Hemorrhoids are normal anatomy. Every human being walking on the face of the earth has hemorrhoids. It is only when the hemorrhoids bleed, prolapse or thrombose that they cause a problem. Bleeding usually comes from internal hemorrhoids that are enlarged and often times will come out of the anus while straining. These sometimes will return to the anus on their own, but sometimes will need to be put back inside manually. Thrombosed hemorrhoids are extremely painful and are caused by a blood clot that forms in the external hemorrhoid or the hemorrhoids that are in the most sensitive part of the anus. While these will resolve spontaneously in most cases, removing the clot at the onset of symptoms will speed recovery and, therefore, return to normal activities.

Anal pain is only rarely caused by hemorrhoids, although often times people who have anal pain are referred in just for that diagnosis. Other causes of anal pain are anal fissure or a tear in the anal skin that is an exceptionally painful condition that may lead to surgery. Abnormal spasm of the muscles of the anal canal and pelvic floor also can cause debilitating and severe anal pain that often times can be treated with nonsurgical techniques.

Most hemorrhoids are mildly bothersome and, therefore, can be treated simply with small office-based procedures. Our preference here at Virtua Surgical Group is to treat internal hemorrhoids with infrared coagulation, a type of laser which makes the blood vessels that feed the hemorrhoids shrink. Other options include rubber-banding of the hemorrhoids which choke off the blood supply to the enlarged tissue, and injection therapy where a substance is injected directly into the hemorrhoid to prevent blood flow and enlargement. Often times after a patient has had a thrombosed hemorrhoid, a tag of skin is left behind which can cause difficulties with hygiene and can be removed surgically. This is different from prolapsing hemorrhoids where tissue comes out but this usually goes back in on its own after a bowel movement. If a hemorrhoid needs to be pushed back in, this is considered an advanced hemorrhoid that should be removed surgically.

The surgical treatment of hemorrhoids includes formal hemorrhoidectomy where the vessels that feed the hemorrhoid are tied off and the excess tissue cut out and sewn closed. While this is very effective, it is also extremely painful and often times not our first recommendation for surgical treatment. A newer procedure termed a “stapled hemorrhoidopexy” (procedure for prolapsing hemorrhoids—PPH) is designed to cut out the feeding blood supply to the hemorrhoids and pull the excess tissue up into the rectum where it can no longer prolapse. The external hemorrhoids often times are pulled into the anus at the same time and, therefore, the external component that most people feel often times goes away with this.

The best way to prevent hemorrhoids from being bothersome is to maintain a high fiber diet while not having to strain to move your bowels. As human beings, the simple acts of standing upright, coughing, sneezing, and straining engorge the hemorrhoids with blood that make them enlarge, eventually prolapse or clot off as is the case with a thrombosed hemorrhoid. Adding a simple fiber supplement or stool softener to your diet daily will hopefully prevent the need for anything more than minimal office therapies if your hemorrhoids are bothering you.