Rubber band ligation | Internal piles | Hemorrhoid falls off | Mild pain, minor bleeding |
| Sclerotherapy | Small hemorrhoids | Shrinkage in days | Little to no pain |
| Infrared/laser coagulation | Bleeding hemorrhoids | Quick session | Mild discomfort |
-
Rubber Band Ligation (Banding)
- The doctor puts small rubber bands around the base of an internal hemorrhoid.
- This cuts off blood flow, so the hemorrhoid dries up and falls off.
- You might notice mild bleeding or discomfort a few days later.
-
Injection Therapy (Sclerotherapy)
- A liquid chemical is injected to shrink the hemorrhoid.
- This method is usually painless, though it might not work quite as well as banding.
-
Coagulation Methods
- Lasers, infrared light, or heat are used to make small internal hemorrhoids harden and shrink away.
- These treatments are quick and don’t usually cause much discomfort.
Surgical and Advanced Methods for Hemorrhoids
If nothing else works, or if the hemorrhoids are really large or severe, surgery might be the next step.
Types of Surgical Treatments
-
Hemorrhoid Removal (Hemorrhoidectomy)
- The surgeon removes the extra hemorrhoid tissue that’s causing trouble.
- They can use local, spinal, or general anesthesia to keep you comfortable.
- This method is the most effective for stopping severe or repeat cases, but pain and sometimes trouble passing urine can follow.
- Rarely, infections can happen.
-
Hemorrhoid Stapling (Stapled Hemorrhoidopexy)
- This surgery staples and blocks blood flow to internal hemorrhoids.
- People usually have less pain and get back to normal faster compared to a full removal.
- The downside? Hemorrhoids might return, and in some cases, a part of the rectum could slip out (rectal prolapse).
- Other possible issues include bleeding, bladder problems, or—though it’s very rare—serious infections.
| Surgery Type | Used For | Pros | Possible Problems |
|---|---|---|---|
| Hemorrhoidectomy | Severe or repeat hemorrhoids | Highly effective | Pain, urinary issues |
| Stapled hemorrhoidopexy | Internal hemorrhoids | Less pain, faster recovery | Return of symptoms, rare infections |
It’s always worth talking with your healthcare provider to figure out which option fits your situation best.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Getting organized before a doctor’s visit for hemorrhoids really helps.
Check any instructions you got when you booked the appointment—sometimes you might need to change your diet or do something else ahead of time.
It’s smart to bring a list that covers:
- A summary of symptoms and when they started.
- Personal details like pregnancy history, recent childbirth, weight changes, and your typical fiber intake.
- All current medications, including supplements or vitamins.
- Questions you want to ask during the visit.
Think about asking what’s causing your symptoms, which treatments might work, how to prevent future problems (like eating more fiber), and whether things like obesity or chronic diarrhea could be making things worse.
You might also want to ask if self-care is safe for you or if you should avoid certain activities, like anal intercourse.
Sample questions for your provider:
| Question | Purpose |
|---|---|
| What’s the likely reason for my symptoms? | To learn about causes |
| Could my diet or weight be a factor? | To discuss prevention and risk factors |
| Is this related to pregnancy or recent childbirth? | To address special situations |
| Are there home steps I can take for relief? | For advice on self-care |
| Should high-fiber foods or supplements be added? | To improve fiber intake |
Questions Your Healthcare Provider Might Ask
During your appointment, your provider will want to know how bad your symptoms are and about your daily habits.
They’ll probably ask about:
- How much discomfort you feel and how often symptoms happen
- Your bowel movement habits and any changes you’ve noticed
- How much fiber you eat each day
- Anything that seems to make symptoms better or worse
- Family history of hemorrhoids or digestive diseases
- Details about pregnancy, childbirth, or obesity if any of those apply
Having clear answers ready helps your doctor give you the best advice and speeds up getting the right tests or care.
Actions to Take While Waiting for Your Appointment
While you wait to see your provider, a few simple steps can sometimes ease symptoms or keep them from getting worse:
- Eat more fiber by adding fruits, veggies, and whole grains to meals.
- Drink enough water— aim for 6 to 8 glasses a day to keep things moving.
- Don’t strain during bowel movements, which is especially important if you deal with chronic diarrhea, pregnancy, or obesity.
Skip any activities that might make symptoms worse.
A few steady changes in your daily habits can sometimes make a big difference until you get a diagnosis and treatment plan.
