Hemorrhoids are one of the most common reasons people see a gastroenterologist, and for many people in Northern Virginia they are uncomfortable but very treatable. Understanding what hemorrhoids are, what causes them, and which symptoms call for an evaluation can help you decide when simple measures at home are reasonable and when it is worth seeing a physician. This guide walks through internal and external hemorrhoids, the symptoms to watch for, common causes, general conservative measures, and an overview of the in-office options a gastroenterologist may discuss.
This article is general education, not medical advice. Your symptoms should be evaluated by a physician who can consider your full history.
What are hemorrhoids: internal versus external
Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. Everyone has these vessels, but they can become enlarged and bothersome. There are two main kinds. Internal hemorrhoids form inside the rectum, above the area where you can feel them, and are often not painful even when they bleed. External hemorrhoids form under the skin around the anus, where they can be felt as one or more firm, tender lumps. Some internal hemorrhoids can also prolapse, which means they push through the anal opening, and that can cause more noticeable discomfort. According to the National Institute of Diabetes and Digestive and Kidney Diseases, internal hemorrhoids that have not prolapsed most often are not painful.
Common symptoms of hemorrhoids
Symptoms depend on whether a hemorrhoid is internal or external. Internal hemorrhoids most often show up as bright red blood on the stool, on the toilet paper, or in the toilet bowl after a bowel movement, usually without pain. External hemorrhoids tend to cause anal itching, an ache or pain that is worse when sitting, and one or more hard, tender lumps near the anus. Many people find that the symptoms of external hemorrhoids ease within a few days. Because the signs overlap with other conditions, it helps to have any new or ongoing symptoms looked at rather than assuming the cause.
What causes hemorrhoids
Hemorrhoids develop when the vessels in the anal area come under repeated pressure. Common causes and contributing factors include straining during bowel movements, sitting on the toilet for long periods, chronic constipation or diarrhea, a diet low in fiber, and the natural weakening of supporting tissue that can come with age. Pregnancy and frequent heavy lifting can also raise the pressure in this area (our page on digestive problems in pregnancy covers hemorrhoids during pregnancy). Many of these factors are everyday habits, which is part of why hemorrhoids are so common and why small adjustments can make a meaningful difference for some people.
Rectal bleeding should not be assumed to be hemorrhoids
This is the most important point for anyone dealing with hemorrhoids in Northern Virginia. Hemorrhoids are a frequent cause of rectal bleeding, but they are not the only cause. The NIDDK is clear that not every anal symptom is caused by a hemorrhoid, and that bleeding can also come from other conditions, including inflammatory bowel disease such as Crohn's disease or ulcerative colitis, and colorectal cancer. For that reason, new, persistent, or changing rectal bleeding deserves a professional evaluation rather than self-diagnosis. A gastroenterologist can examine the area, look higher in the colon when appropriate, and rule out other causes. You can learn more in our guide to colon polyps and colorectal cancer in Northern Virginia.
General conservative measures that may help
For milder hemorrhoids, some everyday measures may ease symptoms, and they are reasonable to consider while you decide whether to see a physician. People often find it helpful to add more fiber through high-fiber foods or a fiber supplement, to drink water and other nonalcoholic fluids through the day, and to avoid straining or sitting on the toilet for long stretches. Sitting in a few inches of warm water, sometimes called a sitz bath, several times a day is another comfort measure many people use. Over-the-counter products are widely available, and topical treatments are generally meant for short-term use, so it is worth reading labels and checking with a pharmacist or physician. These steps are general and may not be enough on their own, especially when symptoms are frequent or bleeding is present, so think of them as a starting point rather than a substitute for evaluation.
In-office and procedural options for hemorrhoids
When conservative measures are not enough, a gastroenterologist may discuss office-based procedures, most of which are designed to shrink an internal hemorrhoid by reducing its blood supply. The NIDDK describes several common approaches. Rubber band ligation places a small band around the base of an internal hemorrhoid to cut off its blood supply. Sclerotherapy involves injecting a solution that causes scar tissue to form. Infrared photocoagulation and electrocoagulation use heat or an electrical current to create scar tissue that reduces blood flow. For more severe or persistent hemorrhoids, a surgeon may discuss a hemorrhoidectomy or a stapling procedure performed under anesthesia. Each option has its own benefits, what-to-expect details, and possible risks, which is why the right choice is individualized and made together with your physician. You can read more from the National Institute of Diabetes and Digestive and Kidney Diseases.
When to see a gastroenterologist
It is reasonable to see a physician for hemorrhoids in Northern Virginia when symptoms are persistent, painful, or interfering with daily life, or when home measures have not helped. Bleeding is the symptom that most deserves attention. Because rectal bleeding can have causes other than hemorrhoids, any new or ongoing bleeding is worth an evaluation, and it should be looked at promptly if it is heavy, if you feel lightheaded, or if you notice black or tarry stools. A change in bowel habits, unintended weight loss, or a family history of colorectal cancer are also good reasons to talk with a gastroenterologist rather than continuing to guess.
Hemorrhoid care in Northern Virginia with GC of NoVA
Gastroenterology Center of Northern Virginia helps patients across Arlington, Annandale, and the surrounding communities understand and manage hemorrhoids and related digestive concerns. Our physicians can evaluate your symptoms, look for other possible causes of bleeding, and talk through the options that fit your situation, from conservative measures to in-office procedures. We see patients at our Arlington office, next to VHC Health, and our Annandale office, in the Woodburn Medical complex.
To schedule an evaluation, contact our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106, or learn more at gcofnova.com.
Frequently asked questions about hemorrhoids in Northern Virginia
What is the difference between internal and external hemorrhoids?
Internal hemorrhoids form inside the rectum and are often not painful even when they bleed, while external hemorrhoids form under the skin around the anus, where they can feel like firm, tender lumps and may itch or ache.
Is rectal bleeding always caused by hemorrhoids?
No. Hemorrhoids are a common cause of rectal bleeding, but bleeding can also come from other conditions, including inflammatory bowel disease and colorectal cancer. New, persistent, or changing bleeding deserves a professional evaluation to rule out other causes.
What can I do at home for hemorrhoids?
General measures some people find helpful include adding fiber, drinking fluids, avoiding straining and long periods on the toilet, and using warm sitz baths for comfort. These steps may not be enough on their own, so it is reasonable to see a physician if symptoms persist or bleeding is present.
When should I see a gastroenterologist for hemorrhoids?
Consider a visit when symptoms are persistent, painful, or not improving with home measures, and especially when you notice rectal bleeding, a change in bowel habits, unintended weight loss, or a family history of colorectal cancer.
This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.
