Gastroenterologist or Colorectal Surgeon for Hemorrhoids: What’s Best?

When dealing with the discomfort and uncertainty of hemorrhoids, one question often leaves patients at a crossroads: should you see a gastroenterologist or a colorectal surgeon? The answer isn’t always straightforward—and making the right choice could significantly affect your comfort, treatment success, and recovery. But what factors truly determine the best path forward? The surprising truth may challenge what you think you know.

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What’s the Role of a Gastroenterologist in Treating Hemorrhoids?

A gastroenterologist plays a key role in diagnosing, treating, and preventing hemorrhoids—especially when symptoms persist or at-home remedies don’t help. Their approach involves evaluating the condition, offering minimally invasive therapies, and referring to a colorectal surgeon when surgery might be needed.

They may perform tests such as an anoscopy, which allows a direct view of the anal canal and lower rectum to assess the presence and severity of hemorrhoids.

If hemorrhoids don’t respond to conservative treatment or become more severe, the gastroenterologist can refer the patient to a colorectal surgeon. In some cases, surgery such as a hemorrhoidectomy may be necessary to remove the hemorrhoids.

When hemorrhoids cause complications like heavy bleeding or thrombosis, a gastroenterologist can take steps to stabilize the condition, relieve symptoms, and prevent future episodes with a tailored treatment plan.

Differences in Approach: Medical vs. Surgical Treatment

Hemorrhoid treatment can vary depending on how severe the condition is. Medical approaches are typically enough for mild to moderate cases, while surgery is reserved for more complex or treatment-resistant situations. Here’s a breakdown of the two paths:

Medical Treatment

This is usually the first option for managing hemorrhoids. The goal is to relieve symptoms and prevent the condition from worsening without surgery.

Lifestyle and dietary changes
These help reduce straining during bowel movements and ease pressure on hemorrhoidal veins.

Medications

• Topical: Creams and ointments with corticosteroids or lidocaine can reduce swelling, itching, and pain.
• Oral: Stool softeners and venoactive drugs improve blood flow and ease symptoms.

Surgical Treatment

If medical therapies don’t work or hemorrhoids are too advanced, surgery might be needed.

Common reasons for surgery

• Internal hemorrhoids at an advanced stage
• External hemorrhoids with persistent symptoms
• When conservative methods fail

Medical treatment is often effective for less severe hemorrhoids. Surgical options are best for advanced cases that haven’t responded to other approaches. Treatment decisions should be based on the severity of the condition and the patient’s needs, guided by a healthcare provider.

Non-Surgical Options: How a Gastroenterologist Can Help

With adjustments to daily habits, medications, and minimally invasive procedures, a gastroenterologist can help relieve symptoms and keep the condition from progressing without the need for surgery.

Lifestyle Changes

The first step in non-surgical care involves correcting habits that contribute to hemorrhoids.

• High-fiber diet: Eating fruits, vegetables, legumes, and whole grains softens stool and promotes easier bowel movements, reducing rectal pressure.
• Proper hydration: Drinking enough water supports regular digestion and prevents constipation.
• Regular exercise: Staying active improves circulation and lessens rectal vein pressure.
• Avoid straining: Not pushing during bowel movements and minimizing toilet time helps prevent irritation.

Topical and Oral Medications

A gastroenterologist may recommend medications to manage symptoms such as pain, itching, and swelling.

Topical treatments

• Creams and ointments with hydrocortisone, witch hazel, or lidocaine ease external discomfort.
• Suppositories soothe internal hemorrhoids, reduce pain, and support healing.

Oral medications

• Pain relievers for symptom control
• Venoactive and anti-swelling agents to strengthen veins and reduce heaviness or bleeding

Minimally Invasive Procedures

When conservative care doesn’t work, gastroenterologists can offer in-office procedures that don’t involve surgery.

• Rubber band ligation: A band is placed around the base of the hemorrhoid to cut off blood flow, causing it to shrink and fall off.
• Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it and reduce bleeding.
• Infrared coagulation: Infrared light is used to heat and shrink the hemorrhoidal tissue.

These non-surgical solutions offer effective, lower-risk options for managing hemorrhoids, improving daily life, and often eliminating the need for surgery.

Surgical Solutions: When a Colorectal Surgeon Is Necessary

If hemorrhoids become too severe for medical or minimally invasive treatments, a colorectal surgeon may be needed. These specialists are trained to diagnose and treat complex conditions involving the colon, rectum, and anus, including advanced hemorrhoids.

Surgical options include rubber band ligation, hemorrhoidectomy, stapled hemorrhoidopexy, infrared coagulation, and transanal hemorrhoidal dearterialization (HAL-RAR). Rubber band ligation is a common office procedure for internal hemorrhoids. Hemorrhoidectomy is a more involved surgical method typically used for severe or prolapsed hemorrhoids. Other techniques, like stapled hemorrhoidopexy or HAL-RAR using Doppler guidance, provide targeted solutions based on the patient’s condition.

Surgical decisions should be based on the severity of symptoms, overall health, and a thorough evaluation by the colorectal surgeon. While some techniques are minimally invasive, others may be more complex. These options can offer long-term relief and are often the best course for patients with advanced or recurring hemorrhoids.

Sources:

• Doctor, F. Y. F. Hemorrhoids.
• Garg, P. (2018). Conservative treatment of hemorrhoids deserves more attention in guidelines and clinical practice. Diseases of the Colon & Rectum, 61(7), e348.