Hemorrhoids are swollen, enlarged veins that form inside the anus or lower rectum, similar to varicose veins. These irritated blood vessels can cause symptoms like pain, anal itching, and bright red bleeding, especially during bowel movements. While the condition is highly common, affecting about half of all adults over the age of 50, it often resolves with simple home treatments. Determining which medical professional to consult is the first step toward finding relief and ensuring symptoms are not related to a more serious underlying issue.
The First Step: Primary Care Physician
The initial point of contact for hemorrhoid symptoms is a Primary Care Physician (PCP) or General Practitioner (GP). A PCP performs the initial triage and evaluation, which is important for ruling out conditions that mimic hemorrhoid symptoms, such as anal fissures or, rarely, colorectal cancer. They conduct a physical examination and take a thorough history to assess the severity and identify potential risk factors.
Most mild-to-moderate cases are managed successfully by a PCP using conservative treatments. This typically involves dietary modifications, such as increasing fiber and water intake to soften stool and reduce straining. They also recommend over-the-counter remedies like topical creams, hydrocortisone ointments, or warm sitz baths to alleviate pain and inflammation. If symptoms are mild, this guidance is often sufficient to resolve the issue within about a week.
When A Specialist Is Necessary
If symptoms are severe, persistent, or fail to improve after a week of conservative treatment, a referral to a specialist becomes necessary. Persistent or excessive rectal bleeding, severe pain, or a prolapsed hemorrhoid that cannot be pushed back inside are typical reasons for this escalation in care. Two main types of specialists manage advanced hemorrhoidal disease: the Gastroenterologist and the Colorectal Surgeon.
A Gastroenterologist (GI) specializes in the digestive system, including the rectum and anus, and is often involved in the initial specialist diagnosis. They use tools like an anoscope or a sigmoidoscope to view the internal canal and confirm the grade of the internal hemorrhoid. GIs are skilled in performing certain office-based, minimally invasive procedures.
The Colorectal Surgeon, also called a proctologist, specializes in surgical and non-surgical treatment of disorders of the colon, rectum, and anus. They are the specialist of choice for more advanced or complicated cases, such as large, recurring internal hemorrhoids, Grade III or IV prolapsed hemorrhoids, or a painful thrombosed external hemorrhoid. The Colorectal Surgeon has the broadest range of treatment modalities, including surgical intervention if needed.
Diagnosis and Treatment Options
A specialist’s examination begins with a visual inspection of the anal area to identify external hemorrhoids or a prolapsed internal hemorrhoid. This is often followed by a digital rectal exam, where the doctor inserts a lubricated, gloved finger into the rectum to feel for any abnormalities or internal swollen veins. For internal visualization, an anoscopy—using a short, lighted tube—is the most common procedure performed in the office.
If conservative measures have failed, specialists offer several effective, minimally invasive procedures that can be performed in an outpatient setting. These office-based procedures are highly effective for Grade I to Grade III internal hemorrhoids and typically result in minimal pain and a quick recovery.
The most common is rubber band ligation, where the doctor places a small elastic band around the base of an internal hemorrhoid, cutting off its blood supply, which causes the tissue to wither and fall off within a week. Sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue, causing it to shrink and scar.
Another option is coagulation, which uses infrared light or heat to create scar tissue and shrivel small, bleeding internal hemorrhoids. Surgical removal, known as a hemorrhoidectomy, is generally reserved for the most severe or recurring cases, such as large Grade IV prolapsed hemorrhoids, due to the increased pain and recovery time involved.