Hemorrhoids involve the swelling of veins in the lower rectum and anus. These swollen blood vessels cause discomfort, itching, and bleeding, with severity depending on their size and location. Treatment depends on how advanced the condition is, which determines the type of medical professional and procedure required for management or removal.
Initial Consultation and Diagnosis
A Primary Care Provider (PCP) is usually the initial point of contact for patients experiencing symptoms. The PCP confirms the diagnosis, ruling out more serious underlying conditions like fissures, fistulas, or colorectal cancer, especially if rectal bleeding is present. They perform a physical examination, which includes a visual inspection and a digital rectal exam to assess the area.
For mild cases (Grade I or Grade II internal hemorrhoids), the PCP focuses on conservative management. This involves recommending lifestyle adjustments, such as increasing dietary fiber and fluid intake to soften stools and reduce straining. They may also suggest over-the-counter topical creams or suppositories containing hydrocortisone or witch hazel to alleviate itching and inflammation. If these methods fail or the hemorrhoids are more advanced, the PCP refers the patient to a specialist for definitive treatment.
The Specialists Who Treat Hemorrhoids
When hemorrhoids require treatment beyond home care, two main specialists handle definitive removal: Gastroenterologists and Colorectal Surgeons. The choice of doctor depends on the hemorrhoid’s grade and the required procedure. Both manage digestive tract disorders, but their approaches to hemorrhoid removal differ significantly.
Gastroenterologists (GI) specialize in the digestive system and focus on non-surgical, office-based procedures for internal hemorrhoids. They treat Grade I, II, and some Grade III internal hemorrhoids that have not responded to conservative care. These minimally invasive techniques are preferred because they offer quick recovery and can be performed without general anesthesia.
Colorectal Surgeons (sometimes called Proctologists) focus specifically on the colon, rectum, and anus. They perform surgical removal, which is reserved for the most severe cases, including large external hemorrhoids and permanently prolapsed Grade III or Grade IV internal hemorrhoids. Their expertise is utilized when minimally invasive procedures have failed or are unsuitable due to the size and complexity of the tissue requiring excision.
Treatment Options Based on Specialist
The procedure used for removal is linked to the specialist and the condition’s severity. Minimally invasive methods are generally performed in an outpatient setting and are the first line of treatment when conservative measures fail.
Gastroenterologists frequently perform Rubber Band Ligation (RBL). This non-surgical technique involves placing a small rubber band around the base of an internal hemorrhoid, cutting off its blood supply. The banded tissue withers and falls off within about a week, allowing the wound to heal. Another non-surgical option is sclerotherapy, where a chemical solution is injected into the hemorrhoid tissue, causing it to shrink and scar.
Colorectal Surgeons utilize surgical procedures for permanent removal of advanced hemorrhoidal disease. The most definitive treatment is a traditional Hemorrhoidectomy, which involves the surgical excision of the tissue. This is highly effective for large external and high-grade internal hemorrhoids. The surgery requires general or regional anesthesia and offers the lowest recurrence rate, but it has a longer recovery period. A less invasive option is Stapled Hemorrhoidopexy (PPH), which uses a circular stapling device to reposition the tissue and disrupt the blood supply, often resulting in less post-operative pain.