Hemorrhoids: Symptoms, Diagnosis, and Treatment Options – St. Mark’s Hospital

(cheerful music) – [Jill] Hemorrhoids commonly
will cause protrusion, bulging, itching and of course bleeding, and sometimes even pain. There is a difference between internal and external hemorrhoids. External hemorrhoids are
the ones on the outside. Patients will typically know about them because they typically have folds or bulges in the skin there. External hemorrhoids are inner, they are much like the
rest of skin on the body. So that if one were to have a cut, a pinch, or a pull at
the external hemorrhoid, it hurts very badly. Internal hemorrhoids are further inside of the anal canal. At the level where the
internal hemorrhoids live, there are no sharp pain sensation nerves. So, if there is a bulge for example, at the level of the internal hemorrhoids, a patient might have a
feeling that they haven’t completely emptied their rectum after a bowel movement. When folks come to me complaining of hemorrhoids, I will talk with them about what exactly their symptoms are, I will commonly ask the
quality and the frequency of bleeding as well as weather there is associated incontinence, bulging, or problems with itching, or cleanliness. Typically I will perform an exam in which I will look at the hemorrhoids, both on the outside of the anus. As well as an endoscopic exam to look at the hemorrhoids on
the inside of the anus. For an external hemorrhoid,
that has thrombosed, depending on the duration
of the symptoms and weather the symptoms are improving or not, I will advise a patient
to keep the hemorrhoid and suffer through it, or to
go ahead and excise it. Most commonly in the office. The most common treatment approach for internal hemorrhoids in this country is hemorrhoid banding. This is an office procedure where I place a tiny little rubber band right over the hemorrhoid causing the blood supply of the hemorrhoid to be cut off and then, in about four to five days the hemorrhoid actually sluffs off
with the bowel movement and the patient doesn’t even usually know that this has occurred. I will usually offer this treatment to patients first because it is much less painful than operative treatment options for hemorrhoids. Unfortunately, the banding technique does not work on the external hemorrhoids because they are on
the outside and do have those sensitive nerves
in them that will cause excruciating pain, if
banded with a hemorrhoid rubber band. The operative hemorrhoidectomy is probably one of the most painful
operations on the planet. I encourage patients to try all other measures prior to proceeding with
operative hemorrhoidectomy. But, some hemorrhoid disease is only going to be fixed with operative treatment. If a patient were to elect to have an operative hemorrhoidectomy, the patient would come into the hospital, same day of the procedure,
have the procedure, and then go home that same day. I typically advise
patients that if they need an operative hemorrhoidectomy, they’re going to be quite sore, they’re probably going to not feel like going to work, or doing
any important activities for at least a week and
they’re gonna know they had surgery and maybe even still wish they didn’t for another
couple of weeks after that. I do advise patients that hemorrhoids aren’t dangerous and keeping them and not having a procedure to fix them, is typically not life threatening, but I would caution patients to know that they should not write
off annal rectal bleeding as only just their hemorrhoids and not worry about it. It’s important to
recognize that colon cancer commonly can have that symptom or can even not have symptoms at all. – [Woman] For more information
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