Most Hemorrhoids Never Need Surgery. Here Is What Gets Done Instead.

People put off getting hemorrhoids looked at because they assume the answer is surgery. It usually is not. Most cases are handled in an office visit, and the person walks out the same day.

Two kinds, and the difference matters

Internal hemorrhoids sit above a line inside the anal canal. There are almost no pain nerves up there. They bleed. They often do not hurt. So bright red blood on the paper can turn up with no pain at all.

External ones sit below that line, where the skin is richly supplied with nerves. Those hurt.

The distinction drives treatment. Office procedures work well on internal hemorrhoids precisely because that tissue does not register pain the same way.

What gets tried first

Before any procedure, the basics get addressed, and they resolve a lot of cases on their own.

More fiber and water make stools softer. Less straining means less pressure. Sitz baths ease the ache. Time on the toilet gets cut down too. Sitting and reading in there is its own risk factor.

If bleeding or discomfort continues past a few weeks of that, an office procedure is the next step.

Rubber band ligation

The most common one. A small band is placed at the base of an internal hemorrhoid, cutting off its blood supply. The tissue shrinks and falls away within about a week or two.

It takes a few minutes. No anesthesia in most cases. Patients describe pressure or fullness, not sharp pain. Some ache for a day afterward.

Often only one column is banded per visit, so more than one appointment may be needed.

Sclerotherapy

A solution is injected into the hemorrhoid. It scars the vessel and shuts it down. This suits smaller internal hemorrhoids. It also suits people who bleed easily or take blood thinners, where banding carries more risk.

Infrared coagulation

A short burst of infrared light seals the tissue at the base. Also quick, also done in the office. It is generally chosen for smaller internal hemorrhoids.

When surgery does come up

Some situations do call for an operation. Large hemorrhoids that slip out and will not go back. Cases that keep returning after office treatment. Big external ones causing constant pain. A clotted external hemorrhoid may need draining. That works best within the first couple of days.

Our general piece on hemorrhoids and treatment options covers the wider picture, and our hemorrhoid service page explains how we handle them.

Do not assume it is hemorrhoids

This part matters more than any of the above. Rectal bleeding gets blamed on hemorrhoids constantly, and sometimes the cause is something else. An anal fissure bleeds too, and so do conditions that need finding early.

See someone if bleeding is new for you. See someone if it keeps happening, or if you are over 45. A change in your bowel habits alongside it is another reason. A quick exam settles the question.

This article is general information, not medical advice about your situation. If something back there has been bothering you for weeks, call 818-847-7067.