Opinion: What a doctor sees when Joe Biden hesitates

President Biden, carrying a book, talks to news media.

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As a geriatrician, I discuss the effects of aging with patients every day. I wish I had a chance to give my usual talk to everyone who chortles or tears their hair out about President Biden’s fitness for his job.

First, memory. I explain to patients that there are three components to consider. One is formation. Then storage. And, finally, recall. The most common issue among seniors is slow recall. This is the familiar “tip of the tongue” phenomenon, when a word seems to hide or a name won’t come to mind. You know the name, it’s in your bank of memories, it just can’t be accessed quickly. Given time, it usually arrives.

This problem, called age-associated memory impairment, often starts for people in their 30s and gradually progresses. It’s a nuisance but not disabling. If, like me, you find yourself using the term “whatchamacallit,” you probably have it. Don’t worry, you’ll be fine.

President Joe Biden boards Air Force One at John F. Kennedy International Airport, Monday, Feb. 26, 2024, in New York, to return to the White House in Washington. (AP Photo/Evan Vucci)

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Alzheimer’s disease, the most common cause of dementia, is a different story. Those affected lose the ability to store new memories. They can still access old memories in their memory bank and may recount events that occurred decades ago. But they can’t tell you what they had for breakfast because that never entered the memory bank. (I reassure my patients with age-associated memory impairment by asking whether they remember their breakfast. They do.)

Alzheimer’s is cognitively crippling. Losing the ability to form new memories freezes one in time. Those affected can’t make new friends or address new situations without fresh memories. Additionally, the disease progressively impairs other domains, including behavior and ultimately physical skills.

Fortunately, President Biden shows no signs of Alzheimer’s disease. At news conferences, he references new events and obviously creates new memories efficiently. He speaks slowly and pauses to find words like others with benign age-associated memory impairment. These issues are exacerbated by a chronic speech impediment. Biden has struggled with stuttering since childhood , and remnants of the condition have long been apparent in his speech.

El presidente Joe Biden durante un evento de campaña, el domingo 4 de febrero de 2024, en Las Vegas. (AP Foto/Stephanie Scarbrough)

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Unfortunately, word hesitations coupled with the mild stutter can’t help but affect his public speaking. Biden’s political opponents and the uninformed exploit it, along with stereotypes about older people, to create a false narrative about intellectual impairment.

I take care of many high-functioning seniors like President Biden in my practice. One that I know, who is not a patient of mine, has been my family’s lawyer for five decades. Melvin Spears, at 96, recently responded to an emailed legal question with succinct and well-targeted advice, as he always has. When I spoke to him, he acknowledged some concessions to his age. He speaks more slowly, and transportation is a challenge because he’s stopped driving. (He considers Uber and Lyft “a hassle.”) Like Biden, Spears focuses on his work and lets others worry about his age if they choose.

Studies show that high-functioning seniors like Mel Spears and the president compensate for slower reaction time by applying superior knowledge and judgment. The presidency is not a job that requires lightning-quick reflexes. First-hand experience with the successes and failures of U.S. foreign policy over decades, for example, combined with time-tested judgment offers far more than speed in speech or decision-making.

President Joe Biden delivers remarks on a $95 billion Ukraine Israel aid package being debated in Congress, in the State Dining Room of the White House, Tuesday, Feb. 13, 2024, in Washington. (AP Photo/Evan Vucci)

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Actuarial tables show that the 81-year-old president’s life expectancy extends nearly eight years, well beyond a second term. He gets excellent healthcare, has no major chronic illnesses, and at his recent physical at Walter Reed Military Medical Center, he was declared “healthy, active” and “fit for duty.” All that means that Biden is likely to beat the actuarial estimate. Given his overall health and the absence of current cognitive impairment, he would likely complete a second term with stable cognition.

All candidates for political office in the United States deserve to be evaluated on their accomplishments and capabilities rather than by their age. Seniors may be the last minority whose natural traits are singled out for ridicule and stereotyping. If the American people disagree with President Biden’s policies and prefer change, they should support his opponent. But in the absence of valid evidence of true cognitive impairment, their judgment should not be influenced by ageist social stereotypes. Biden and the American political process deserve better.

Daniel J. Stone is an internist and geriatrician in Beverly Hills.

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Ransomware attack on U.S. health care payment processor ‘most serious incident of its kind’

UnitedHealth Group headquarters

Fallout from a ransomware attack on the country’s largest health care payment processor is “the most serious incident of its kind leveled against a U.S. health care organization,” American Hospital Association CEO Rick Pollack said Thursday evening .

The attack has crippled Change Healthcare, a company that provides a widely used program for health care providers to manage customer payments and insurance claims. The company has taken most of its systems offline to prevent the attack from spreading, a common countermeasure.

“Nine days into the attack on Change Healthcare, a health care technology company that is part of Optum and owned by UnitedHealth Group, effects are continuing to be felt throughout the entire health care system,” Pollack said in a news release. The American Hospital Association is the country’s largest health care industry group.

That outage has been devastating for small and midsize health care providers. Doctors told CNBC that the outage has prevented them from being able to electronically fill prescriptions and has kept insurance providers from reimbursing providers.

Later on Friday, Change said it had completed a new workaround for its electronic prescription service that is immediately available to all customers.

Change says it processes 15 billion health care transactions each year and is involved in a third of all American patient records.

In an emailed statement, a spokesperson for Change Healthcare’s parent company, UnitedHealth Group, indicated that thousands of pharmacies are using “offline processing workarounds.” More than 90% of the more than 70,000 U.S. pharmacies that use Change Healthcare’s payment processor are using alternate ways to process payments, the spokesperson said.

UnitedHealth Group announced on its website that it discovered the attack Feb. 21, and that cybercriminals deployed a type of ransomware called Alphv.

Alphv is created by Russian-speaking cybercriminals, though it’s unclear who installed it on Change Healthcare’s systems. The same ransomware was used in the devastating attack on MGM Resorts in Las Vegas last year, though experts and a person familiar with that attack said it was installed by a small group of young, English-speaking hackers .

