Most of us have experienced the itching, pain and difficulty sitting that hemorrhoids can cause. Since this is one of the most common symptoms Gastroenterologists (also called GI doctors) see patients for, I wanted to create a Hemorrhoids FAQs page to answer the most popular questions.

For additional information, please visit my hemorrhoids webpage.

What are hemorrhoids?

There are two types of hemorrhoids: internal & external. Hemorrhoids develop when the veins around the anus or lower rectum become swollen and inflamed. When the veins swell inside the anal canal, it causes internal hemorrhoids. However, when the veins near the opening of the anus swell, they form external hemorrhoids. It is not uncommon to have both internal and external hemorrhoids at the same time.

How do hemorrhoids start?

Hemorrhoids are typically start due to prolonged increased pressure in the vessels of the rectum. Common activities that cause this increased pressure are constipation, frequent diarrhea, obesity, sitting for prolonged periods of time, pregnancy and heavy lifting.

How do hemorrhoids affect our bodies?

Hemorrhoids can affect our bodies on a broad spectrum from just occasional nuisance to actually causing hemorrhage leading to real health issues. Generally speaking, hemorrhoids tend to be more of a daily annoyance where they may bleed, cause itching or just make it difficult to clean up after a bowel movement. Sometimes, hemorrhoids can prolapse out of the anus and cause significant discomfort and bleeding. When an external hemorrhoid fills up, it can clot called a thrombosis and this can be very painful as well.

Are hemorrhoids common?

Hemorrhoids are one of the most common symptoms GI doctors see in their patients. About half of all people will have experienced hemorrhoids by age 50.

Are hemorrhoids deadly?

Generally speaking, hemorrhoids are not deadly, but if left untreated they can be indirectly ‘deadly’ by causing chronic blood loss. If your hemorrhoids bleed regularly this can lead to anemia, which can be a risk factor for heart attacks, fainting, and severe fatigue. I personally have only treated one person who was in the ICU hemorrhaging from a hemorrhoid, so the risk is low but possible.
An exception would be if a patient had a grade IV non-reducible hemorrhoid. These will require surgery and can be deadly.

Can pregnancy cause hemorrhoids?

Yes. As the uterus enlarges it can put pressure on the veins near the anus. The veins can become swollen, which creates hemorrhoids. This is very common especially during the 3rd trimester.

Symptoms

How do I know if I have hemorrhoids?

The most common symptoms for hemorrhoids are: Bright red blood from the anus, Rectal pain, Itching around the anus, Protruding (thrombosed) lumps from the anus

When hemorrhoids itch are they healing?

No. Taking a sitz bath or using topical creams can help reduce the itching sensation. If the itching is severe or lasts for several days, you should seek an evaluation from your doctor.

Can hemorrhoids burst or bleed?

Both internal and external hemorrhoids can become thrombosed, which means that a blood clot forms inside the vein. If the vein becomes too full of blood, it can burst. The bleeding typically will last a few seconds to several minutes (less than 10 minutes). Since all bleeding is abnormal, you’ll want to be evaluated by a medical professional to ensure that this is not a sign of a larger medical issues.

What causes hemorrhoids to shrink?

Hemorrhoids function like shock absorbers when we defecate. So they are capable of shrinking if they are not too big, which means once they have been stretched out they tend to fill to capacity. Generally, hemorrhoids can decrease if you don’t strain hard when lifting or defecating, as well preventing constipation, and not spending too much time on the toilet will help them decrease.

Can hemorrhoids be painless?

Internal hemorrhoids that do not prolapse are painless since they are above the dentate line where there are no pain fibers. A prolapsed hemorrhoid extends beyond the anus and can be painful. External hemorrhoids can be very uncomfortable. The pain is due to the skin becoming irritated or a blood clot forms inside of an external hemorrhoid.

Bowel Cancer

Are hemorrhoids a sign of bowel cancer?

