I was surprised to learn from Dr. Cima that over-the-counter hemorrhoid lotions and gels often do not help as much as people expect them to. They might briefly ease symptoms, he said, but they don’t resolve the underlying problem.
If your hemorrhoid symptoms don’t ease, an office-based procedure could help, Dr. Narang said. One popular treatment is rubber band ligation, in which a doctor uses a tool to place a rubber band around the base of the hemorrhoid, which stops blood flow to the inflamed tissue and causes it to die and fall off within one to four days. It is fast, relatively painless and requires very little downtime for the patient, Dr. Mathur said — some people can go right back to work after the procedure. But you may need to come back in for multiple treatments. Another less common office treatment is infrared photocoagulation, in which a physician uses infrared light to cut off blood supply to the bothersome tissue, causing it to shrink.
Serious hemorrhoids can be treated with surgery.
Grade 3 and 4 internal hemorrhoids — grade 3 means the hemorrhoid protrudes outside the anus but can be manually pushed back in, and grade 4 is when it’s constantly outside the anus — sometimes require surgery.
A handful of surgical options are available. One is an excisional hemorrhoidectomy, which is the surgical removal of the hemorrhoid, Dr. Narang explained. Another option is stapled anopexy (also called stapled hemorrhoidopexy), in which a doctor removes part of the hemorrhoid and then staples it back together, reducing it to a normal size, Dr. Cima said. Some doctors instead use Doppler-guided hemorrhoidal artery ligation, which is a good choice for hemorrhoids that bleed a lot, Dr. Narang said. In this procedure, a doctor ties off the main arteries feeding the hemorrhoid, causing it to wither and fall off.
Although surgical procedures often work, they aren’t without potential downsides, Dr. Mathur said. They can have painful and longer recoveries than the office procedures and can cause fecal incontinence. Also, even after surgery, hemorrhoids can return — some surgeries, such as the artery ligation, are associated with up to a 30 percent chance of recurrence, Dr. Narang said. That’s in part because these treatments remove or kill off a portion of the body’s hemorrhoidal tissue, but leave behind the rest, which can then become engorged and inflamed, Dr. Cima said. If people don’t address the lifestyle factors that cause hemorrhoids, they are more likely to see their hemorrhoids return.
I learned quite a lot about hemorrhoids this week, and although I didn’t love the images that came to mind (especially while eating my lunch), I’m grateful to know more about how to prevent and treat them. As Dr. Zaghiyan said to me when we spoke, hemorrhoids are “not a cocktail conversation” — but I am happy that our discussion has made it into The Times.