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Hemorrhoids? What You Need To Know

July 26, 2023

For most people, hemorrhoid troubles are a natural part of life from time to time. So, if you’re having a flareup, take heart in knowing that you’re not alone. It’s estimated that three of every four adults will be in your shoes at some point.

Technically, everyone has hemorrhoids, which are essentially blood vessels in the anus and lower rectum. They can become bothersome for a variety of reasons – some of which are not well understood. But they can make life miserable, causing itching, pain and bleeding. They’re one of the biggest reasons people visit colorectal specialists, with hemorrhoids getting blamed for pretty much any symptom that happens in the anus.

Fortunately, hemorrhoidal flareups often can be treated with over-the-counter medications, lifestyle changes and painless therapies. Treatment options often depend on the severity of the hemorrhoids.

Grading Hemorrhoids

Your hemorrhoids, which can be found both inside and outside the rectum and anus, become problematic when swollen and enlarged. Internal hemorrhoids are evaluated on a four-point scale:

  • Grade 1:  These internal hemorrhoids are enlarged enough to protrude into the anal canal. They may bleed, but rarely cause pain.
  • Grade 2: These will pop out of the anus during a bowel movement, but then move back inside on their own.
  • Grade 3: After emerging from the anus, these have to be pushed back inside manually.
  • Grade 4: At this point, the hemorrhoid will not go back into the anal canal, even if pushed. Surgery is often recommended.

Avoiding Trouble

There is a lot that’s not known about what causes hemorrhoids to flare up. But your bathroom habits may play a key role. In particular, sitting on the toilet too long may be one of the biggest risk factors.

Too many people head into the bathroom with a cell phone in hand. So, even after they’ve finished, they’ll sit there for a while with their phone. The problem is that when you sit on an open toilet, it sends a signal to your body to relax the anal sphincter, which allows the hemorrhoids to fill with blood. The longer you sit there, the greater the risk. So, get in there, do what you need to do and then get off the toilet.

You also need to avoid excessive straining while in the bathroom. If you aren’t having easy bowel movements, add more fiber to your diet or consider using a stool softener, or even medication if needed.

Treating Hemorrhoids

Treating hemorrhoids often starts with over-the-counter medications – such as those that shrink blood vessels, help with inflammation, or soothe or numb the area. When using these creams or suppositories, stick with it for five to seven days, even if you see improvement after a couple days. You’ll get the best results with the full treatment.

For more extreme cases, options include:

  • Rubber band ligation: This treatment is only used on internal hemorrhoids. They are wrapped with a rubber band, which cuts off the blood supply, causing the hemorrhoid to drop off after a few days.  The procedure may cause mild discomfort and bleeding.
  • Hemorrhoid energy therapy: This is a newer treatment for internal hemorrhoids. It uses thermal energy – applied by a device inserted into the anus – to shrink the hemorrhoids. The procedure is usually done with sedation.
  • Transanal hemorrhoidal dearterialization (THD): Your surgeon uses ultrasound to locate the arteries feeding your hemorrhoids. The arteries are tied off, and a suture is used to lift and choke off the internal hemorrhoids
  • Hemorrhoidectomy: This is the gold standard for removal of troublesome hemorrhoids, internal and external. The surgery, which involves general anesthesia, removes the extra tissue that’s causing bleeding and/or swelling. This may be the best option if you have severe grade 3 or grade 4 hemorrhoids. But there is often a period of intense pain for about two weeks after the procedure.
  • Other: Other therapies such as injections, laser, or cauterization may also be used.

Is It Something Else?

Hemorrhoids are quite common. But that doesn’t mean your discomfort or rectal bleeding isn’t a sign of something else. There are several other conditions that could be responsible, including anal fissures, Crohn’s disease, ulcerative colitis, anal lesions/cancer and colon cancer. So, if there’s persistent or recurrent bleeding, you shouldn’t assume it’s just hemorrhoids.

Try an over-the-counter remedy for a few days. But if the symptoms don’t go away, you should see a specialist. And while few people are comfortable talking about what’s happening with their anus, remember it’s just another body part for colorectal specialists.  For them, it’s like looking at your ear or your hand. The important thing is getting to the bottom of your problem.

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