Hemorrhoids: What Your Doctor Actually Wants You to Know

Understanding the Anatomy: Internal vs. External

Hemorrhoids are actually "cushions" of tissue and blood vessels that help with bowel continence. They only become a "disease" when they become symptomatic.

• Internal Hemorrhoids: Located inside the rectum. They are covered by tissue that has no sensation, which is why they usually cause painless bleeding. They are graded (1–4) based on how far they prolapse (bulge out).

• External Hemorrhoids: Located under the skin around the anus. This area has many nerves, so if a blood pool forms (thrombosis), it can be extremely painful.

The Signs: Is it Hemorrhoids or Something Else?

Not all rectal discomfort is a hemorrhoid. During an office visit, we look for these key differentiators:

• Painless Bright Red Blood: Often an internal hemorrhoid.

• Sharp, "Knife-like" Pain during bowel movements: Usually suggests an anal fissure (a small tear).

• Itching and Swelling: Common symptoms of external hemorrhoids or skin tags.

Crucial Note: If you have unexplained iron deficiency anemia or persistent bleeding, a colonoscopy may be necessary to rule out polyps or colon cancer.

The 2026 Treatment Blueprint

We categorize treatment into three phases, starting with the least invasive:

Phase 1: Lifestyle & Non-Operative

• The Fiber Rule: Adding 7 to 20 grams of supplemental fiber daily (via cereals, vegetables, or gummies) can improve bleeding in 50% of patients.

• Hydration: Increased fluid intake is mandatory for fiber to work effectively.

• Topical Relief: Hydrocortisone, Lidocaine, or Witch Hazel can reduce inflammation and itching.

• Toilet Habits: Avoid prolonged sitting on the toilet, which increases pressure and prolapse.

Phase 2: Office Procedures

If fiber doesn't work, we offer minimally invasive options:

• Rubber Band Ligation: A painless procedure where a small band is placed around the hemorrhoid, causing it to wither and fall off.

• Sclerotherapy: An injection that shrinks the hemorrhoid tissue through fibrosis.

Phase 3: Surgical Intervention

For severe, fourth-degree hemorrhoids or cases with complications like strangulation, we refer patients to a general surgeon for a hemorrhoidectomy.

When to See a Doctor in Houston

Rectal bleeding should never be ignored. If you are experiencing pain, fever, or persistent bleeding, it is time for a professional evaluation to ensure you receive the correct diagnosis.

Are you ready to find relief?

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