Hemorrhoids

When you come to see us, the first thing we’ll do is listen. We want to hear about your specific symptoms so we can figure out how best to help you. And we’ll ask if you’ve had any bleeding, pain, swelling or tissue that comes out when you use the bathroom. Hemorrhoid symptoms can be mild or severe — but are rarely dangerous.

Types of hemorrhoids

You may think hemorrhoids are all pretty much the same, but they’re not — and some cause more problems than others. Hemorrhoids can be:

• External: The veins under the skin around your anus can become swollen, itchy, painful and sometimes bleed.
• Internal: These swollen veins form inside your rectum. These may bleed or can prolapse (stretch and bulge) outside your anus with straining if they become too enlarged. Prolapsing internal hemorrhoids can cause pain.

What to expect at your first visit

Hemorrhoids aren’t the easiest thing to talk about, so we get it if you feel a little anxious when you come to your first appointment. That’s OK. We understand your hesitation. That’s why we provide personalized and private care that’ll ease your mind — and help you feel as comfortable as possible. We start by talking just a bit to find out:

• What kind of symptoms you have.
• When you first noticed your symptoms.
• If your symptoms have gotten worse.
• How your symptoms are affecting your daily life.

We’ll also go over your medical history and give you a physical exam so we can check your overall health.

Testing for hemorrhoids

To confirm a diagnosis, your provider may also order some tests. The tests may be a little uncomfortable, but they shouldn’t be painful. And they’re the best way for us to know what’s going on so we can create a personalized treatment plan for you. They typically take place in your provider’s office. You won’t need anesthesia, and you can go home the same day.

You may have:

• Digital rectal exam: Your provider inserts a gloved, lubricated finger into your rectum to feel for any swollen hemorrhoid tissue.
• Anoscopy: We insert a lighted tube called an anoscope into your rectum to look at the internal hemorrhoid tissue and lining of your rectum.
• Flexible sigmoidoscopy: We insert a sigmoidoscope (a lighted tube with a camera) into your anus to check the inside of the lower (sigmoid) part of your colon and rectum.

Your provider may also have you schedule a colonoscopy to check for signs of colon cancer, especially if you’re experiencing bleeding.

Meet Our Hemorrhoids Team

Cleveland Clinic’s team-based approach to care means you’ll have what you need during and after your treatment.

Your primary care provider (PCP) can treat mild hemorrhoids symptoms, but depending on your needs, your care team could also include gastroenterologists and colorectal surgeons.

While you may have found some relief at home with over-the-counter products, our providers often have better options to target your hemorrhoids and stop them in their tracks more directly. They may use:

• Rubber band ligation: This is our most common treatment and can usually be done in the office without anesthesia. Your provider places a small rubber band around the base of the hemorrhoid to cut off blood supply to the vein. You’ll feel pressure, but not pain, during the procedure. The rubber bands (and hemorrhoid) will fall off in the toilet in a few days.
• Sclerotherapy: Your provider injects a solution (known as a sclerotic agent) into the swollen vein to destroy hemorrhoid tissue. This solution causes an inflammatory reaction in the tissue, which makes the tissue of the hemorrhoid harden and fall off.
• Doppler-guided hemorrhoid treatment: If your hemorrhoids are more severe, or you have medical problems that increase your bleeding risk, your provider may recommend this same-day procedure under anesthesia. They may use a device with doppler technology to locate the problem by “listening” to where the blood vessels come into the hemorrhoid tissue. Your provider would then use stitches to tie off those vessels. We may also use stitches to treat prolapsing internal hemorrhoid tissue, one that protrudes from your anus.
• Hemorrhoidectomy: If your provider determines that your hemorrhoids are more severe, they may choose to do a same-day surgery under anesthesia called hemorrhoidectomy to remove large external or severe prolapsing internal hemorrhoids.

Follow-Up Care

Our team of providers will continue to support you after treatment. Follow-up care always includes a plan for eating foods higher in fiber and making lifestyle changes. This may include talking about the way you poop. About how much time you spend in the bathroom and whether you delay or push too hard or too long while on the toilet.

Oh, and one more thing — no phones in the bathroom! Seriously, research suggests that taking the phone into the bathroom may keep some of us on the toilet too long, causing blood to build up in the hemorrhoid tissue and make it swollen, painful and more likely to bleed.

Taking the Next Step

If you have hemorrhoids, you may feel like you’ll never be comfortable (or able to sit down) again, but they’re treatable — and relief is possible. Hemorrhoids don’t have to run or ruin your life. Cleveland Clinic’s healthcare providers can help you feel better now. And they’ll help you learn how to make lifestyle changes and manage medications so you can put hemorrhoids behind you and get back to enjoying life.