Embarrassed? Talk to Your Doctor Anyway

Q:  When would one need surgery for hemorrhoids? I am a healthy 40-year-old mother of three and I have not been free of hemorrhoid problems since the birth of my daughter 12 years ago.

I have tried Tucks witch hazel pads and Preparation H, which sometimes help, but I also have times of soreness and itching, even between bowel movements, that persist no matter what I try.

I don't want to bother my doctor with this embarrassing problem if there's nothing he can do.

A:  Before recommending any kind of treatment, the first step is to be sure the diagnosis is actually hemorrhoids. It is worth a trip to the doctor for this step alone.

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

Hemorrhoids can be either inside the anus (internal) or under the skin around the anus (external). The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Hemorrhoids are common in both men and women. About half of the population has hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus on the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

As common as hemorrhoids are, there are other common problems of the anal area, such as anal fissures (small tears about the opening), skin tags, tumors, polyps and sexually transmitted warts.

Assuming you do have hemorrhoids, you may be a candidate for surgery, depending on the hemorrhoid location and size.

Doctors usually try non-surgical options first, recommending attention to hygiene and stool softeners to keep stools easy to pass and regular.

Local treatments can help with hygiene and drying (like the Tucks pads), inflammation and itching (such as ointments, particularly those with hydrocortisone) and pain (like anesthetics), but you have tried these.

Hemorrhoid surgery is offered to patients who have persistent pain, itch, or fecal incontinence due to hemorrhoids that protrude and continue to protrude even between bowel movements. Complications are few, but like all surgeries, hemorrhoid surgery is not risk-free.

The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs. Exercise, including walking, and increased fiber in your diet help reduce constipation and straining by helping to make stools that softer and easier to pass.

Do go to your doctor. We are used to dealing with embarrassing things.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.

For more information on this topic, see the HealthLink article Hemorrhoids: Very Common, But Usually Not Dangerous.