Hemorrhoids are a common condition involving swollen, enlarged veins that form inside the rectum or beneath the skin around the anus. These engorged blood vessels can cause uncomfortable symptoms, including pain, itching, swelling, and bleeding. Knowing which healthcare professional to consult is important for determining the appropriate level of care, from initial self-treatment to specialized procedures.
Initial Steps: Self-Care and When to Call a Doctor
For many individuals, initial hemorrhoid discomfort can be managed effectively with simple at-home measures. Increasing dietary fiber intake and ensuring adequate hydration helps soften stool, reducing straining during bowel movements. Soaking the anal area in a warm bath, known as a sitz bath, for 10 to 15 minutes a few times a day can help relieve irritation and pain. Over-the-counter creams, ointments, or wipes containing ingredients like witch hazel or hydrocortisone provide temporary symptom relief.
These conservative treatments often resolve mild symptoms within a week. If symptoms persist beyond this timeframe, worsen significantly, or involve noticeable rectal bleeding, seek professional medical advice. Bleeding should always be evaluated by a healthcare provider to rule out other gastrointestinal conditions. Medical attention is also necessary if a painful lump develops near the anus, which could indicate a thrombosed external hemorrhoid.
Starting Point: Primary Care Physicians
A Primary Care Physician (PCP) is the appropriate first medical contact for hemorrhoid concerns. The PCP performs an initial physical examination, which may include a digital rectal exam, to confirm the diagnosis. This assessment is important for differentiating hemorrhoids from other conditions that cause similar symptoms, such as anal fissures, polyps, or sources of rectal bleeding.
For mild to moderate cases not responding to self-care, the PCP can prescribe stronger topical treatments than those available over the counter, such as prescription-strength hydrocortisone or anti-inflammatory suppositories. They also provide guidance on long-term lifestyle changes, including dietary adjustments and stool softeners, to prevent recurrence. If hemorrhoids are more advanced or fail to improve with medication, the PCP initiates a referral to a specialist. Most patients with Grade 1 or 2 internal hemorrhoids are successfully managed within a primary care setting.
Specialized Treatment: When to See a Specialist
When conservative treatments prove ineffective or symptoms suggest a more advanced condition, a specialist is required for procedural intervention. The main specialists who treat hemorrhoids are Gastroenterologists and Colorectal Surgeons (sometimes called Proctologists). Gastroenterologists focus on the entire digestive system and perform non-surgical procedures. Colorectal Surgeons specialize in the colon, rectum, and anus, performing both office-based procedures and surgical interventions.
A referral is warranted for persistent bleeding, prolapsed internal hemorrhoids that do not retract, or large, painful external hemorrhoids. Specialists frequently treat internal hemorrhoids using minimally invasive, office-based procedures.
Minimally Invasive Procedures
Rubber band ligation (RBL) is a common procedure where an elastic band is placed around the base of the internal hemorrhoid, cutting off its blood supply so it withers and falls off. Sclerotherapy involves injecting a chemical solution directly into the hemorrhoid tissue to shrink it. Infrared coagulation uses heat to create scar tissue that cuts off the blood flow.
These non-surgical options are highly effective for Grade 1 and 2 hemorrhoids and some Grade 3 cases. If hemorrhoids are Grade 3 or 4, consistently fail to respond to less invasive methods, or are severely thrombosed, a surgical hemorrhoidectomy may be necessary. This procedure physically removes the excess tissue causing the bleeding and prolapse and is reserved for the most severe cases.
Urgent Care Situations
While most hemorrhoid discomfort is addressed through scheduled appointments, certain acute symptoms demand immediate medical attention, often requiring a visit to an urgent care center or emergency room. Profuse or unrelenting rectal bleeding that saturates toilet paper or the toilet bowl should not be ignored, as this can lead to blood loss. Bleeding accompanied by signs of severe anemia, such as lightheadedness, dizziness, or fainting, indicates a need for emergency evaluation.
Sudden, intense, and rapidly worsening pain is a critical symptom, potentially indicating a severely thrombosed external hemorrhoid or a strangulated hemorrhoid. A thrombosed hemorrhoid has a blood clot inside it, causing significant acute pain that may require immediate removal or incision to relieve pressure. Furthermore, a fever along with anal swelling or pain suggests a possible infection, such as an abscess, which needs prompt medical intervention. These acute situations bypass the typical PCP-to-specialist pathway and require rapid assessment to stabilize the patient.