Hemorrhoids are swollen, irritated blood vessels located in the lower rectum and anus. These vascular cushions are a normal part of human anatomy, but when enlarged or inflamed due to increased pressure, they cause symptoms such as pain, itching, and bright red bleeding during bowel movements. Approximately half of all people experience symptomatic hemorrhoids by age 50. When discomfort persists despite home care, knowing which medical professional to consult is the first step toward effective treatment.
The Primary Care Provider’s Role
Most individuals begin their medical journey with a primary care provider (PCP), such as a general practitioner, family doctor, or internist. The PCP’s role is to offer an initial diagnosis and manage mild-to-moderate hemorrhoid cases using conservative therapies. This initial management often focuses on lifestyle modifications, including increasing dietary fiber and fluid intake to soften stool and reduce straining during defecation.
A PCP can also recommend over-the-counter treatments like topical creams or sitz baths, which involve soaking the anal area in warm water to alleviate pain and swelling. Beyond treatment, the PCP rules out more serious gastrointestinal conditions that mimic hemorrhoid symptoms, such as anal fissures or colorectal cancer. Bleeding requires careful evaluation to ensure it is not a sign of a deeper issue within the digestive tract.
If symptoms fail to improve within one to two weeks of conservative management, or if the patient experiences severe pain, substantial bleeding, or advanced prolapse, a referral to a specialist becomes necessary. The primary care provider acts as the gatekeeper, deciding when the condition requires intervention beyond what can be handled in a general practice setting. This transition directs the patient toward professionals who specialize in anorectal disorders and removal procedures.
Specialists Trained in Removal
When conservative treatments prove insufficient, hemorrhoid removal is typically performed by one of two specialized medical professionals. The choice depends on the severity of the hemorrhoid and the type of procedure anticipated. Both specialists are trained to diagnose and treat these conditions, but they approach the problem from different disciplinary angles.
The Colorectal Surgeon, formerly known as a proctologist, is the definitive specialist for surgical removal of hemorrhoids and other diseases of the colon, rectum, and anus. These surgeons have extensive training in advanced excisional techniques and perform the most complex operations for severe, recurrent, or high-grade hemorrhoids. Their expertise is centered on the anatomy and surgical correction of the lower digestive tract.
Gastroenterologists (GI) specialize in the diagnosis and treatment of the entire digestive system. They are highly trained in managing hemorrhoids, particularly through non-surgical methods, and frequently perform office-based procedures using specialized instruments. While a GI doctor often manages less severe cases, they refer patients requiring major surgery, such as a hemorrhoidectomy, to a colorectal surgeon.
Methods of Professional Removal
Professional removal techniques are generally categorized into minimally invasive office procedures and more involved surgical procedures. The approach chosen is based on the hemorrhoid’s grade and location. Minimally invasive treatments are typically reserved for Grade I, II, and some Grade III internal hemorrhoids that have not responded to initial conservative care. These procedures are performed in an outpatient setting and rarely require general anesthesia.
Minimally Invasive Procedures
- Rubber Band Ligation (RBL) is one of the most common office procedures, where a small elastic band is placed around the base of the internal hemorrhoid. This cuts off the blood supply, causing the hemorrhoid to wither and fall off within about a week.
- Sclerotherapy involves injecting a chemical solution into the hemorrhoidal tissue. This solution causes the tissue to scar and shrink, stabilizing the cushion and reducing symptoms.
- Infrared Coagulation (IRC) uses a burst of infrared light to create scar tissue. This non-surgical approach helps cut off blood flow and shrink the hemorrhoid.
Surgical procedures are reserved for the most severe cases, typically Grade III and Grade IV hemorrhoids, or those that have failed multiple non-surgical attempts.
Surgical Procedures
- Hemorrhoidectomy is the conventional surgical removal, involving the excision of swollen blood vessels and surrounding excess tissue. This is the most definitive treatment, offering the lowest recurrence rates, but it is associated with more post-operative pain and a longer recovery period.
- Stapled Hemorrhoidopexy is a less invasive option where a circular stapling device lifts the prolapsed tissue back into its normal anatomical position and blocks its blood flow.