Dr. Miller: Rectal bleeding. Could that be a hemorrhoid or what is that? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: Hi, I'm Dr. Tom Miller for Scope Radio, and I'm here with Dr. Molly Gross. She's an Assistant Professor in the Department of Surgery, and she's also a colorectal specialist.
Tell me a little bit about rectal bleeding. If someone comes in and says, "Look, I had some blood that I saw on my stool or in the toilet bowl." Is that usually due to a hemorrhoid, or what should they think?
Dr. Gross: Everyone has hemorrhoids, and often it could be due to hemorrhoidal disease, bleeding from internal hemorrhoids. However, there are other things that can cause bleeding such as a fissure which is a skin tear in the skin by the anus.
Dr. Miller: Is that painful?
Dr. Gross: Yeah. That kind of bleeding usually is associated with pain with the bowel movement. People describe pooping a knife out sideways.
Dr. Miller: Now sometimes hemorrhoids can be painful and sometimes not. What's the difference there? Is there a problem with recognizing what's painful and what isn't in terms of hemorrhoids?
Dr. Gross: Internal hemorrhoids which are up inside usually aren't painful, and they just bleed. External hemorrhoids which is on the outside of the anus, those hurt when they have problems and when the blood vessels inside clot off or thrombose.
Dr. Miller: Is there a simple way to take care of those hemorrhoids, or does one always need to see a surgeon about that?
Dr. Gross: Rectal bleeding can also be concerning because it could represent cancer or a polyp which should be seen by a professional. Hemorrhoids, if you know that you don't have a cancer, and you just have hemorrhoids, the patient can first start to do some things at home to help with those.
Dr. Miller: And what might those things be?
Dr. Gross: The important thing is to have good formed bowel movements. I say have a bowel movement looking like a greased banana. So how do you get that greased banana? Fiber, fiber and fiber.
Dr. Miller: And so what is the best source of fiber? Should people purchase fiber at the store like Metamucil, or do they just up their diet in terms of vegetables and fruits?
Dr. Gross: It's really hard for the average person to eat enough fiber in the day. You'd be having to eat lettuce all day long to get 30 grams of fiber. So I recommend starting Metamucil, Citrucel, or the generic, Fibercon, Konsyl, any of these options. Start with one tablespoon once a day.
Dr. Miller: And then move up to maybe twice or three times a day depending on how it goes?
Dr. Gross: Correct.
Dr. Miller: Okay.
Dr. Gross: Also, the other thing is to not strain on the toilet. Don't bring your phone.
Dr. Miller: Don't sit and read the newspaper, if people are still reading newspapers.
Dr. Gross: Or your phone.
Dr. Miller: Or your iPad.
Dr. Gross: Yeah.
Dr. Miller: And then the other thing about that is what about over-the-counter remedies, Preparation H? Do those things actually work?
Dr. Gross: They can't hurt, but really what needs to happen is to have a better bowel movement and not strain. As long as you're having those troubles, you will continue to have some bleeding. But I also want to stress the importance of being seen by a health care professional to rule out other causes of bleeding like rectal cancer.
Dr. Miller: And so how would one determine if they had those more rare and serious causes of bleeding?
Dr. Gross: A colonoscopy is the best way to rule out other causes of bleeding.
Dr. Miller: So one must not necessarily assume that it's just due to a hemorrhoid. They actually need to see a physician or a health care provide that could actually send you to have a colonoscopy or a sigmoidoscopy to sort out the cause of the bleeding. Now, does everyone that has rectal bleeding need a colonoscopy to rule out the serious nature of bleeding?
Dr. Gross: Not everyone. However, if the bleeding continues despite treatment of the hemorrhoids, or the patient has a family history of colon and rectal cancer, or if they're above 50, they definitely need a colonoscopy.
Dr. Miller: What else would you say for patients that have painful hemorrhoids? Should they use a donut that you can purchase at the pharmacy? Does that work? Does that make any sense?
Dr. Gross: No, donuts really don't work. People who have painful hemorrhoids, like external thrombosed hemorrhoids, if they have a blood clot in them sometimes they get better just from lancing it in the first 24 to 72 hours after the clot has formed. Otherwise, we often recommend sitz baths, so that's filling your bathtub with a little bit of warm water and sitting in it.
Dr. Miller: That sounds like a home remedy. Does that really work?
Dr. Gross: It does work.
Dr. Miller: And if they do that what, once, twice, three times a day?
Dr. Gross: Once or twice a day and after bowel movements.
Dr. Miller: Now, there's something that I understand is called laparoscopic banding. Do you do that?
Dr. Gross: Rubber band ligation is a management, an office procedure to treat internal hemorrhoids that are bleeding. That is simple and easy to do in the office at the time of our initial consultation if we see large hemorrhoids that are causing some problems. Those are for internal hemorrhoids only.
Dr. Miller: Now, if I remember what you said, internal hemorrhoids are not necessarily painful, so banding them would not be painful either.
Dr. Gross: Correct. Banding shouldn't be painful. If it is painful, that can be concerning. Usually patients say it feels like they're sitting on a cue ball for a couple days. There's some pressure but no pain.
Dr. Miller: So the bottom line is if you have rectal bleeding it could be due to a hemorrhoid, but you have to assume that there are other things and perhaps some rare things that are very serious, and you need to have that checked out by a health professional, and certainly bleeding that's persistent needs to be looked at.
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updated: May 7, 2019
originally published: January 6, 2016