No. Hemorrhoids and bowel cancer (called colorectal cancer) are very different conditions. Although they can share similar symptoms like rectal bleeding. Bowel Cancer is composed of abnormal, uncontrolled cells that may spread to other organ systems. Hemorrhoids, on the other hand, do not spread and are blood vessels that have become swollen due to increased abdominal pressure, constipation or diarrhea.

Can hemorrhoids turn into cancer?

No, hemorrhoids do not cause cancer.

Seek Medical Attention

When do hemorrhoids require medical attention?

If you have hemorrhoids that don’t improve after a week of home care therapy, it is recommended to see your primary care physician or a gastroenterologist (digestive health specialist). If you are experiencing symptoms like itching around the anus, rectal pain, bright red blood from anus or protruding lumps from the anus, it is advised to have an exam performed by a Gastroenterologist for the proper diagnoses. Although, these are signs and symptoms of hemorrhoids, the same symptoms can mimic many other conditions and diseases. It’s important to rule out these other causes and get a treatment plan created for your hemorrhoids.

Which doctor treats hemorrhoids?

All doctors are able to examine and get a good idea of what type of treatment will help or if a gastroenterologist is necessary. A primary care doctor will be able to examine and start some pharmaceutical treatment which helps sometimes. When this does not work most will refer to a gastroenterologist or colorectal surgeon for further treatment. As a gastroenterologist I prefer to use the least invasive, safest, and least painful method of treatment called hemorrhoid banding. When this fails, I will refer to a colorectal surgeon to discuss possible surgical options.

Hemorrhoids Treatments

How are hemorrhoids treated?

A GI doctor will typically start by having the patient increase the amount of fiber they are eating. This makes your stool a little easier to evacuate resulting in less constipation and strain. Also, getting more aerobic exercise can help stimulate bowel function. Over the counter creams can be used initially to help with symptoms, but do not help with the causes. You should not be taking a cream for longer than a week.If initial treatment is unsuccessful, hemorrhoid banding will be considered to remove the internal hemorrhoids. Surgery, while less common, is an option that is used in some cases.

Are there natural hemorrhoids treatments?

Some of my patients prefer natural treatment options when possible. For these patients I recommend using Atrantil. The anti-inflammatory properties of horse chestnut seed extract can help relieve symptoms of hemorrhoids by reducing inflammation and swelling in the affected veins.Atrantil has the added benefit of helping your overall digestive health due to the polyphenols in this product. Polyphenols act as a prebiotic-type substance, meaning that they increase the number of healthy bacteria in the gut.

Do hemorrhoids require surgery?

Most hemorrhoids do not require surgery. Hemorrhoid banding is the best non-surgical option to remove internal hemorrhoids. However, if you have hemorrhoids that are persistently painful, that protrude, or that return after minimally invasive procedures, your doctor may recommend surgery.

What is rubber band ligation for hemorrhoids?

Rubber band ligation (hemorrhoid banding) is a fast and non-surgical approach to hemorrhoid removal. The banding procedure works by cutting off the blood supply to the hemorrhoid. During the brief and painless procedure, a small rubber band is placed just above the internal hemorrhoid where there are few pain-sensitive nerve endings. This causes the hemorrhoid to shrink, and the band will fall off typically within 24 hours. To learn more about this hemorrhoid removal option, please visit my hemorrhoid banding page.

Is hemorrhoid banding painful?

No. Less than 1% of patients feel pain or a pinching sensation after the procedure. If a pinching sensation does occur, your gastroenterologist can typically correct that by simply moving the band a few millimeters.

Can hemorrhoids return after rubber band ligation treatment?

Band ligation has a very low recurrence rate. The possibility of new hemorrhoids developing is dependent on the patient’s habits. Discuss dietary & lifestyle changes with your doctor to lessen this chance. That being said I sometimes have to do a touch up band every few years to prevent them from getting too big again.

Is hemorrhoid banding covered by insurance?

Most insurance plans will cover rubber band ligation treatments. If you have questions regarding your insurance coverage, please call my office at 972-867-0019 and my staff will be happy to help you.