A coalition of U.S. and European law enforcement agencies announced an operation to disrupt Alpv in December, though it appears it has somewhat recovered.

Change Healthcare is working with U.S. law enforcement and has retained two major cybersecurity companies, Google-owned Mandiant and Palo Alto, to work on recovery, a spokesperson said in a statement.

The FBI, the Department of Health and Human Services and the Cybersecurity and Infrastructure Security Agency are all providing assistance, an FBI spokesperson said in an email Friday afternoon.

Kevin Collier is a reporter covering cybersecurity, privacy and technology policy for NBC News.

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Robert R. Cima, M.D.

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Laparoscopic surgery, Colorectal surgery, Minimally invasive abdominal surgery, Colonoscopy, Colectomy, J-pouch surgery ... , Flexible sigmoidoscopy, Transanal endoscopic microsurgery, Colostomy, Robotic ventral hernia repair, Anorectal surgery, Coloanal anastomosis, Ileostomy surgery, Ulcerative colitis, Inflammatory bowel disease, Crohn's disease, Lynch syndrome, Colon cancer, Carcinoid tumor, Familial adenomatous polyposis, Recurrent cancer, Colon polyps, Hemorrhoids, Anal fissure, Diverticulitis, Anal fistula, Fistula, Anorectal disease, Polyposis syndromes, Abscess, Colonic dysmotility

Scott R. Kelley, M.D.

Scott R. Kelley, M.D.

Colonoscopy, Robotic surgery, Regenerative medicine therapy, Colectomy, J-pouch surgery, Flexible sigmoidoscopy, Transa ... nal endoscopic microsurgery, Laser surgery, Colostomy, Anorectal surgery, Platelet rich plasma injection, Coloanal anastomosis, Ileostomy surgery, Proctectomy, Complex oncologic multidisciplinary pelvic surgery, Ulcerative colitis, Inflammatory bowel disease, Crohn's disease, Lynch syndrome, Colon cancer, Ischemic colitis, Rectal cancer, Familial adenomatous polyposis, Recurrent cancer, Perianal abscess, Anal cancer, Hemorrhoids, Anal fissure, Diverticulitis, Anal fistula, Anorectal disease, Polyposis syndromes

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Kellie L. Mathis, M.D.

Laparoscopic surgery, Colorectal surgery, Colonoscopy, Robotic surgery, Colectomy, J-pouch surgery, Flexible sigmoidosc ... opy, Rectal prolapse surgery, Intraoperative radiation therapy, Colostomy, Anorectal surgery, Coloanal anastomosis, Ileostomy surgery, Proctectomy, Ulcerative colitis, Inflammatory bowel disease, Constipation, Lynch syndrome, Colon cancer, Rectal cancer, Carcinoid tumor, Familial adenomatous polyposis, Recurrent cancer, Colon polyps, Anal cancer, Rectal prolapse, Hemorrhoids, Anal fissure, Diverticulitis, Anal fistula, Pelvic floor dysfunction, Fistula, Vaginal fistula, Pouchitis, Polyposis syndromes, Polyp, Abscess, Anorectal abnormality, Pelvic floor defecatory dysfunction

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Nicholas P. McKenna, M.D., M.S.

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Learn about types of hemorrhoids here

Types of Hemorrhoids: An Overview

Hemorrhoids occur when veins in your rectum dilate and become swollen. Blood pools in the swelling veins, making your veins stretch into your rectal and anal tissue membranes. Often times hemorrhoids can feel quite uncomfortable. While you can’t always see or feel a hemorrhoid, when they fill with blood and enlarge, they can look and feel like a small knob or lump.

Hemorrhoids are extremely common, affecting millions of people across the United States. In fact, the vast majority of people who have hemorrhoids do not even know they have them. While a small number of people have symptoms, an even smaller amount seeks out treatment. 

What Causes Hemorrhoids?

While doctors often do not know why certain people end up having hemorrhoids , many people end up with them following an increase in pressure on the veins in the rectum area. Things that may cause this type of pressure include:

  • Constipation followed by straining during bowel movements
  • Sitting on the toilet for extended periods of time
  • Diarrhea and overuse of laxatives
  • Pregnancy (when the baby puts pressure on your veins, or while pushing during childbirth), and 
  • Sitting for extended periods of time during long air flights, road trips, or in office work environments that are highly sedentary. 

Hemorrhoids tend to be more likely if you do not get enough fiber in your diet, and if you are overweight. They are also more common with age.

The majority of adults will experience a hemorrhoid at some point in life. While all hemorrhoids are similar, there are some variations. Follow along to learn more about the different kinds of hemorrhoids.

Common Types of Hemorrhoids

1. Internal Hemorrhoids are a type of hemorrhoid that is located inside your rectum. Oftentimes they are not visible, and frequently they disappear without any treatment. Some of the time, an internal hemorrhoid may swell up and when this happens, it may rise out of your anus. When this occurs it is referred to as a prolapsed hemorrhoid.

Many times you do not even know if you have an internal hemorrhoid because there aren’t nerves that identify pain in this part of your body. It may be something that comes to your attention when your physician makes note of it following a colonoscopy or childbirth. If hemorrhoids expand in size, you may experience more symptoms that are typical of larger hemorrhoids. This can include a protrusion that you can actually feel as a soft lump, along with burning, cutting or itching sensations and sometimes severe pain.

When you go to the bathroom, feces passing through your rectal area may agitate internal hemorrhoids which can cause some bleeding that you may see on toilet paper. Please note: Any kind of rectal bleeding can be a sign of other more serious health problems, so it is always advisable to discuss this symptom with your doctor.

2. Prolapsed Hemorrhoid is a term used to describe internal hemorrhoids that have swollen and may appear outside of your anus. This type of hemorrhoid, which appears like a swollen lump, may be visible with a mirror. Some people do not experience any symptoms with prolapsed hemorrhoids, while others 

Often physicians are able to assign a grade to a prolapsed hemorrhoid, depending on severity. 

