Hemorrhoids, commonly referred to as piles, are swollen, enlarged veins located in the lower rectum and around the anus. Symptoms often include discomfort, itching, swelling, and rectal bleeding. Understanding the various types of medical professionals available is important for addressing this condition effectively. The appropriate doctor to consult depends largely on the severity of the symptoms and whether initial treatments have proven successful.
Starting with Primary Care
The first medical professional to consult for symptoms suggestive of hemorrhoids is typically a Primary Care Physician (PCP), General Practitioner (GP), or family doctor. Most cases of hemorrhoids are mild and respond well to conservative management, making the PCP the ideal first point of contact. During the initial visit, the doctor will take a detailed patient history and perform a physical examination, which includes a visual inspection of the perianal area.
The PCP can often diagnose external hemorrhoids by sight and may perform a digital rectal examination to check for internal issues or rule out other growths. If the diagnosis is confirmed as a mild case, the treatment plan centers on conservative, non-invasive measures. This initial management focuses on lifestyle adjustments to reduce the pressure and straining that cause the condition to worsen.
Standard recommendations include significantly increasing dietary fiber intake to between 25 and 30 grams daily, alongside drinking plenty of water to ensure stools are soft and bulky. The physician may also suggest over-the-counter topical treatments, such as creams or suppositories containing hydrocortisone, for temporary relief of pain and inflammation. Sitz baths are frequently advised to soothe discomfort.
Roles of Specialized Doctors
If symptoms persist, recur frequently, or involve more severe pain and bleeding despite conservative care, the PCP will typically provide a referral to a specialist. The decision on which specialist to see—a gastroenterologist or a colorectal surgeon—depends on the specific nature and grade of the hemorrhoids. Both specialists are equipped to diagnose and treat the condition, but they focus on different approaches.
Gastroenterologist
A gastroenterologist specializes in the diseases of the entire digestive tract, which includes the colon and rectum. They occupy an important middle ground between the primary care physician’s conservative approach and the surgeon’s procedures. Their focus is generally on non-surgical, minimally invasive treatments for internal hemorrhoids that have not responded to initial home care.
These specialists are skilled in diagnostic procedures like colonoscopy or flexible sigmoidoscopy, which may be used to confirm the hemorrhoid diagnosis and rule out more serious causes of rectal bleeding. A common office-based procedure is rubber band ligation (RBL), where a small rubber band is placed around the base of an internal hemorrhoid to cut off its blood supply. The hemorrhoid then shrinks and falls off within a few days.
Colorectal Surgeon (Proctologist)
A colorectal surgeon, formerly known as a proctologist, is a surgical specialist focused exclusively on conditions of the colon, rectum, and anus. They become the appropriate choice when hemorrhoids are large, complex, recurrent, or involve complications that require surgical intervention. This includes high-grade internal hemorrhoids or external hemorrhoids that are particularly problematic.
These surgeons manage conditions requiring operative procedures such as a hemorrhoidectomy, which is the surgical removal of the hemorrhoidal tissue. While this is the most effective treatment for both external and internal hemorrhoids, it is often reserved for severe cases due to the potential for post-operative pain. Colorectal surgeons also perform other advanced techniques, including stapled hemorrhoidectomy and hemorrhoidal artery ligation.
Immediate Medical Attention
There are specific, severe symptoms that warrant bypassing a routine doctor’s appointment and seeking immediate care at an Emergency Room (ER) or urgent care facility. Profuse or persistent rectal bleeding is a serious concern; if the toilet water turns red or if large blood clots are passed, this requires immediate medical evaluation to prevent significant blood loss.
Severe, unbearable anal pain that makes sitting or moving difficult is another sign of an acute problem. This intense pain may indicate a thrombosed hemorrhoid, which is an external hemorrhoid where a blood clot has formed. A doctor can often provide immediate relief by performing a small incision to remove the clot, ideally within 72 hours of its formation. Any accompanying signs of infection, such as a high fever, chills, or pus-like discharge from the anal area, signal a medical emergency.