Rectal bleeding isn’t always caused by hemorrhoids. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, advises seeing a doctor for any rectal bleeding, and getting care right away for severe pain in the anus with rectal bleeding, especially with abdominal pain, diarrhea or fever.
In the video above, colorectal surgeon Dr. Jennifer Lowney explains the two types of hemorrhoids, why surgery is usually the last option, and a newer outpatient procedure that doesn’t involve cutting. A patient describes years of discomfort and getting back to an active life.
What hemorrhoids are
NIDDK describes hemorrhoids as swollen, inflamed veins around the anus or in the lower rectum. They are common: NIDDK estimates that about 1 in 20 Americans has them, and about half of adults over 50.
Dr. Lowney explains that there are two types:
- External hemorrhoids form under the skin around the anus. NIDDK says they can cause itching, hard or tender lumps, and pain, especially when sitting.
- Internal hemorrhoids form in the lining of the anus and lower rectum. According to NIDDK, they can cause bright red bleeding and can prolapse, meaning they push out through the anal opening. They are usually painless unless they prolapse.
NIDDK lists straining during bowel movements, sitting on the toilet for a long time, long-lasting constipation or diarrhea, a low-fiber diet, aging, pregnancy and frequent heavy lifting as common causes.
Get bleeding checked
Other conditions can also cause rectal bleeding, including Crohn’s disease, ulcerative colitis and colorectal cancer, NIDDK notes. A summary of the American Society of Colon and Rectal Surgeons (ASCRS) guideline, published by the American Academy of Family Physicians, warns that bleeding from colon cancer is often blamed on hemorrhoids. It says a colonoscopy should be considered when there is no obvious source of bleeding, or for people with abdominal pain, new or worsening constipation, or bleeding that continues despite treatment.
To diagnose hemorrhoids, NIDDK says a doctor takes your medical history and does a physical exam, which can include a rectal exam and a look inside with a short scope.
Treatment usually starts at home
NIDDK and the ASCRS guideline summary describe these first steps:
- more fiber in your diet, a fiber supplement or a stool softener
- enough fluids
- not straining, and not sitting on the toilet for long periods
- over-the-counter pain relievers, warm sitz baths, and creams or suppositories for short-term relief
NIDDK suggests seeing a doctor if symptoms continue after a week of home treatment.
Office procedures
If symptoms continue, a doctor can treat internal hemorrhoids in the office. NIDDK lists rubber band ligation, sclerotherapy, infrared photocoagulation and electrocoagulation. The ASCRS guideline summary says office procedures are preferred over surgery because they offer similar benefits with fewer complications.
When surgery is considered
Dr. Lowney says surgery is usually the last option, and that most patients can avoid it. It’s considered when diet changes, medicines and office procedures haven’t controlled the symptoms, or a patient couldn’t tolerate them.
The traditional operation, a hemorrhoidectomy, removes the hemorrhoid tissue. Dr. Lowney explains that it’s done as an outpatient procedure but can be painful, with a long and difficult recovery. NIDDK also lists hemorrhoid stapling among the procedures done in an outpatient center or hospital.
An incisionless option
Dr. Lowney describes a newer, minimally invasive outpatient procedure that doesn’t require any incisions. Instead of cutting away the swollen tissue:
- a Doppler ultrasound is used to find the swollen blood vessels, which are then tied off
- hemorrhoids that come in and out are tucked back in and stitched in place
This approach is often called Doppler-guided hemorrhoidal artery ligation. Dr. Lowney says it has been very successful in her practice: patients get back to their daily activities more quickly, with minimal pain. She mentions patients who ran triathlons five weeks later.
Every procedure has trade-offs, and not every patient is a candidate. Ask your surgeon how recovery, pain and the chance of hemorrhoids coming back compare across the options for your type of hemorrhoids.
The patient’s outcome
The patient in the video says the problem had lasted four or five years and forced changes in daily life. After the procedure, Dr. Lowney says, the patient took up biking and swimming. The patient calls it a reset.
Prevention
NIDDK suggests the same habits that help with treatment: a high-fiber diet, enough fluids, not straining, not sitting on the toilet for long periods, and avoiding regular heavy lifting.
Questions to ask your doctor
- Are my symptoms caused by hemorrhoids, or should other causes of bleeding be ruled out?
- Do I need a colonoscopy?
- Are my hemorrhoids internal, external or both?
- Which home treatments should I try, and for how long?
- Am I a candidate for an office procedure such as rubber band ligation?
- If I need surgery, which procedures fit my case, and how do they compare?
- What will recovery be like, and when can I return to work and exercise?
- How can I keep hemorrhoids from coming back?
Dr. Lowney is a colorectal surgeon in the Dallas-Fort Worth area. See Dr. Lowney’s Best Docs Network profile for more about the practice.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