  • Grade one hemorrhoids are not prolapsed in any way.
  • Grade two hemorrhoids are prolapsed but also retract on their own. They may protrude from your anus at certain times like if you are straining during a bowel movement.
  • Grade three prolapsed hemorrhoids stick out of your anus and require you to push them back in yourself. It is possible if you are experiencing this, you may want to consider some type of treatment to avoid possible infections and/or to limit discomfort.
  • Grade four hemorrhoids are large enough that you cannot easily manually push them back into your anus without a significant amount of pain and discomfort. In these cases , it is highly advisable that you consult with your physician to explore treatment options.

3. External Hemorrhoids appear on your anus. You can’t always see them, but if you are able, they tend to appear like lumps. External hemorrhoids are typically not a serious issue, unless they cause you discomfort that negatively affects your daily life. The symptoms of external hemorrhoids tend to be similar to other types, including pain while going to the bathroom – especially if straining, doing certain activities, and sitting (especially on hard surfaces) for prolonged periods.

4. Thrombosed Hemorrhoids can cause people a lot of discomfort. This type of hemorrhoid contains a thrombosis or a blood clot within the tissue of the hemorrhoid. They often look and feel like small lumps around your anus. Thrombosed hemorrhoids are complications associated with hemorrhoids where blood clots appear. They can happen with both external and internal hemorrhoids, though more commonly with external. If you are experiencing one, you may have difficulty sitting, walking or going to the bathroom without discomfort. You may also notice redness along with a blue color around the hemorrhoid area.

If you are experiencing discomfort from hemorrhoids, the experienced team of medical professionals at Gastroenterology Health Partners is here for you using the most advanced treatment options available. For more information or to schedule an appointment, contact Gastroenterology Health Partners today at a location near you. 

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What Are Hemorrhoids?

Types of hemorrhoids.

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  • Next in Hemorrhoids Guide Hemorrhoids: Signs, Symptoms, and Complications

Hemorrhoids are swollen and inflamed veins in the rectum or anus (the very far end of the digestive tract where poop comes out). You may or may not be able to see hemorrhoids.

They may cause itching or bleeding, depending on the location. Over-the-counter (OTC) treatments can often help with swelling and effectively manage hemorrhoids. Surgery may sometimes be needed to remove the swollen blood vessels.

This article discusses the symptoms, causes, diagnosis, and treatment of hemorrhoids.

Charday Penn / Getty Images

Hemorrhoids are divided into three types, depending on where they are located. They have similar causes and treatments and are:

  • Internal hemorrhoids : Occur inside the body at the lower point of the intestines (the veins bulge out of the lining of the rectum and anus)
  • External hemorrhoids : Occur in the skin surrounding the anus on the outside of the body
  • Thrombosed hemorrhoids : Can be external or internal and occur when a blood clot forms inside a hemorrhoid

Hemorrhoids are a common condition. About half of people 50 years and older will have hemorrhoids.

What Are the Symptoms of Hemorrhoids?

In most cases, the symptoms of hemorrhoids depend on their type and location. Most people find the symptoms mild and can often be treated with home remedies.

External Hemorrhoids

The symptoms of external hemorrhoids include:

  • Itching around the anus
  • One or more hard bumps under the skin around the anus
  • Pain or aching near the anus, often worse with sitting down

Internal Hemorrhoids

Internal hemorrhoids are often not painful. Symptoms include blood when pooping, blood on your stool, or blood in the toilet or on the toilet paper when you wipe.

Another symptom is a prolapsed hemorrhoid that dangles from the intestines and falls out of the anal opening.

A healthcare provider should check any blood in your poop or when you have a bowel movement. While hemorrhoids are often common and mild, bleeding from your intestines can be serious and should not be ignored.

What Causes Hemorrhoids?

Healthcare providers do not understand why some people get hemorrhoids, and others do not. People get hemorrhoids due to increased pressure in the veins of the far end of the intestine (rectum or anus). However, there are some common behaviors and health conditions that may make you more likely to develop hemorrhoids, including:

  • Pushing or straining when you poop
  • Sitting on the toilet for a long time
  • Constipation , especially over time
  • Diarrhea , especially over time
  • A diet low in fiber
  • Getting older (the tissues in the rectum and anus get weaker)
  • Frequent heavy lifting (due to straining and pressure)
  • Being overweight or obese

How Do I Know If I Have Hemorrhoids?

Your healthcare provider can diagnose hemorrhoids. In most cases, they will:

  • Take a medical history
  • Physically examine your anus and the skin around it
  • Perform a digital rectal exam
  • Use an internal scope (if needed) to visualize the inside of the anus and rectum

How to Treat Hemorrhoids

If you think you have hemorrhoids, get a confirmation from your healthcare provider. Some other serious medical conditions have similar symptoms and require medical care.

In many cases, home remedies are enough to manage hemorrhoids. For some people, more invasive medical treatments are needed.

Home Remedies

If cleared by your provider, you can treat your hemorrhoids at home. Some possible ways to help hemorrhoids go away include:

  • Increasing the fiber in your diet
  • Taking a fiber supplement
  • Drinking more water or other fluids (not alcohol)
  • Avoiding pushing or straining while pooping
  • Sitting on the toilet for shorter periods
  • Sitting in warm water ( sitz bath ) several times a day for relief

Several OTC medications can help treat hemorrhoids. Always check with your provider to ensure these treatments are safe for you to use. Some people find the following helpful:

  • Pain relievers
  • Hemorrhoid creams or ointments
  • Hemorrhoid suppositories (inserted into the rectum)
  • Stool softeners

Be sure to see a medical professional if you have bleeding or if your hemorrhoid symptoms last more than one week. You may also need to follow up with them if your home remedies cause new or worsening symptoms.

