Ask the Doc

Ask the Doc

Jonathan Williams, DO Your embarrassing questions answered!

Q: I have hemorrhoids and they are, quite literally, a pain in my rear. Why are they plaguing me, and what can I do to relieve the itching and bleeding?

A: Hemorrhoids are a very common problem. People ask about them all the time.

Hemorrhoids are swollen or dilated blood vessels in the rectum. Everybody has these veins in the rectum, but they only pop out when there’s an increase in pressure in the rectum, like when people strain during a bowel movement or exercise, have hard stools, or have prolonged standing or sitting. The blood can pool in the hemorrhoids, and they become increasingly swollen and engorged. 

Often, hemorrhoids will come and go. They’ll be fine for a while, then something may happen and cause them to flare up and get irritated.

A lot of times hemorrhoids are asymptomatic; they don’t cause any trouble. When people do have symptoms, they could be as simple as itching or irritation around the anus. Another common complaint is seeing blood in the stool or blood on the tissue when they wipe. And sometimes, the more acute cases have really severe pain in the rectum area. 

Most of the time, you can manage hemorrhoids on your own at home. The most important thing is to ensure your bowel movements are soft and regular. That means avoiding any constipation or hard stools. The best way to do that is to eat a lot of fiber — fruits, vegetables, and other foods with fiber, such as multigrain breads and cereals. Fiber helps improve the quantity and the quality of bowel movements. It helps keep the stool soft, making it easier to come out. 

The other important thing is to drink plenty of water. Dehydration is a common cause of constipation. And when you have constipation, it can cause more hemorrhoidal issues. If things like fiber and water don’t improve bowel movements, we can use stool softeners or gentle laxatives. 

As far as symptomatic relief, the easiest thing to do is to use a warm bath or sitz bath. Also, this sounds crazy, but I tell people to get rid of all their toilet paper and only use wet wipes, because anything dry on their bottom can cause irritation and microabrasions. To relieve some of the pain, itching, or swelling, you can use topical creams or ointments like Preparation H. A suppository at nighttime may help, too. 

If those steps don’t relieve the problems, there are a few things we can do in the office, including rubber band ligation. We put a small rubber band tie around the hemorrhoid, which chokes off the blood supply and causes the hemorrhoid to shrink and eventually fall off. 

There are some other treatments, such as using a laser to burn off the hemorrhoids, but they’re not as effective and have more potential side effects. If the hemorrhoids are very severe and trouble-some and none of the other treatments help, then there are more invasive surgical procedures, but we try to minimize those. 

It’s really important not to brush off rectal bleeding, pain, or discomfort, because in some cases they can mask a more serious medical condition, like colon cancer, that we don’t want to miss. We want to make sure nothing else is causing the problems. 

Anytime you have blood in the stool, you want to get it evaluated. Generally, you need a physical examination or rectal exam. If you haven’t had a colonoscopy within the past year or two, then that would be important to do. Talk about hemorrhoids with your doctor, and get them checked out.

Originally published in the Fall/Winter 2021 print issue.