Hemorrhoids? See a gastroenterologist

We humans seem to have a nearly universal need to avoid embarrassment. It could be something as simple as mispronouncing a word or tripping as you walk along a crowded sidewalk. No matter the blunder, our response is instinctive: Hide, hope no one noticed and move on.

But what happens when what you are embarrassed about is related to your health? There are some aspects of your body and how it functions that you’d really rather not talk about—even with a doctor. But sharing potentially embarrassing symptoms with your physicians may be the only way for them to accurately diagnose and treat you. Chances are specialists have heard it—and seen it—all before and know how to help.

“When people talk about problems with private parts in particular, there are issues of shame and embarrassment,” acknowledges Toby Chai, MD, a Yale Medicine urologist, who treats urinary incontinence (the involuntary loss of control of urine). “But, there is no taboo topic.”

If you’re concerned about discussing these or other health conditions, know that your doctor is the right person to tell. “We are advocates for the patient, and we have to know how an issue affects him or her to help,” Dr. Chai says.

Still, it can be awkward and difficult, and you’re not alone in feeling that way. Studies show that just about everyone experiences social discomfort when dealing with such “embarrassing” medical conditions as incontinence, hemorrhoids, and saggy skin after weight-loss surgery, to name a few. Our doctors help walk you through what might happen if and when you broach the subject with your physician.

Hemorrhoids and gastroenterology

Everybody has veins, and hemorrhoids are what happen when veins in the rectum get inflamed and swollen, says Mayra Sanchez, MD, a Yale Medicine gastroenterologist. Hemorrhoids can happen to anyone. They can trigger itching, rectal bleeding and pain—all symptoms worth mentioning to your doctor.

“When patients strain a lot, this can cause hemorrhoids,” says Dr. Sanchez. Straining can come in many forms, including childbirth, heavy lifting or difficult-to-pass bowel movements, which cause veins in the skin to pop out around the anus (external hemorrhoids) or the lower rectum (internal hemorrhoids).

While hemorrhoids are relatively common as people age or for women who have had a couple children, she says, they can happen in younger people, too. “Weight lifting can make you have hemorrhoids,” says Dr. Sanchez, “and sometimes it’s embarrassing for young guys who spend time at the gym to come in and say they have symptoms like rectal bleeding.” This happens because lifting weights increases abdominal pressure. “When blood vessels pop up on your neck during weight lifting, vessels are also going to distend in the rectum,” she explains.

Straining to go to the bathroom when constipated also builds abdominal pressure, making the veins in the rectum swell, she says. And, the gas and bloating that typically go hand-in-hand with constipation can make a private problem that people with hemorrhoids experience suddenly a very public one.

If you suspect you have hemorrhoids, your doctor will take your medical history and perform a physical exam to see if you have swollen tissues in the anus. Your doctor will also likely perform a digital rectal exam (which is when the doctor inserts a gloved finger into the rectum) to feel for internal hemorrhoids. For mild hemorrhoids caused by constipation, simple solutions such as adding fiber to your diet (or cutting back if you have a lot) and increasing your water intake may be suggested. Your doctor may also suggest over-the-counter creams or prescription medications to help alleviate itchiness, swelling and any mild pain you may have.

If you’re experiencing rectal bleeding, your doctor will likely want to perform a colonoscopy to rule out other conditions. “Blood mixed with the stool is usually not hemorrhoid related,” she says. “We are seeing an increase in younger patients with colon cancer, so if you have rectal bleeding, see your doctor.”

If no other causes of rectal bleeding are found during a colonoscopy, a quick endoscopic laser treatment can be performed to seal the leaky blood vessels associated with hemorrhoids.

For hemorrhoids that are thrombose (protruding) and bleeding, your doctor may recommend a surgical procedure (performed by a colorectal surgeon) to drain the hemorrhoids. If very enlarged, Dr. Sanchez says, a minor surgical procedure using elastic bands or staples can be used to repair blood vessels.

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