Medical Treatment

If your hemorrhoids do not improve with home remedies, or you have heavy bleeding or a blood clot, you may need medical treatment. A provider can often treat hemorrhoids at an outpatient center or hospital. Some common medical interventions for hemorrhoids include:

  • Ligation ( banding ): A small surgical rubber band is placed at the bottom of the hemorrhoid to cut off blood flow to the tissue; after about a week, the hemorrhoid falls off, and a scar forms.
  • Injection : A needle is used to put a solution directly into the hemorrhoid to cause it to shrink.
  • Stapling and suturing : Staples and stitches are used to shrink the hemorrhoid tissue.
  • Hemorrhoidectomy : Surgical removal of hemorrhoids is performed in an operating room under anesthesia.

Depending on the severity of your hemorrhoids and their symptoms, your provider will discuss possible treatment options with you and review the risks and benefits of each.

Hemorrhoids During Pregnancy

Hemorrhoids are common during pregnancy. It is estimated that up to half of pregnant people will have hemorrhoids. During pregnancy, hemorrhoids come from several causes, including increased blood volume, constipation, and pressure from the uterus on the rectum.

Check with a provider to ensure any treatments chosen are safe for you and the baby.

Complications and Outlook

Hemorrhoids are a common digestive system issue and are often easily managed with home remedies. There are a few complications that can be severe and require medical attention, including:

  • Blood clot in the hemorrhoid
  • Infection in an open area (sore or ulcer) of an external hemorrhoid
  • Strangulated hemorrhoid (loss of blood flow to a prolapsed hemorrhoid)
  • Bleeding and blood loss ( anemia )

How to Prevent Hemorrhoids

Recommendations for preventing hemorrhoids are based on reducing or avoiding the things that cause them. Focus on:

  • Eating adequate fiber in your diet
  • Avoiding pushing or straining when pooping
  • Drinking plenty of fluids
  • Using OTC stool softeners if needed
  • Preventing diarrhea and constipation as much as possible
  • Spending less time sitting on the toilet

Tips for Managing Hemorrhoids

Hemorrhoids typically get better within a few days to a week, especially if you can reduce or avoid factors that increase the pressure in your rectum and anus. If your hemorrhoids are painful, OTC treatments may be helpful.

A sitz bath may help relieve discomfort in the anus and inflamed tissues. You may find three to four sitz baths daily help you manage your symptoms.

Avoid sitting too long, whether on the toilet or a chair. Walk around every hour or so. Increasing your physical activity can help improve your bowel motility. And consider changing positions when you have a bowel movement. Some people find a squatting position more comfortable than a traditional sitting position.

American Society of Colon and Rectal Surgeons. Hemorrhoids .

National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts of hemorrhoids .

National Institute of Diabetes and Digestive and Kidney Diseases.  Symptoms & causes of hemorrhoids .

American Academy of Family Physicians. Hemorrhoids .

American College of Obstetricians and Gynecologists. Problems of the digestive system .

National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of hemorrhoids .

National Institute of Diabetes and Digestive and Kidney Diseases. Treatment of hemorrhoids .

Office on Women's Health. Body changes and discomforts .

Hardy A, Cohen C. The acute management of haemorrhoids .  Ann R Coll Surg Engl . 2014;96(7):508-511. doi:10.1308/003588414X13946184900967

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What Doctor to See for Hemorrhoids?

Read time: 6 min

Posted on: Sep. 13, 2022

Jessica Guht

Without medical expertise, knowing what doctor to see for hemorrhoids can be difficult. There are a few doctors who may be able to help with your symptoms, but it will depend on your individual experience.

Minor cases may only need a primary care physician, while others may need a surgeon. In most cases, if you have the time, it’s better to be preferred by your physician.

Table of Contents

What are hemorrhoids, when to see a doctor for hemorrhoids, which doctor should you see for hemorrhoids, how to treat hemorrhoids yourself, how can drhouse help you, key takeaways.

Hemorrhoids are swollen lumps that form on the inside and outside of your rectum. They can be painful and irritable, and may even cause rectal bleeding . The lumps are a result of inflamed and swollen veins inside the rectum. Aside from bleeding, you may find your rectum to be both itchy and irritable, and it can be difficult to relieve.

Generally, hemorrhoids are only a minor condition and should clear up within a few days. It’s also a very common condition, but there are some occasions when you would need to see a doctor over your hemorrhoids.

While most cases of hemorrhoids will clear up over the course of a few days, there are some cases that call for a doctor’s input. Your hemorrhoids may last longer than a week or could cause greater complications than just minor hemorrhoid symptoms.

You should call your doctor as soon as possible if your hemorrhoid symptoms haven’t gone away after a week.

If your condition is worsening each day, it could be a sign of a greater complication than just a hemorrhoid. You may be experiencing hemorrhoid thrombosis , in which a professional would have to intervene.

Bleeding or a lack of bowel control are also severe symptoms that you should contact your doctor about. It’s better to be safe than sorry.

Depending on your condition, you may require the expertise of a specialist, in which case a primary care physician isn’t going to be enough. 

Primary Care Physician

If you’re unsure of how severe your symptoms are, you should visit a primary care physician first. You can discuss your symptoms, as well as have a physical examination done to get a better understanding of your condition.

Your primary care physician can use your symptoms and condition to help you find the right specialist for the job, as over-the-counter treatments may not be effective for your case.

Gastroenterologist

A gastroenterologist is qualified to diagnose your hemorrhoid condition, as well as prescribe you the suitable treatment for it. However, they’re not always the right choice. The gastroenterologist may decide that colonoscopy is the best course of action, which will allow them to get a better idea of your condition.

Hemorrhoid ligation or hemorrhoid banding may be performed by your gastroenterologist, which is the act of tying a band around a hemorrhoid, cutting off its blood circulation. Within a week, your hemorrhoid should fall off completely. Note, that this procedure can cause bleeding, but it will remove the swollen hemorrhoid.

Proctologist

A proctologist, or surgeon, would be necessary if your hemorrhoid needed surgically removed. Severe cases will require a hemorrhoidectomy , in which the surgeon will remove your external hemorrhoids completely. If your hemorrhoids are causing a blood clot externally, this is known as hemorrhoid thrombosis. Your proctologist may need to perform a hemorrhoid thrombectomy to prevent further complications.

