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DIGESTIVE SERVICES

Diagnosis & Treatment

Hemorrhoids

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How Are Hemorrhoids Diagnosed?

Diagnosis

Your doctor will begin by asking you to describe any symptoms, such as rectal bleeding, and will ask about your medical history, diet, how often you have bowel movements, whether you use laxatives, and if you have any other medical conditions.

External hemorrhoids can usually be diagnosed by a quick check of the anal area. Internal hemorrhoids may require other procedures to look inside your anus.

Your doctor may do any of the following:

  • Visual exam. Your doctor will check your anal area for:
    • Lumps
    • Prolapsed internal hemorrhoids
    • External hemorrhoids
    • Leakage of BMs or mucus
    • Skin irritation
    • Skin tags
    • Anal fissures (small anal tears that can cause itching, pain, or bleeding)
  • Digital rectal exam. Your doctor may examine the anal canal and the lower part of the rectum. This is to check your anal muscle tone and any lumps or masses that could indicate internal hemorrhoids. Additionally, the exam can identify and evaluate abnormal masses and examine the prostate in patients assigned male at birth.
  • Anoscopy. If your doctor thinks you might have internal hemorrhoids, they will use an anoscope — a hollow tube with a light — to look directly inside the anus. They can also examine it to look for signs of other digestive tract or bowel diseases.
  • Sigmoidoscopy. This allows a doctor to look more closely at the anus and rectum. They will insert a sigmoidoscope — a short, flexible, lighted tube — through the rectum. You’ll need to perform a bowel cleanout before the procedure, for which your doctor’s office will give you instructions.
  • Colonoscopy. If you have any rectal bleeding, your doctor may want to perform a colonoscopy to rule out colon cancer. While you are under sedation, the doctor will insert a colonoscope into the anus and examine the entire colon. The procedure takes about an hour. You’ll need to do bowel prep a day before the procedure. If you do have internal hemorrhoids, your doctor will spot them during the test.

How Are Hemorrhoids Treated?

Treatment

There are many options for hemorrhoid treatment, including:

Home treatments

There are many home remedies for hemorrhoids. Your doctor may recommend the following:

  • Stool softeners. Docusate sodium (Colace, Docu) is one of the most common stool softeners. This softens bowel movements to help avoid straining while sitting on the toilet.
  • Eat more fiber. You should aim for 20 to 35 grams of fiber a day. Fiber prevents constipation, which can worsen hemorrhoids. If getting that much fiber is difficult, try a supplement such as psyllium (Konsyl, Metamucil) or methylcellulose (Citrucel).
  • Warm sitz baths. Made with water and a soothing salt, such as mineral bath salts (like Epsom) or sea salts, a sitz bath improves blood flow and relaxes anal muscles. You can find these salts in drugstores. To use them, soak your rectal area in warm water for 10 to 15 minutes, two to three times a day.
  • Anal wipes. These help with pain, itching, and dryness. You must gently clean and dry the area before you use them.
  • Witch hazel. This dries and tightens the skin around the anus. You can use witch hazel after you’ve had a bowel movement. It comes in liquid, pad, and wipe form.
  • Steroid creams. Hydrocortisone creams like Preparation H hydrocortisone reduce swelling and pain caused by hemorrhoids. Don’t use these creams for longer than two weeks consecutively.
  • Phenylephrine ointments or suppositories. These remedies, like Preparation H or Rectacaine, temporarily shrink swollen hemorrhoids and relieve itching and discomfort.
  • Numbing ointments. Benzocaine, dibucaine, and lidocaine rectal ointments can all help with pain and itching but should be used only occasionally, in small amounts. Talk to your doctor before you use them.
Medical office procedures

If conservative hemorrhoid treatments at home don’t work, your physician may have other suggestions for how to treat a hemorrhoid. They may first want to start with minimally invasive procedures at their office, such as:

  • Rubber band ligation. This is a very common way to treat hemorrhoids and works for most patients. Your doctor will place a rubber band or ring around the base of an internal hemorrhoid. This restricts blood supply. The hemorrhoid will shrink and fall off after a few days.
  • Laser or infrared light. These can destroy the blood vessels within internal hemorrhoids.
  • Sclerotherapy. Your doctor will inject a chemical solution into the hemorrhoid, which causes the tissue to break down.
Surgical options

You may need more intensive treatment for bleeding hemorrhoids or hemorrhoids that do not improve with nonsurgical treatment or are very painful.

The two most common surgical options for hemorrhoids are:

  • Hemorrhoidectomy. This involves the surgical removal of hemorrhoids and can be used as treatment for both internal and external hemorrhoids. It requires anesthesia and taking some time off to recover.
  • Hemorrhoids stapled and sutured. Used primarily to treat internal hemorrhoids, this surgery uses a medical stapling device to remove hemorrhoidal tissue.

FAQs

FAQs

They normally look like rubbery lumps. A thrombosed hemorrhoid may be a dark blue because of the blood clot inside it.

Many hemorrhoids will resolve on their own, with or without home treatment. You may need treatment if they are severely prolapsed (protruding) or bleeding.

You may feel a hard lump near your anus if you have an external hemorrhoid. You may feel an internal hemorrhoid if it prolapses.

They can make it hard to clean your anal area after a bowel movement thoroughly. Some hemorrhoids also leak mucus, which can cause itching.

Most symptoms of hemorrhoids last about a week. Sometimes, however, they can last longer and may require medical treatment.

They aren’t life-threatening. But if you have a strangulated hemorrhoid, in which the blood supply to an internal hemorrhoid is cut off, or a thrombosed hemorrhoid, in which you may experience extreme pain, you must seek prompt treatment.

Get Care

Trust NewYork-Presbyterian for Hemorrhoids Treatment

It’s important to know the symptoms of hemorrhoids so you can get the care you need. Contact the experts at New York-Presbyterian to make an appointment with one of our colon and rectal surgeons.