As a medical writer, my friends often share their health adventures with me. Now that I’m in my 50s, the stories get more interesting. A friend told me recently he had hemorrhoid surgery. A high school swim and tennis coach, he’s the picture of health. So, I was a bit surprised that he needed surgery.
But then I had a days-long bout of terrible hemorrhoid pain and could totally understand why lots of people get a hemorrhoidectomy. Just like it sounds, this is surgery to remove hemorrhoids. Hemorrhoids are swollen veins either inside your rectum or on the anus. They show up right where poop leaves your body.
I’ve been dealing with constipation – a common cause of hemorrhoid pain – my whole life. So going to the bathroom has never been fun for me. But recently, I felt throbbing pain not just when going to the bathroom. I was in pain when I sat, stood, or lay down. For three days.
I was in tears by the time I called my doctor’s office. I thought for sure I had something more severe.
What You Think is Hemorrhoid Pain Could Be Something Else
Interestingly, hemorrhoids are often not the cause of severe rectal pain, explains colon and rectal surgeon Traci Hedrick, MD.
“People have a lot of misconceptions about hemorrhoids,” Hedrick says. “When someone has rectal pain, they automatically assume it’s hemorrhoids. It’s not actually hemorrhoids for about 40 to 50% of the people I see, who come and complain of hemorrhoids. It’s more commonly a tear in the lining of the anus. So, it’s important to get an accurate diagnosis.”
1 of 3 things can cause sudden and severe rectal pain, Hedrick says:
- A firm and purple (thrombosed) hemorrhoid that you can feel on the outside of the anus. This happens when a blood clot forms inside a hemorrhoid.
- A tear in the lining of the anus (anal fissure). This can be caused by a severe bout of constipation or diarrhea. You can develop a skin tag that looks like a hemorrhoid but is swelling that the tear causes.
- An anal gland infection (perirectal abscess) that Hedrick describes as “horribly, horribly painful.”
Get Urgent Care But Skip the ER
If you have severe rectal pain that doesn’t go away, call your primary care provider so they can refer you to a colorectal surgeon at the UVA Digestive Health Center. “You really need to be seen by someone who deals with this a lot. We have urgent appointments available for very severe pain. We have clinic 4 days a week and even 5 days if we need to,” Hedrick says.
Relief for Rectal Pain
You can usually treat an anal tear with a cream, but it sometimes requires surgery. Antibiotics can treat abscesses, which usually need to be drained when they don't pop on their own.
You can treat most hemorrhoids by:
- Applying hemorrhoid cream from your local drugstore
- Sitting in warm water for 10-15 minutes a few times a day
- Not straining while going to the bathroom
- Drinking plenty of fluids
- Eating lots of fiber-rich foods like whole grains, fruits, and vegetables
Who Needs a Hemorrhoidectomy?
Surgery's a good option for people with large hemorrhoids. These can cause:
- Long-lasting pain
- Lots of blood loss
- Leaking stool or mucous
During this outpatient procedure, the surgeon cuts away the hemorrhoid. Doctors can use lasers, staples, and other tools. But removing them with a sharp blade is "the safest and best way to prevent them from coming back," Hedrick says.
“The vast majority of hemorrhoids don’t require surgery. But it is a common surgery. At UVA, we see hundreds of patients with hemorrhoids and do between 75 to 100 hemorrhoidectomies each year,” says Hedrick. She's one of three UVA colon and rectal surgeons who do these procedures.
“The biggest downside to surgery is an uncomfortable recovery,” she adds. “It’s going to take 2 to 4 weeks to recover, and the first week is when bowel movements are the most painful. We give a numbing medicine that lasts 2 to 3 days. And taking acetaminophen or ibuprofen can help relieve pain. We try not to use opioids, as they can constipate you.”
Hedrick adds, “Patients are happy after they’ve done the surgery but usually only after about a month.”
Hemorrhoids Can Bleed a Lot
There are two types of hemorrhoids: inside and outside. The outside ones on the anus cause the discomfort, pain, and itching. The internal ones don't typically cause pain (no nerve sensors in the rectum, Hedrick explains).
Still, the internal ones can cause bleeding. They sometimes slip outside the anus (prolapse). They can occasionally cause so much blood loss, Hedrick says, that people become anemic and need blood transfusions.
Bleeding typically happens during a bowel movement. But people can also bleed through their pants while shopping or going about their day.
Surgeons can remove small internal hemorrhoids with an office-based banding procedure that cuts off the blood supply. But a hemorrhoidectomy is needed to remove large internal hemorrhoids that cause lots of bleeding.
Cancer or polyps can also cause bleeding. So, if you have rectal bleeding, you should get a colonoscopy. That way, if you do have polyps, surgeons can take them out before they turn into cancer.
What Causes Hemorrhoids?
Major causes are:
- Straining while going to the bathroom (don’t force anything)
3 Ways to Prevent Hemorrhoids
Hemorrhoids are a normal part of life and become more common as we age, according to Hedrick. She says, “Everybody is going to have them to some degree." To prevent them from becoming a problem, she recommends that you take these steps every day:
- Drink lots of water and get plenty of fiber
- Get exercise
- Don’t sit on the toilet too long
Constipated & Middle Aged Like Me?
Constipation can cause hemorrhoids but can also be a sign of colon cancer.
Would a stool help? You've probably seen the commercials for special stools that give you a more "natural" position when sitting on the toilet. These actually can help, Hedrick says. A stool under your feet helps waste move through your bowels easier and with less strain.
How I Found Relief & the Joys of the Fiber Cocktail
Fortunately, my hemorrhoid pain went away pretty quickly. How did I do it? I:
- Gladly paid more than $80 on prescription-strength hemorrhoid medication (who knew insurance doesn’t cover suppositories?)
- Took a few baths, which I remember worked like a charm after giving birth 16 and 20 years ago
- Skipped squat poses during yoga
- Took a laxative left over from my colonoscopy prep
- Drank a lot of water
- Avoided bagels and pizza, which I love but always constipate me
Now, I don’t go a day without an after-dinner glass of water mixed with a heaping teaspoon of psyllium husks powder. It’s kind of like drinking very fine sawdust (I avoid the brands with added sweeteners). It can make you a bit gassy. But the morning after is much more pleasant. I am so grateful to a good friend who introduced me to the wonders of fiber-laden psyllium husks.
My Colonoscopy Found More Than a Polyp
I’m also grateful that I got my first colonoscopy screening last year. I was not surprised to read in my colonoscopy report that I have an internal hemorrhoid, which explains the blood when I go.
I also wasn’t surprised that I had a polyp in my colon, the kind that could become cancer. My maternal aunt and grandfather both died of colon cancer because they never had a colonoscopy screening. Over the years, my mother and father have both had lots of polyps removed during their colonoscopies.
During my colonoscopy, my polyp was also removed – along with its potential to become cancer. Hopefully, I won’t need to worry about having any hemorrhoid removed. I just need to keep up with my nightly fiber cocktail. Cheers to fun-for-the-go fiber and life-saving colonoscopies!