Hemorrhoids

Hemorrhoids are swollen blood vessels in the rectal and anal area that can cause discomfort, itching, pain, and bleeding. They are extremely common and often manageable with the right care.

Internal hemorrhoids

Located inside the rectum, these often cause painless bleeding and may go unnoticed until symptoms progress.

External hemorrhoids

Found under the skin around the anus, these can cause itching, pain, swelling, and in some cases thrombosis or rupture (“bursting”), which may result in sudden bleeding and pressure relief.

Thrombosed hemorrhoids

Occurs when a clot forms within an external hemorrhoid, causing significant pain and swelling.

Prolapsed hemorrhoids

Internal hemorrhoids that protrude outside the anus and may require medical intervention.

Internal hemorrhoids are classified by severity, which helps determine the most effective treatment approach:

• Grade I: Hemorrhoids are present but remain inside the rectum. They may cause mild bleeding, but do not prolapse.
• Grade II: Hemorrhoids may prolapse during bowel movements but return inside on their own without intervention.
• Grade III: Hemorrhoids prolapse during bowel movements and require manual repositioning.
• Grade IV: Hemorrhoids remain prolapsed outside the anus and cannot be pushed back in. These often require advanced treatment and may not respond to conservative care.

Internal hemorrhoids are usually painless and often go unnoticed because they form inside the rectum. However, they may cause bright red bleeding or prolapse outside the anus, sometimes needing gentle repositioning.

External hemorrhoids occur under the skin around the anus and are more likely to cause symptoms such as itching, soreness or pain, tender lumps, and bleeding when wiping.

When bleeding means something else

While bleeding hemorrhoids are common, rectal bleeding should always be evaluated to rule out other conditions.

Hemorrhoids are often caused by increased pressure in the lower rectum due to:

• Straining during bowel movements 
• Chronic constipation
• Sitting for long periods 
• Pregnancy 
• Low-fiber diet 
• Diarrhea

Risk factors that make hemorrhoids more likely

• Aging 
• Obesity 
• Sedentary lifestyle 
• Heavy lifting
• Family history

Physical and digital rectal exam

A quick in-office evaluation to assess external and internal symptoms. A chaperone can be available to make the exam more comfortable for you.

Anoscopy and Flexible Sigmoidoscopy

• Anoscopy: A short, rigid scope (about 3–5 inches) is used to examine the anus and lower rectum for conditions such as hemorrhoids, anal fissures, and inflammation. No bowel preparation is required.
• Flexible Sigmoidoscopy: A longer, flexible scope is used to view the lower third of the colon, including the sigmoid colon. It helps detect abnormalities, such as polyps or signs of colon cancer, and can also be used to obtain small tissue samples if needed.

When a colonoscopy is recommended

If you experience ongoing digestive issues such as persistent diarrhea, constipation, or a feeling that your bowel doesn’t empty, it’s important to speak with your NYGA physician. Early detection is key, and your doctor can determine whether a colonoscopy or other diagnostic tests are necessary.

It’s also time to schedule a colonoscopy if you are over 45, have a family history of colon cancer, or have experienced any concerning digestive symptoms. If you haven’t had a colonoscopy in over 10 years, you should schedule a repeat screening exam to help prevent serious health complications through early detection.

At-home care and lifestyle changes

Mild hemorrhoids and anal fissures can often improve with increased fiber intake, hydration, stool softeners, and avoiding straining. Warm sitz baths may also help reduce discomfort and promote healing.

HemWell™: NYGA's Nonsurgical Hemorrhoid Procedure

Performed in our endoscopy centers under anesthesia, HemWell™ uses an electric current to produce a natural chemical reaction that shrinks and ultimately resolves the hemorrhoid. This procedure is typically conducted in conjunction with a colonoscopy.

Infrared coagulation (IRC)

Infrared coagulation is a minimally invasive procedure that uses infrared light to treat internal hemorrhoids. A small probe delivers a quick pulse of infrared energy to the base of the hemorrhoid, creating a controlled burn that cuts off the blood supply. This can be done in office without any prep or downtime.

Rubber band ligation

This in-office internal hemorrhoid treatment is typically performed in a series of two to four sessions. With each treatment, the hemorrhoids gradually shrink until they are eliminated. Once blood flow is cut off, the tissue naturally dies and is passed within seven to 10 days. We refer to our surgical colleagues for this treatment.

When surgery is considered

Surgery is typically reserved for severe, recurrent, or prolapsed hemorrhoids that do not respond to minimally invasive treatments. It may also be considered in cases where complications such as persistent thrombosis or repeated hemorrhoid rupture occur.

NYGA is one of New York City’s leading independent gastroenterology practices, known for expert diagnosis and treatment of hemorrhoids, anal fissures, and rectal bleeding. Our gastroenterologists provide comprehensive, patient-centered care with advanced, minimally invasive options in a convenient setting.

Simple lifestyle habits can go a long way in preventing hemorrhoids from returning:

• Eat a high-fiber diet
• Stay hydrated 
• Avoid straining 
• Stay active 
• Don’t sit for long periods 

Prevention is key to reducing the risk of recurrence after treatment.

Hemorrhoids can cause discomfort and bleeding, which is often manageable with the right care. However, rectal bleeding and related hemorrhoid symptoms are not always caused by hemorrhoids. If you’ve noticed sudden bleeding and are unsure of the source, it’s important to be evaluated.

At NYGA, our physicians identify the exact cause of your hemorrhoids and symptoms and provide targeted treatment options to help relieve discomfort and reduce the risk of recurrence.

Don’t wait—prioritize your health today.