Hemorrhoids are normal blood vessels in the anal area that have become swollen due to increased pressure, thus stretching the overlying tissue and causing symptoms. Some factors that may contribute to hemorrhoids including straining with bowel movement or spending prolonged time on the toilet, heavy lifting, weight gain, increased pelvic pressure during pregnancy, and prolonged sitting etc. Hemorrhoids are broadly classified as external vs internal based on location, and the symptoms and treatment are different.

Symptoms of hemorrhoids

External hemorrhoids typically cause uncomfortable sensation described variably as pressure/swelling/burning, itch and moisture. It can bulge significantly in a short time and be excruciatingly painful when "thrombosed" (due to the blood vessel broke open resulting in a blood clot under the skin). If left untreated, pain from the thrombosed hemorrhoid may start to improve slowly after 4-5 days as the blood clot begins to dissolve on its own. If the skin overlying the thrombosed hemorrhoid opens up, you may notice oozing of blood from the blood clot. Internal hemorrhoids are often painless but would bleed during bowel movement. Bleeding is typically bright red blood and the amount can vary from a small drop of blood on toilet paper when wiping, to a continuous drip or squirt of blood from your anus. The bleeding typically stops on its own or after you put pressure with a tissue over the area and when you stand up. When internal hemorrhoids get bigger, they may protrude out (prolapse) and cause symptoms similar to external hemorrhoids.

Diagnosis and treatment of hemorrhoids

Hemorrhoids are diagnosed by history and physical exam, and only needs to be treated when they cause symptoms. Since other conditions such as abscess, fissure, certain anal skin conditions or cancer may cause similar complaints, seeing a proctologist like Dr. Choi for accurate diagnosis and treatment is important. Treating the underlying condition that brought on or exacerbate the hemorrhoids is key. Often, this along with nonsurgical treatment such as warm sitz bath and topical cream for pain relief is sufficient. Internal hemorrhoids may be treated with simple office-based procedures such as rubber band ligation or sclerothearpy, which are offered in Dr. Choi's office. External hemorrhoids and large prolapsing internal hemorrhoids usually require outpatient surgical removal (excisional hemorrhoidectomy) under anesthesia. In the case of painful thrombosed hemorrhoids, Dr. Choi can perform simple office procedure to remove the blood clot, which allow faster pain relief and recovery.

Prevention of hemorrhoids

While not all hemorrhoids are preventable, conditions known to be associated with hemorrhoids should be identified and corrected. Common problems include constipation related to inadequate diet, poor toilet habit such as spending too much time on toilet. Unfortnately this is often easier said than done, especially when you do not realize certain things you do habitually is the source of the problem. Dr. Choi can help you uncover the cause and give practical suggestions to bring about healthy changes to keep your hemorrhoids from bothering you.

Helpful links:


*American Society of Colon and Rectal Surgeons