FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

IF RECTAL PROBLEM ISN’T BETTER IN A FEW WEEKS, SEE DOCTOR

Question: I’ve recently developed a hemorrhoid, and it itches and is slightly painful. As before, I can feel a small pea-sized lump in the rectal area. I have no signs of bleeding. The last time I had a hemorrhoid, I went to the doctor and he examined me, confirmed it was a hemorrhoid, and told me that it would probably go away on its own. A few weeks later it was gone. How long would it be reasonable for me to wait before seeing a doctor this time?

Answer: As you probably know, hemorrhoids are a very common ailment of the human race. It’s been estimated that by age 50, more than half the U.S. population will have had one or more bouts with hemorrhoids. Hemorrhoids are virtually never life threatening, and as your experience indicates, they usually do resolve spontaneously. When they don’t get better on their own, there are a number of surgical options that can shrink and/or remove the hemorrhoidal tissue. Many of these can be performed right in your doctor’s office.

Before I answer your question directly, I need to give you and my other readers a little background on hemorrhoids and how they develop. There are two types of hemorrhoids -- internal and external. I’ll tell you, briefly, about each.

A hemorrhoid that arises above the line where the skin from the outside meets with the mucosal skin of the inside of the rectum is called an internal hemorrhoid. When the hemorrhoid originates below this mucosal junction, it is called an external hemorrhoid.

Both types of hemorrhoids develop by a somewhat similar process. The only difference is the location of the blood vessels involved. The rectum -- on both sides of the mucosal junction -- contains a large number of veins which are all interconnected. A hemorrhoid develops when one of these veins becomes swollen and dilated in a process similar to the development of a varicose vein in the leg.

The primary symptom of an internal hemorrhoid is bright red bleeding on the toilet tissue or in the toilet. It may also protrude to the outside and become painful and irritated. An external hemorrhoid is commonly first noticed as a painful swelling or lump in the rectal area. Frequently people with hemorrhoids complain of rectal itching, as well.

From your description, it sounds like you may have an external hemorrhoid. Since you report no bleeding, I think it would be safe to wait a couple of weeks. We doctors call this “watchful waiting.” However, if at the end of that watchful waiting period you are still bothered by the same symptoms, I’d schedule an appointment with your doctor. Though the odds are that you are suffering another bout of hemorrhoids, it’s always best to err on the safe side.

Symptoms like those that you describe can in rare circumstances be the first sign of rectal cancer. As with all cancers, early detection is the key to successful treatment and a complete cure.

In the meantime, you can use over-the-counter preparations to receive some symptomatic relief. Also, taking a sitz bath a few times a day, and eating a high-fiber diet to soften your stool can be helpful.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org