Booking an appointment with your doctor can take time, and speaking with a doctor face to face about it might be embarrassing – especially if you’re unsure of your condition. Speaking to an online doctor can help you to get professional advice, without having to visit the physician’s office. Some online doctors will also be able to prescribe you your medication to help relieve the symptoms.

Hemorrhoid Relief

If you haven’t gone to see a doctor, there are a few ways you can relieve your symptoms at home. You don’t always need the help of a doctor, and simply soaking in hot water may help to relieve some of the swelling and the pain – if only temporarily.

You can also help to relieve the pain by using common anti-inflammatory products like aspirin or ibuprofen . While it won’t cure your condition, it will help to bring the swelling down for a short time, giving you some relief throughout the day. No matter how uncomfortable your condition is, do not take more than recommended on the packaging.

Hemorrhoid Treatment

There are a few OTC treatments you can get your hands on, but some of them may require your doctor to prescribe them. There are creams to help treat your hemorrhoids , as well as suppositories that you can use at home. This treatment should reduce the swelling as well as relieve the pain that you’re experiencing as a result of the condition.

DrHouse can help you to get in touch with a professional doctor within minutes. You don’t have to wait weeks for an appointment, only to be told your condition is a false alarm, or that you’ll just have to wait it out. You can be in contact with a trained doctor, ready to help you at any time of the day.

  • Most hemorrhoid cases won’t require you to visit a doctor and will go away within a week of appearing.
  • You should visit your primary care physician if your conditions are severe, getting worse each day, or have lasted longer than one week.
  • Your primary care physician can help you to decide on the best course of action for your symptoms. They may also refer you to another specialist if your condition can’t be easily treated.
  • Your gastroenterologist can diagnose your hemorrhoids, as well as perform internal procedures such as ligation.
  • Seeing a proctologist is necessary if your hemorrhoids need to be surgically removed.
  • Amy Halverson, Hemorrhoids, Clin Colon Rectal Surg 2007; 20(2): 077-085. DOI: https://www.doi.org/10.1055/s-2007-977485  
  • Eberspacher C, Mascagni D, Antypas P, et al. External hemorrhoidal thrombosis in the elderly patients: conservative and surgical management. Minerva Chirurgica. 2020 Apr;75(2):117-120. DOI: https://www.doi.org/10.23736/s0026-4733.18.07724-6 . PMID: 30600960.
  • Hemorrhoids Treatment. WebMD. Available from: https://www.webmd.com/digestive-disorders/understanding-hemorrhoids-treatment-medref  
  • Albuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg . 2016;8(9):614-620. Doi: https://www.doi.org/10.4240/wjgs.v8.i9.614  
  • Yeo D, Tan KY. Hemorrhoidectomy – making sense of the surgical options. World J Gastroenterol . 2014;20(45):16976-16983. doi: https://www.doi.org/10.3748/wjg.v20.i45.16976  

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Hemorrhoids

What are hemorrhoids symptoms, causes, diagnosis, treatment, and prevention.

Lindsey Konkel

Hemorrhoids are enlarged and swollen (also called varicose) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel and leads to the anus, the opening at the end of the bowel where fecal matter leaves the body.

Everyone has hemorrhoidal tissue in this area, made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles.

Hemorrhoids can be associated with various conditions, and it's thought that they're most often related to straining to pass a bowel movement. Lifting heavy objects, along with other activities that can cause straining, may also lead to hemorrhoids. Increased pressure during pregnancy, and being overweight, are other contributing factors.

Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they're rarely serious, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.

Types of Hemorrhoids: Internal and External

Hemorrhoids are either internal or external.

Internal hemorrhoids  These hemorrhoids develop inside the rectum (the part of the large bowel leading to the anus) and are not usually visible to the naked eye. Internal hemorrhoids generally don't hurt, but they often bleed painlessly.

In some cases, internal hemorrhoids may protrude through the anus and can be seen, which is known as prolapse. When this happens, they will usually shrink back inside the rectum on their own or can be pushed back in. ( 1 )

External hemorrhoids  These hemorrhoids develop under the skin around the outside of the anus. These are the most uncomfortable hemorrhoids and can be itchy or painful, and may feel lumpy. When a blood clot forms within an external hemorrhoid, this is known as a thrombosed hemorrhoid, which can result in severe, ongoing pain. (1) Sometimes clots dissolve on their own, but if they don’t, your doctor can remove the clot, a procedure that’s most effective if done within 72 hours after the clot forms. ( 2 )

Common Questions & Answers

They usually go away after a few days or a week. If they’re recurrent, they might be a literal and figurative pain in the rear to deal with, but they're rarely serious.

Signs and Symptoms of Hemorrhoids

Seeing blood in your toilet bowl after a bowel movement is no doubt alarming, and it’s one of the main symptoms of hemorrhoids. Other symptoms include:

  • Bright red blood on toilet paper or in your stool after a bowel movement
  • Itching in the anal area
  • Pain in the anal area, especially when sitting
  • Pain during bowel movements
  • One or more hard, painful lumps around the anus

If you experience any of these hemorrhoid symptoms, avoid excess straining, rubbing, or cleaning around the anus, which can make irritation and itching worse, and can even lead to bleeding. In addition, try to pat the area dry instead of wiping it.

Learn More About the Signs and Symptoms of Hemorrhoids

Causes and Risk Factors of Hemorrhoids

Several conditions and habits are thought to cause hemorrhoids.

  • Chronic constipation or diarrhea
  • Straining too hard during bowel movements
  • Sitting on the toilet for a long time

Straining, constipation, and prolonged sitting can all affect the blood flow in the area, causing blood to not move at its expected rate (known as pooling) within the vessels, leading to hemorrhoids.

Factors that raise your risk of hemorrhoids:

  • Lack of fiber in the diet
  • Overweight or obesity can put pressure on the hemorrhoidal tissue.
  • Aging; the connective tissue in the rectum and anus becomes weaker, potentially resulting in bulging hemorrhoids.
  • Pregnancy; as the fetus grows and puts pressure on the abdomen, the veins in the rectum and anus become enlarged. The problem typically goes away after birth.

