Hemorrhoids are a common medical condition involving the swelling and enlargement of veins located in the lower rectum and around the anus. They can cause uncomfortable symptoms, including bright red bleeding during bowel movements, painful swelling, and anal itching. While often mild, these symptoms can closely mimic those of more serious gastrointestinal conditions, such as inflammatory bowel disease or colorectal cancer. Seeking professional medical advice is the correct first step to receive an accurate diagnosis and begin an appropriate treatment plan.
Where to Start: Primary Care Providers
The journey for most people experiencing symptoms should begin with their primary care provider (PCP), such as a General Practitioner (GP), a Family Medicine physician, or an Internal Medicine doctor. These providers are skilled at conducting an initial evaluation, which includes assessing symptoms and performing a physical exam to confirm the presence of hemorrhoids. They are the appropriate entry point for managing mild to moderate cases, especially when symptoms have just started or are intermittent.
For many patients, the primary care provider will recommend conservative, non-prescription treatments to manage the discomfort and encourage healing. This initial treatment focuses heavily on dietary and lifestyle modifications, such as significantly increasing daily fiber intake and ensuring adequate water consumption. These changes soften the stool, which reduces straining during a bowel movement, a major factor in hemorrhoid development. Topical treatments, including over-the-counter creams, ointments, or suppositories, may also be recommended for temporary relief of pain and irritation.
Primary care doctors also play a crucial role in determining if a patient needs a higher level of care. If symptoms fail to resolve after a few weeks of conservative treatment, or if the diagnosis is uncertain, the PCP will initiate a referral to a specialist. This referral is necessary when the hemorrhoids are persistent, severe, or require an intervention beyond simple home care.
When to See a Specialist
A patient is typically referred to a specialist when conservative measures have failed, or the hemorrhoids are large, prolapsed, or causing chronic bleeding. The definitive specialist for advanced hemorrhoid treatment is the Colorectal Surgeon, often referred to as a Proctologist. These surgeons have specialized training in diseases of the colon, rectum, and anus, qualifying them to perform both advanced office-based procedures and all surgical interventions.
Gastroenterologists, who specialize in the entire digestive tract, are also frequently involved in the management of hemorrhoids. They may perform diagnostic procedures, such as a colonoscopy, to rule out other sources of bleeding if the patient is over 50 or has other risk factors. Gastroenterologists often manage hemorrhoids using less-invasive, in-office treatments. The decision to see one specialist over the other often depends on the severity of the condition and whether a surgical solution is anticipated.
Common Procedures and the Doctor Who Performs Them
Minimally invasive, office-based procedures are the next step when conservative treatment is unsuccessful for internal hemorrhoids. Rubber band ligation, performed by both Colorectal Surgeons and Gastroenterologists, involves placing a small elastic band around the base of the hemorrhoid to cut off its blood supply. Other non-surgical methods include sclerotherapy, where a chemical solution is injected to shrink the hemorrhoid, and infrared coagulation (IRC), which uses heat to create scar tissue.
For larger, more advanced hemorrhoids, particularly Grade III or Grade IV internal hemorrhoids that chronically protrude, surgical intervention becomes necessary. These procedures are performed exclusively by Colorectal Surgeons. The most common surgical treatment is a hemorrhoidectomy, which removes the excess tissue causing the bleeding and swelling. A less painful surgical option is stapled hemorrhoidopexy, where a circular stapling device is used to reposition the tissue and block blood flow.