By Gregg Baranski, MD, Colorectal Surgeon, Virtua Surgical Group - Colorectal Surgery

Hemorrhoids are a problem not many people like to talk about. In fact, some people try to ignore hemorrhoid symptoms and avoid seeking professional help. The reality is, more than 50% of people over age 50 experience symptoms of hemorrhoids and many are unaware of the variety of treatment options available.

Recognizing how awkward the subject can be, I take careful measures to make patients comfortable. I make a conscious effort to put the patient at ease as we talk about his or her medical history and symptoms. Unfortunately, many conditions that affect the anus and rectum are attributed mistakenly to hemorrhoids. Therefore, they’re often misdiagnosed and inappropriately treated. Therefore, as embarrassing as it may be, it’s important to discuss your symptoms with your doctor and, ideally, someone specializing in the field.

What are hemorrhoids?

Hemorrhoids are swollen blood vessels inside the rectum or around the anus that become irritated by diarrhea or constipation, straining, pregnancy and delivery, age and family history. They can be internal (inside the rectum) or external (protruding outside the anus) and are graded from 1 to 4 depending on the severity. Common symptoms include pain after a bowel movement, itching, burning, bleeding, and even a palpable lump. It's the severity of these symptoms that helps determine the best treatment.

For patients with minor symptoms, treatment may not be necessary. If hemorrhoid symptoms are mild, it's a problem that can be managed with simple dietary and lifestyle changes or with over-the-counter medications.

How are hemorrhoids treated? 

For patients with frequent pain and bleeding, or with severe external hemorrhoids, surgical intervention may be necessary. The majority of these patients can be treated effectively with one of these office-based procedures.

Rubber banding
A banding device is used to place a small rubber band around the base of the hemorrhoid. The band cuts off circulation to the hemorrhoid, and the hemorrhoid disappears in a few days. This painless office procedure allows a patient to return to work in a day.

Infrared coagulation
An infrared wand is used to heat and destroy the blood supply in the hemorrhoid. The procedure is painless and recovery is quick.

Surgical treatment for advanced hemorrhoids

For some patients with advanced hemorrhoids, or for those whose hemorrhoids don’t respond to office-based treatments, surgical intervention, such as the options mentioned below, may be necessary.

Procedure for prolapse and hemorrhoids (PPH)
PPH is a procedure for the treatment of advanced hemorrhoids that protrude through the anus. PPH lifts the tissue and restores it to its original position, also interrupting blood flow to the hemorrhoids, which then shrink within a few weeks.

Hemorrhoidal artery ligation (HAL)
Using Doppler (ultrasound) guidance, HAL involves cutting off the blood supply to the hemorrhoidal “cushions” to decrease the pressure inside them. This procedure is safe and effective for certain grades of hemorrhoids.

Excisional hemorrhoidectomy
This approach involves surgically removing the hemorrhoidal tissue, while avoiding injury to the underlying sphincter muscle.

You don’t have to live with the pain of hemorrhoids, or die of embarrassment talking to your doctor about them. Call 888-847-8823 to schedule a consultation with a Virtua colorectal surgeon.