Hemorrhoids: Knowing when it’s time to go to the doctor

Hemorrhoids are a widespread disease, prevalent across the globe and recognized as one of the most common medical conditions in the general population.^[1] In the US alone, an estimated 20% of the public has been diagnosed with hemorrhoids, although – rather worryingly – it has been noted that women seem to be far more likely to report hemorrhoids to the doctor than men.^[2]

If you have hemorrhoids and are racked with worry and indecision, wondering when it is time to go visit the doctor, here are some warning signs to take action and seek professional help.

What are hemorrhoids and can they be dangerous?

Hemorrhoids refer to when the blood vessels, muscle, and connective tissue that exist in our anal canals, around the anus and lower rectum swell: enlarging usually as the result of straining, becoming and remaining enlarged, very similar in many ways to varicose veins in the legs. The condition most of us call hemorrhoids (or piles) develops when those veins become swollen and distended.^[3]

Hemorrhoids are usually found in the following 2 types:

• Internal hemorrhoids. These can bleed but, because of their position, they are not typically seen.
• External hemorrhoids. These types of hemorrhoids tend to be more painful, since the external area of the anus has many nerves. They can also bleed and are easier to spot.^[4]

Hemorrhoids can create quite a lot of discomfort and become recurrent or chronic, especially by the age of 50, when it is estimated that half the population has already experienced one of its symptoms, such as rectal bleeding. 3

Although treated hemorrhoids are not dangerous, the hemorrhoidal disease is degenerative and can quickly evolve and worsen. These are the 4 main accepted and classified grades:

• Grade I. First grade of hemorrhoids, they are visible but they do not prolapse.
• Grade II. Hemorrhoids prolapse but they also spontaneously return.
• Grade III. At this stage, hemorrhoids do prolapse but they do not spontaneously reduce and they need to be manually return.
• Grade IV. The presence of non-returnable hemorrhoids.^[5]

When hemorrhoids fail to heal and continue advancing through these stages, it is a clear sign that you’ll need the help of a specialist to avoid the worsening of the disease. Luckily enough, there are some common warning signs that will help you understand when it is necessary to seek help.

Hemorrhoids: 4 signs it is time to go to the doctor

A total of 40% of individuals with hemorrhoids are asymptomatic.^[6] It is always highly recommended to go to the doctor immediately to begin curing the hemorrhoids with efficient treatments, such as venotonic oral medications. If, however, you are unsure as to whether or not you should visit a specialist, here are the 4 most important warning signs that tell you it is time to get professional help.

1. Hemorrhoids that last for more than a week. Typically, with small hemorrhoids, they should disappear untreated after a few days. If however, you are getting close to a week, or you have already passed the week mark, it might be a sign that the hemorrhoids are not small and that medical help is required. Find more information in the article: How long do hemorrhoids last?
2. Bleeding hemorrhoids. When hemorrhoids start to bleed it means that the sensitive skin has broken and it might require medical attention to properly heal. Bleeding can be linked to, and exacerbated by, bowel movements.^[7] However, rectal bleeding can also become serious if the cause is due to ulceration or even necrosis of the skin. In these cases immediate medical attention is not only recommended, it is required.^[8] You can read more about why hemorrhoids bleed and how to treat them.
3. Prolapsed hemorrhoids. Prolapsed hemorrhoids refer to those that are pushed outwards and become exposed, as mentioned previously in the 4 common stages, and without proper medical care and intervention, prolapsed hemorrhoids can reach the grade 4 where they become very painful and cannot be pushed back inside manually anymore.^[9]
4. Painful hemorrhoids. Discomfort can be quite a normal occurrence with hemorrhoids. However, if general irritation and discomfort magnifies into occasional moments of sharp and sometimes excruciating pain, it is time to go to the doctor.^[10] The reason is that more often than not, pain is more commonly associated with external hemorrhoids than with the internal variety, which means that if hemorrhoids become increasingly painful it might be a symptom of a prolapsed hemorrhoid.^[11] Explore here how to reduce the swelling of hemorrhoids.

There are obvious reasons why many people are hesitant about raising such issues with their doctors: self-consciousness, modesty, embarrassment, to name but a few. It is, however, absolutely necessary that such medical problems be addressed quickly, due to their degenerative nature: “A stitch in time, saves nine”, so to speak. Another potential risk factor, concerning hemorrhoids, is that they are nearly always “self-diagnosed” at first, and in this way, various other illnesses – some of a far more serious nature – can be missed and left to progress undetected.

On a more positive note, seeking medical advice as soon as possible is not only the most guaranteed way of painlessly putting hemorrhoids in your rear-view mirror but has another advantage too. Professional advice could be invaluable when taking into account that the recurrence rate even after medical management can be up to 50% within the first 5 years,^[12] and the doctor will be able to recommend a venotonic treatment with oral flavonoid medication that can be used not just to provide fast-acting relief, but also as a effective preventative measure for the future.