Hemorrhoids and Pregnancy

Hemorrhoids are common during pregnancy, particularly in the third trimester, when the enlarged uterus puts pressure on the pelvis and the veins near the anus and rectum. The increased level of the hormone progesterone during pregnancy can also contribute to the development of hemorrhoids: Progesterone relaxes the walls of the veins, making them more likely to swell.

Some women get hemorrhoids for the first time when they’re pregnant. But if you’ve had hemorrhoids before, you’re more likely to get them again when you’re pregnant.

Fortunately, hemorrhoids usually aren't harmful to your health or the health of your baby, and they typically go away on their own once you give birth. You can often alleviate symptoms with home care, but check with your doctor first to make sure any treatments are safe to take during your pregnancy.

Learn More About Hemorrhoids and Pregnancy

How Are Hemorrhoids Diagnosed?

Your doctor will ask you to describe your symptoms and will take your medical history. They may also look for skin irritation, lumps or swelling, external hemorrhoids, prolapsed internal hemorrhoids, skin tags (excess skin left when the blood clot in a thrombosed hemorrhoid is absorbed by the body), and anal fissures (small tears in the anus that can lead to itching and bleeding). ( 3 )

Your doctor may also check for blood in the stool, examine the muscle tone of your anus, and perform a rectal exam to diagnose internal hemorrhoids. This is done in the doctor's office with a gloved, lubricated finger (an exam of the lower rectum called a digital rectal examination) and an anoscope (a lighted tube that’s inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum). (3) Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are older than 40.

Duration of Hemorrhoids

You can often treat hemorrhoids yourself at home, and symptoms should ease within a week. But if they don't, or if you have rectal bleeding, you should see your doctor, according to the National Institute of Diabetes and Digestive and Kidney Diseases. ( 4 ) Bleeding from the rectum could possibly be a sign of digestive tract problems and bowel diseases, such as ulcerative colitis, Crohn’s disease , or anal or colorectal cancer, so it’s important to treat it seriously, especially if you are over 40. ( 5 )

Treatment and Medication Options for Hemorrhoids

Fortunately, most hemorrhoids can be treated at home or with simple medical procedures in a doctor’s office, depending on the type of hemorrhoid and the severity of your symptoms.

At-Home Hemorrhoid Treatment and Remedies

Avoiding constipation is key in treating hemorrhoids. And diet and lifestyle changes, especially consuming more fiber, may help reduce hemorrhoid symptoms. A fiber supplement, like  Metamucil (psyllium) , and stool softeners, like Citrucel (methylcellulose), can help prevent constipation. But avoid laxatives, which can cause diarrhea and worsen hemorrhoid symptoms.

To ease the discomfort caused by hemorrhoids, you can do several things on your own at home.

  • Take a sitz bath. This is a warm shallow bath that specifically targets the area; most drugstores sell a plastic kit that fits over your toilet.
  • Use an ice pack.
  • Avoid straining during bowel movements.
  • Clean your anus properly and keep it clean after each bowel movement. ( 6 )
  • Sit on cushioned surfaces rather than hard ones, to reduce swelling and prevent new hemorrhoids from forming. (6)
  • As needed, take over-the-counter pain relievers, such as  ibuprofen (Advil, Motrin) ,  acetaminophen (Tylenol) , or aspirin. ( 7 )
  • Try over-the-counter creams, ointments, or pads containing hydrocortisone or witch hazel . These can relieve swelling, pain, and itching. (Products with hydrocortisone can also cause the skin to thin or weaken and should not be used for more than a week at a time.)

Hemorrhoid Treatment in a Doctor’s Office, With or Without Surgery

Medical procedures may be needed for hemorrhoids that don’t go away with home treatments.

Painful external hemorrhoids can be excised (cut off) during an office visit following a shot of local anesthetic to numb the area.

For internal hemorrhoids, a few office procedures may be considered. In rubber band ligation, the most common hemorrhoid procedure performed in the United States, the doctor places a small rubber band around the base of the hemorrhoid, cutting off the hemorrhoid's blood supply. (6) The hemorrhoid typically shrinks and falls off within about a week, though several quick follow-up visits may be required to completely get rid of the hemorrhoid. (1)

Other procedures include sclerotherapy, in which a chemical injected into the hemorrhoid causes scar tissue to form, shrinking the hemorrhoid; and infrared coagulation, in which an intense beam of infrared light causes the scar tissue to form, cutting off the blood supply and shrinking the hemorrhoid. (4)

If you have a large external hemorrhoid, both internal and external hemorrhoids, or an internal hemorrhoid that’s prolapsed (popped out through the anus), a surgical operation called a hemorrhoidectomy may be necessary, though few patients require this procedure. (1)

During a hemorrhoidectomy, the hemorrhoid and surrounding tissue are removed via a small incision, which is usually closed up with stitches afterward. The procedure is performed in an operating room with either localized or general anesthesia, or a spinal block that numbs the bottom half of the body. The procedure is successful in 95 percent of cases, though patients may experience postoperative pain. (6)

Another option that aims to reduce postoperative pain is a stapled hemorrhoidopexy, in which a device pulls the hemorrhoidal tissue upward and to its normal position, stapling it in place. (The staples fall out over time.) (1)

Learn More About Treatment for Hemorrhoids: Medication, Alternative and Complementary Therapies, Surgery Options, and More

Prevention of Hemorrhoids

Keeping your stool soft and having regular bowel movements is one of the best ways to prevent hemorrhoids.

The following tips may help you prevent constipation.

Get plenty of fiber in your diet . A high-fiber diet can make stool softer and bulkier so that it passes easily. According to the USDA's Dietary Guidelines for Americans, adult men younger than 50 should aim for at least 34 grams (g) of fiber a day, and adult women under 50 should aim for 25 g. For those older than 50, the recommendation is slightly lower: 28 g for men and 22 g for women. ( 8 ) But be careful to add fiber to your diet slowly to avoid excessive gas or bloating.

