When to See a Doctor About Hemorrhoids

Hemorrhoids, which are swollen veins in the anus and lower rectum, can be a pain in the butt. Jokes aside, these lumps have a variety of causes but are mainly due to excess pressure on these veins, such as straining to pass a bowel movement.

Hemorrhoids are quite common, affecting about 1 in 20 Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Approximately half of adults over age 50 in the United States have hemorrhoids.

While they can be unpleasant, hemorrhoids are rarely dangerous. A number of effective treatment options exist that can alleviate symptoms.

Symptoms of Hemorrhoids

There are two types of hemorrhoids: internal and external. Internal hemorrhoids occur inside the rectum and are typically not visible to the naked eye. External hemorrhoids are located outside of the rectum around the anus under the skin.

Many people may have hemorrhoids and don't even know it. “Hemorrhoids are often asymptomatic, but in 40 percent of individuals, they can cause symptoms,” says Kenneth N. Josovitz, MD, a Virginia-based gastroenterologist with Gastro Health, a multistate network of gastrointestinal (GI) medicine practices.

Symptoms of external hemorrhoids include:

• Itching or irritation of the anus
• Swelling around the anus
• Pain in the anus, especially when sitting
• Rectal bleeding

Internal hemorrhoids are more likely to be symptomless, per the Cleveland Clinic. They are often painless but may cause rectal bleeding. This may present as blood on toilet paper following a bowel movement, in stool, or in the toilet.

If a hemorrhoid prolapses, it stretches and protrudes outside of the anus. This can cause pain, irritation, and bleeding.

When You Should See a Doctor

While hemorrhoids can often be treated at home, it’s best to see a doctor if you are experiencing pain and rectal bleeding.

“Rectal bleeding can be a sign of inflammatory bowel disease, fistulas, abscesses, or even cancer,” says Sergey V. Kantsevoy, MD, PhD, the director of therapeutic endoscopy at the Mercy Medical Center in Baltimore. “A physician should make this diagnosis and administer the appropriate therapy.”

To diagnose hemorrhoids, your doctor may perform a digital examination in which they inspect the anal region, then insert a gloved, lubricated finger into the anus to feel for lumps or anything unusual, according to the Mayo Clinic. They may also use special tools, including lighted tubes and cameras to visually inspect the colon and rectum. If your signs and symptoms signal a more serious concern, such as a digestive disease or cancer, your doctor may recommend a colonoscopy and further evaluation from a gastroenterologist.

How Are Hemorrhoids Treated?

In most cases, symptoms of hemorrhoids can be treated “with dietary and lifestyle modifications, including increasing water and fiber in the daily diet, treating any underlying constipation and avoid straining when having a bowel movement, and topical creams or ointments for symptomatic relief,” Dr. Josovitz says.

Your doctor may also suggest taking over-the-counter pain relievers like acetaminophen or ibuprofen and soaking in a warm bath or sitz bath (a warm water bath you sit in to relieve discomfort in your tush) for 10 to 15 minutes a few times a day.

Using these methods of treatment, hemorrhoids typically go away within a week.

If symptoms last longer than this despite treatment, you may need to be referred to a GI specialist. Minimally invasive procedures can treat more severe or chronic hemorrhoids, including injections, laser treatment, or rubber band ligation, in which two tiny rubber bands are placed around the hemorrhoid to cut off circulation, causing it to fall off.

“In the rare cases that these do not work, surgery can be considered,” Josovitz says.

Can You Prevent Hemorrhoids?

The most effective way to prevent hemorrhoids is to try to keep your stools soft so they will pass without straining.

“Constipation is the most common cause of prolonged suffering or recurrence of hemorrhoids,” Dr. Kantsevoy says. “If the patient has constipation, it should be eliminated to ensure successful treatment and prevention of recurrent hemorrhoids.”

Ways to stay regular include maintaining a diet high in fiber by eating vegetables, fruits, and whole grains; drinking plenty of fluids; managing stress; and staying active with regular exercise.

The U.S. Department of Agriculture’s Dietary Guidelines for Americans (PDF) recommends that adults get between 20 to 30 grams of dietary fiber per day. If you have trouble meeting this, consider fiber supplements. Studies show that fiber supplements like psyllium can help treat hemorrhoids and reduce the risk of persistent symptoms and bleeding.

Other behaviors can help prevent hemorrhoids, including using the bathroom as soon as you feel the urge and avoiding long periods of sitting, especially on the toilet, as this can put pressure on the veins in the anus.