Hemorrhoids are swollen veins located in the lower rectum and anus. While most cases of discomfort, pain, or minor bleeding can be managed effectively with home remedies or a primary care physician, the Emergency Room (ER) is reserved for acute complications. Seeking emergency care is appropriate when symptoms escalate rapidly or become severe, requiring immediate stabilization and assessment. The ER’s role is to address these urgent issues, not to provide definitive, long-term treatment for the underlying hemorrhoidal condition.
Signs Indicating Immediate Emergency Care
The primary reason to visit the ER for hemorrhoids is heavy or continuous rectal bleeding, especially when accompanied by systemic symptoms. Excessive blood loss can lead to signs of shock, such as lightheadedness, dizziness, or fainting, which indicates a significant drop in blood pressure and requires prompt medical intervention.
Unrelenting, severe pain is another warning sign that often suggests a complication like a thrombosed or strangulated hemorrhoid. A thrombosed hemorrhoid occurs when a blood clot forms inside the vein, causing intense pain and swelling.
A hemorrhoid that has prolapsed, meaning it bulges outside the anus and cannot be manually pushed back inside, may also necessitate an emergency visit. This condition, known as an incarcerated hemorrhoid, carries the risk of strangulation, where the blood supply to the tissue is cut off. Finally, any symptoms suggesting an infection, such as a fever, chills, or noticeable purulent drainage from the anal area, require urgent medical evaluation. These signs could indicate a perianal abscess or other severe infection requiring immediate treatment with antibiotics and possible drainage.
Acute Interventions Performed by the ER Physician
Upon arrival, the ER physician will perform a physical examination, which includes a visual and digital check of the anal area to assess the hemorrhoid’s condition and rule out other causes of bleeding or pain. If significant blood loss is suspected, blood work may be ordered to check the patient’s hemoglobin and hematocrit levels to evaluate for anemia. The most common acute intervention for severe pain is the management of a thrombosed external hemorrhoid, typically done through a procedure called an external thrombectomy.
During an external thrombectomy, the physician administers a local anesthetic to numb the area, followed by a small incision to drain the blood clot, offering immediate pain relief. This procedure is most effective when performed within the first 48 to 72 hours of the clot’s formation. For severe, active bleeding, the ER staff may use temporary methods like applying pressure, local packing, or chemical cauterization to stop the hemorrhage. Patients presenting with dehydration or signs of shock due to blood loss may also receive intravenous (IV) fluids and prescription-strength analgesics for stabilization before discharge.
Discharge and Follow-Up Care
Once the acute crisis is managed and the patient is stabilized, the ER staff provides instructions for at-home recovery. These instructions often include taking warm sitz baths several times a day to soothe the area and promote healing. Patients are advised to increase their dietary fiber intake and use stool softeners to prevent constipation and straining during bowel movements. Prescription-strength pain medication and topical ointments may be provided to manage residual discomfort.
Since the ER visit is for stabilization, discharge instructions emphasize follow-up care with a specialist, such as a gastroenterologist or colorectal surgeon. This specialist will determine the best course for definitive, long-term management, which may include non-ER procedures like rubber band ligation or formal hemorrhoidectomy. Patients are given specific warning signs that necessitate an immediate return to the ER, including the inability to urinate, a high fever, or uncontrolled bleeding that saturates dressings.