Hemorrhoids is a common and painful condition that affects nearly three out of four adults throughout their lives. They’re swollen veins that can be located on the inside (rectum) or outside (anus) of your bottom area, also known as internal hemorrhoids or external hemorrhoids.

While the cause of hemorrhoids is often unknown, they commonly impact women during pregnancy or after childbirth, since both can cause pressure that leads to swollen veins. They also often impact individuals who don’t get enough fluid or fiber in their diet – which can lead to constipation, another leading cause of hemorrhoids.

And, while many choose to live with hemorrhoids and overlook symptoms such as pain and bleeding, WakeMed North’s new colorectal surgeon Dr. Breanna Houlihan why that’s not such a great idea.

“Even though hemorrhoids are common, they’re not to blame for all pain and bleeding in that area,” Dr. Houlihan relates. She explains that more serious conditions such as rectal and anal cancers can cause similar symptoms, which is one reason it’s important not to ignore them. “At the same time, hemorrhoids can have a significant impact on your quality of life. Fortunately, they can typically be treated easily through conservative medical management. That’s why seeking treatment is better than ignoring painful symptoms.”

Dr. Houlihan acknowledges that it’s an uncomfortable topic – in more ways than one. While no one looks forward to visiting a doctor for what can feel like an awkward problem, the truth is that it’s incredibly common and there’s nothing to feel embarrassed about. Colorectal surgeons see these things every day and have many tools and techniques that can help.

So, what should you do if you experience pain…back there? Dr. Houlihan recommends starting with a visit to your primary care doctor. They may perform a physical exam, offer conservative treatments such as over-the-counter remedies – or they may choose to refer you to either a gastroenterologist or a colorectal surgeon. A gastroenterologist may order a colonoscopy, which is a diagnostic test that can not only detect hemorrhoids, but can also identify colorectal cancers.

In most cases, hemorrhoids will resolve with what Dr. Houlihan calls ‘good stooling habits,’ such as eating a high fiber diet, drinking plenty of fluids, and not sitting on the toilet for extended periods of time (no phones and no books in the bathroom!). If constipation becomes an issue, or hemorrhoids become a problem, she recommends the following at-home treatments.

Dr. Houlihan’s Favorite At-Home Hemorrhoid Treatments

• Metamucil or other dietary fiber supplement
• Miralax, a laxative that softens the stool
• Sitz bath, which is simply sitting your bottom in a few inches of warm water to relieve swollen blood vessels. You can either sit in the bathtub or buy a sitz bath device, which fits on top of the toilet seat.
• Witch hazel wipes, which can help reduce itching, swelling and irritation

Dr. Houlihan recommends against any cream or treatment that includes a steroid, such as those that contain hydrocortisone.

When Do I Need a Colorectal Surgeon?

When these conservative strategies fail, patients may want to consider further intervention, which is when colorectal surgeons like Dr. Houlihan and her partners often get involved. There are a number of procedural options to help treat recurring hemorrhoids as follows.

Non-surgical (Minimally-Invasive) Procedures

• Rubber band ligation, which involves the placement of one or two small rubber bands around an internal hemorrhoid. This cuts off circulation and the hemorrhoid and rubber band will fall off within a week, providing relief for many patients.
• Sclerotherapy involves the injection of a chemical solution to shrink the hemorrhoid. This procedure is ideal for patients on blood thinners who may not be eligible for other treatments.

Both of these options can be performed in your colorectal surgeon’s office and take less than 15 minutes to perform.

Surgical Procedures

• Hemorrhoidectomy is the surgical removal of a hemorrhoid. Although recovery can be painful, this is the most effective way to treat severe or recurring hemorrhoids.
• Hemorrhoid stapling (hemorrhoidopexy) uses a stapling device to block bloodflow to the hemorrhoid and therefore requires no external incision. This procedure is ideal for large hemorrhoids or those that have prolapsed. When compared to a hemorrhoidectomy, this procedure typically causes less pain and leads to a faster recovery.

Hemorrhoids: The Bottom Line

The most important thing Dr. Houlihan wants patients to know is that if you’re experiencing hemorrhoids, don’t ignore them. Treatment is often easy and painless. Plus, she reiterates that anal and rectal cancers are on the rise and since their symptoms can often be confused with hemorrhoids, you shouldn’t write off pain or bleeding as ‘just hemorrhoids.’ She also reiterates that needing surgery for hemorrhoids is rare, and in most cases – over-the-counter treatments combined with better stooling habits can provide significant relief.