First of all, hemorrhoids are normal structures. They consist of columns of vascular tissue within the anal canal. Most of us have 3 columns. We only notice them when they cause problems. It is at this point that a patient might seek medical advice.

Anatomically, each hemorrhoid consists of an internal and external component. The internal portion lies within the lowermost portion of the rectum and is insensitive to pain. This is what allows ligation and other treatment without discomfort. The external aspect of the hemorrhoid lies just at the opening; which most of us know is extremely sensitive! In fact, it is important to realize that external hemorrhoids cannot be treated surgically without some type of anesthesia.

In a ‘nutshell’, the symptoms caused by internal hemorrhoids are painless bleeding, protrusion, or both. It is at this point that examination and treatment are warranted.

Examination should be done by someone trained in the anatomy and diseases of the anal canal and colon; such as a colorectal Surgeon. The evaluation should include a detailed exam of the anal canal, and quite often colonoscopy to rule out a colonic source of the symptoms.

If the symptoms are being caused by the internal hemorrhoids, treatment will be started. This may consist simply of fiber to treat constipation, sitz baths, and topical ointments. Most patients respond very well to these measures.

If medical treatment fails, ligation can then be used to treat the internal hemorrhoids as described above. This is the most common treatment but other minor procedures can also be considered. .

Hopefully this has helped answer any questions or concerns you might have about hemorrhoids and treatment. Stay tuned for further discussions about common anorectal and colon problems.