What are hemorrhoids?

Hemorrhoids are a naturally occurring part of our bodies. Specifically, they are vascular structures within the anorectal canal that form due to arteriovenous connections and then drain into the superior and inferior hemorrhoidal veins.

When do I see a GI doctor for hemorrhoids?

I recommend seeing a GI doctor for hemorrhoids if you are experiencing new rectal discomfort (or pain!), rectal itching, rectal burning with defecation, passing blood along with (or on top of) stool, passage of mucous per rectum (for instance, if you inadvertently have mucous in your underwear), mild soiling of your underwear with feces or if you are just concerned about hemorrhoids or your rectum.

While most hemorrhoid issues can be seen as an outpatient in an office setting, you should go to the emergency room if you have sudden onset pain that is new, or becoming steadily worse, or if there is a hard “knot” around your rectum. In this scenario, I would be concerned about a thrombosed hemorrhoid.

What is the difference between internal hemorrhoids and external hemorrhoids?

The dentate line is a naturally occurring anatomical landmark that separates internal and external hemorrhoids. Those hemorrhoids that are above the dentate line (and most commonly in the rectum) are internal hemorrhoids, and those hemorrhoids that are below the dentate line (and in the anal canal and outside the body) are external hemorrhoids.
Besides being in different anatomical locations, internal and external hemorrhoids have different nerve endings. Because of their different nerve endings, internal hemorrhoids are relatively painless, whereas external hemorrhoids can be exquisitely painful.

What are typical hemorrhoid symptoms?

The most common reasons patients seek medical attention for hemorrhoids is due to

  • Painless rectal bleeding – usually bright red and coats stool at the end of defecation
  • Mild fecal incontinence
  • Mucous discharge from the rectum
  • Sensation of fullness in the rectal area (due to a prolapsed internal hemorrhoid)
  • Itching in the rectal area
  • Irritation in the rectal area
  • Exquisite pain with a “lump” is concerning for a thrombosed hemorrhoid

What are risk factors for developing hemorrhoids

  • Advancing age
  • Diarrhea
  • Pregnancy
  • Tumors within the pelvis
  • Prolonged sitting
  • Straining during defecation
  • Chronic constipation

How does a gastroenterologist diagnose hemorrhoids?

Proper diagnosis of hemorrhoids starts in the office with a clinic visit to discuss your symptoms. An office visit also includes a physical exam with digital rectal exam. It is possible that you may need further testing, such as anoscopy, blood work, or a colonoscopy, depending on your symptoms and physical exam findings.

How does a gastroenterologist treat hemorrhoids?

Correct treatment of a hemorrhoid first starts with making the right diagnosis! Different symptoms and diagnoses require different treatments, which may include simple measures such as increased fiber intake and water intake, or may require topical creams, suppositories, etc.
If patients require more than just creams or suppositories, then another treatment that is offered is band ligation of hemorrhoids. This procedure is done as an outpatient, in our office, and does not require IV sedation. While you are lying on your side, an anoscope is introduced into your rectum and then used to place small rubber bands over your internal hemorrhoids. Complete treatment of internal hemorrhoids may require several banding sessions.