There are a number of easy, healthy ways to incorporate more fiber into your diet. Fiber-filled foods include fruits such as berries, avocados, and pears (especially when you eat the skin). Broccoli , artichokes, and Brussels sprouts are among the vegetables that can up your fiber intake. Whole grains, such as brown rice, quinoa, and oatmeal, are also an important source. Legumes, including lentils, various beans, and green peas, are a great way to get fiber. Nuts and seeds make for a great fiber-filled snack, too.

If you're having trouble getting enough fiber in your regular diet, consider a fiber supplement. (7)

If you experience chronic constipation and suspect that may be contributing to your hemorrhoids, avoid eating too many foods that contain little or no fiber, such as cheese and fast and processed foods.

Drink plenty of water and other fluids .  Recommendations for daily water intake vary and depend on the individual, but the Institute of Medicine of the National Academies has set adequate intake levels at 2.7 liters (91 ounces [oz]) for women and approximately 3.7 liters (125   oz) for men. ( 9 ) This can come from beverages and food, but caffeinated beverages and alcohol can be dehydrating and should not be counted in reaching this intake goal.

Exercise regularly .  Exercise, especially 20 to 30 minutes of moderate aerobic activity a day, can help keep bowel movements regular. (6) And regular exercise may help you lose weight, which may be contributing to the formation of hemorrhoids.

Other tips for preventing hemorrhoids include:

Don’t strain or hold your breath during bowel movements . Straining can put excess pressure on veins and lead directly to hemorrhoid development.

Go to the bathroom as soon as you feel the urge .  Letting the urge subside can make your stool harder to pass.

Avoid long periods of sitting .  Sitting for too long, especially on the toilet, can stress veins in the anus.

Complications of Hemorrhoids

Hemorrhoid complications are rare. Complications may include:

Anemia  Bleeding from chronic hemorrhoids can cause anemia, or not having enough red blood cells. ( 10 ) Red blood cells carry oxygen throughout the body, so having anemia can make you feel tired, weak, or short of breath.

Strangulated hemorrhoid  In rare situations, swelling may cut off the oxygen supply to a hemorrhoid that has prolapsed, causing a strangulated hemorrhoid. This can be extremely painful and incapacitating, and surgery may be needed to treat it. ( 11 )

Research and Statistics: Who Gets Hemorrhoids?

Hemorrhoids are very common in both men and women, affecting about 1 in 20 Americans. ( 12 )   The most common time to get hemorrhoids is between ages 45 and 65. ( 13 )   Hemorrhoids are also common in pregnant women.

By age 50, about half of us have experienced hemorrhoid symptoms, such as itching, bleeding, and rectal pain. At any given time, about 10 million Americans — roughly 4 percent of adults — have hemorrhoids. ( 14 )   It’s estimated that 75 percent of Americans will have hemorrhoids at some point in their lives. ( 15 )

Related Conditions and Causes of Hemorrhoids

Gastrointestinal problems such as constipation and diarrhea can lead to or worsen hemorrhoids. The prolonged sitting or straining that may occur when you're dealing with these issues puts pressure on the hemorrhoidal tissue.

Hemorrhoids also often develop during pregnancy. This is similarly due to greater pressure in the area but can also be due to an increase in blood volume and as a result of hormonal changes that increase the likelihood of swelling. Constipation during pregnancy is a common cause of hemorrhoids.

Resources We Love

Hemorrhoids can be uncomfortable, both to have and to talk about. But clear, straightforward information can help you deal with them.

Essential Orgs for Hemorrhoid Information

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

In addition to basic info about symptoms, causes, and treatment, the NIDDK website offers recommendations on diet and nutrition — what to eat and what to avoid — as well as links to relevant clinical trials that may be seeking participants.

American Society of Colon and Rectal Surgeons

This site provides a comprehensive review of what hemorrhoids are, what causes them, and how to treat them. In cases when pain is severe and hemorrhoids aren't healing with at-home treatment, in-office treatment by a healthcare provider is necessary. This can involve surgical and nonsurgical options.

Mayo Clinic

The Mayo Clinic offers trusted guidance on symptoms, causes, diagnosis, and treatment of hemorrhoids. You can also find answers to specific questions about home remedies and hemorrhoid treatment during pregnancy .

Favorite Podcast on Hemorrhoids

Each episode of the Cleveland Clinic's Butts and Guts podcast explores a different digestive health issue, including a lively, informative one on hemorrhoids .

Additional reporting by Deborah Shapiro .

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

  • Hemorrhoids: Expanded Version.  American Society of Colon and Rectal Surgeons .
  • Hemorrhoids: Diagnosis and Treatment.  Mayo Clinic . May 12, 2021.
  • Diagnosis of Hemorrhoids.  National Institute of Diabetes and Digestive and Kidney Diseases . October 2016.
  • Symptoms and Causes of Hemorrhoids.  National Institute of Diabetes and Digestive and Kidney Diseases . October 2016.
  • Hemorrhoids: Symptoms and Causes.  Mayo Clinic . May 12, 2021.
  • Hemorrhoids and What to Do About Them.  Harvard Health Publishing . February 6, 2019.
  • Treatment of Hemorrhoids.  National Institute of Diabetes and Digestive and Kidney Diseases . October 2016.
  • Dietary Guidelines for Americans, 2020–2025. USDA . December 2020.
  • Report Sets Dietary Intake Levels for Water, Salt, and Potassium to Maintain Health and Reduce Chronic Disease Risk. National Academies of Sciences, Engineering, and Medicine . February 11, 2004.
  • Hemorrhoids.  MedlinePlus . September 19, 2021.
  • The Acute Management of Haemorrhoids.  Annals of the Royal College of Surgeons of England . October 2014.
  • Fox A, Tietze PH, Ramakrishnan K. Anorectal Conditions: Hemorrhoids.  FP Essentials . March 2014.
  • Lohsiriwat V. Hemorrhoids: From Basic Pathophysiology to Clinical Management.  World Journal of Gastroenterology . May 2012.
  • Sanchez C, Chinn B. Hemorrhoids.  Clinics in Colon and Rectal Surgery . March 2011.
  • Lohsiriwat V. Treatment of Hemorrhoids: A Coloproctologist’s View.  World Journal of Gastroenterology . August 2015.
  • American Academy of Family Physicians . September 2020.
  • Mayo Clinic .

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    Most hemorrhoids can be managed at home but consider seeing your doctor for assessment and treatment if you have any of these symptoms: If the pain or bleeding is severe. If you are soiling yourself with stool. If the hemorrhoids keep returning. If you are continuing to experience pain, bleeding and itching from the hemorrhoids after a week of ...

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    Diagnosis. Your health care provider might be able to see external hemorrhoids. Diagnosing internal hemorrhoids might include an exam of your anal canal and rectum. Digital examination. Your health care provider inserts a gloved, lubricated finger into your rectum. This allows your provider to check for anything unusual, such as growths.

  8. What Do Hemorrhoids Look Like: Types and More

    Prolapsed hemorrhoids look like swollen red lumps or bumps coming out of your anus. You may be able to see them if you use a mirror to examine this area. Prolapsed hemorrhoids may have no other ...

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    Hemorrhoids, which are swollen veins in the anus and lower rectum, can be a pain in the butt. Jokes aside, these lumps have a variety of causes but are mainly due to excess pressure on these veins ...

  10. Hemorrhoids

    Symptoms of hemorrhoids usually depend on the type of hemorrhoid. Internal hemorrhoids. Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause: Painless bleeding during bowel movements.

  11. Hemorrhoids Treatment, Symptoms, Causes & Prevention

    Hemorrhoids. Hemorrhoids, or piles, are a common issue. These swollen veins inside of your rectum or outside of your anus can cause pain, anal itching and rectal bleeding. Symptoms often improve with at-home treatments, but on occasion, people need medical procedures. Eating more fiber can help prevent hemorrhoids.

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    Mayo Clinic researchers continually study new diagnosis and treatment options for people with all types of gastrointestinal conditions, including hemorrhoids. Publications See a list of publications about hemorrhoids by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.

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    When to see a gastroenterologist. In the U.S., it is estimated that by age 50, about half of the population has experienced one or more of the classic symptoms of hemorrhoids. But only about 4.4% seek treatment for the condition at any one time. It's fine to start with over-the-counter treatments, says Dr. Dacha.

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    External hemorrhoids are the most uncomfortable, because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin (a skin tag), which may itch or become irritated.

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    There are two basic types of hemorrhoid surgeries. A hemorrhoidectomy involves a doctor cutting away external hemorrhoids and internal hemorrhoids that have fallen out of the anus. Doctors perform this procedure under anesthesia. Hemorrhoid stapling uses a special surgical tool to block blood flow to internal hemorrhoids.

  17. Types of Hemorrhoids: An Overview

    4. Thrombosed Hemorrhoids can cause people a lot of discomfort. This type of hemorrhoid contains a thrombosis or a blood clot within the tissue of the hemorrhoid. They often look and feel like small lumps around your anus. Thrombosed hemorrhoids are complications associated with hemorrhoids where blood clots appear.

  18. When to See Your Doctor About Your Hemorrhoids

    This type of hemorrhoid forms on the skin around the anus. It may look like a pink or purple bump. Symptoms of external hemorrhoids include: Itching around the anus. Bleeding. Pain/discomfort. Swelling. Occasionally, blood from an external hemorrhoid can form a clot. This can lead to severe pain, swelling or a hard lump.

  19. Hemorrhoidectomy: Types of Surgeries To Remove Hemorrhoids

    Hemorrhoidectomy. Surgery to remove hemorrhoids is called hemorrhoidectomy. The doctor makes small cuts around the anus to slice them away. You may get local anesthesia (the area being operated on ...

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    Donna Hill Howes, RN. Family Practitioner. If you're having some of the characteristic symptoms of hemorrhoids - swelling, bleeding, or pain - you may want to visit your regular doctor first. Often, hemorrhoids are mild and can be treated with certain lifestyle changes. If your doctor sees indications of a more complicated case of hemorrhoids ...

  21. Hemorrhoids: Symptoms, Types, and Treatment

    Symptoms include blood when pooping, blood on your stool, or blood in the toilet or on the toilet paper when you wipe. Another symptom is a prolapsed hemorrhoid that dangles from the intestines and falls out of the anal opening. A healthcare provider should check any blood in your poop or when you have a bowel movement.

  22. What Doctor to See for Hemorrhoids?

    Proctologist. A proctologist, or surgeon, would be necessary if your hemorrhoid needed surgically removed. Severe cases will require a hemorrhoidectomy, in which the surgeon will remove your external hemorrhoids completely. If your hemorrhoids are causing a blood clot externally, this is known as hemorrhoid thrombosis.

  23. Hemorrhoids

    In some cases, surgery is needed. There are several types of surgeries used to remove or reduce internal and external hemorrhoids. These include: Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside your rectum to cut off circulation to the hemorrhoid. The hemorrhoid shrinks and goes away in a few days ...

  24. What Are Hemorrhoids? Symptoms, Causes, Diagnosis, Treatment, and

    Falcetti/iStock. Hemorrhoids are enlarged and swollen (also called varicose) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel and leads to the ...

  25. When to See a Doctor for Hemorrhoids

    When to See a Doctor for Hemorrhoids. In most cases, hemorrhoids can be treated at home by drinking water, eating foods that are high in fiber, and taking a stool softener. But if you have any of the below, you should reach out to your provider for care: Symptoms that persist after one week of at-home treatment. Bleeding from your rectum.

  26. Hemorrhoids: Which Treatment Should I Use?

    Bleeding, which may require another doctor visit to treat. Temporary trouble urinating because of pain. If you are completely unable to urinate, you'll need treatment. Infection or abscess. Rubber band ligation appears to cause more pain than other types of nonsurgical procedures. Infrared photocoagulation usually causes fewer side effects ...