Hemorrhoid Information

What are hemorrhoids?

Hemorrhoidal tissue is a part of every human’s normal anatomy within the anal canal. This tissue is comprised of blood vessels, connective tissue and a small amount of muscle and has the ability to swell and cause noticeable symptoms.

There are two types of hemorrhoids, each of which can have different symptoms and treatment options. Internal hemorrhoids are covered with a lining called mucosa that is not sensitive to touch, pain, stretch, or temperature, while external hemorrhoids are covered by skin that is very sensitive.

Behaviors that can lead to the development of hemorrhoids include obesity, heavy lifting, pregnancy, presence of constipated hard stools that require repeated straining during bowel movements, and sitting on the toilet for extended amounts of time (even without straining).

Hemorrhoid Symptoms

According to the American Society of Colon and Rectal Surgeons, about 5% of people will develop symptoms attributable to their hemorrhoids and only a small fraction of those patients will need surgery. Symptoms may include rectal bleeding, pain, pressure, itching, fecal or mucus seepage, and prolapse (bulging or protruding out).

As a variety of anal conditions typically show symptoms similar to those of hemorrhoids, it is best to see an experienced colon and rectal surgeon for evaluation and proper diagnosis.  As a board certified surgeon, Dr. Perryman has the knowledge and experience to ensure that your condition is accurately diagnosed so that appropriate treatment options can be discussed.

Symptoms of Internal Hemorrhoids

Internal hemorrhoid symptoms are often painless and can include rectal bleeding or prolapse and protrusion. Larger internal hemorrhoids can sometimes be felt on the outside of the anus when wiping or having a bowel movement, though the tissue often goes back inside spontaneously or can be pushed back by the patient. Patients will typically experience bright and painless bleeding, which can be seen on the toilet paper or dripping into the toilet bowl. Prolapsed tissue may also lead to significant irritation and itching around the anus.

Symptoms of External Hemorrhoids

An external thrombosed hemorrhoid is a spontaneously occurring, bluish-colored painful lump outside the anus. This lump tends to appear after an unusual amount of bowel straining or other vigorous physical activity, causing blood clots and severe pain. Patients may also experience intermittent swelling, pressure, and discomfort.

Hemorrhoids During Pregnancy

Over half of all pregnant women are affected by hemorrhoids, typically toward the end of the second and into the third trimester. Symptoms of pregnancy hemorrhoids may include discomfort, heaviness, anal itching, painless bleeding, and anal fissures.

Over half of all pregnant women are affected by hemorrhoids, typically toward the end of the second and into the third trimester. Symptoms of pregnancy hemorrhoids may include discomfort, heaviness, anal itching, painless bleeding, and anal fissures.

While hemorrhoids can be very uncomfortable during a pregnancy, there are ways to successfully manage the discomfort without surgery. Nonsurgical treatment of pregnancy hemorrhoids include over-the-counter creams and ointments as well as adjustments to physical movement. To properly treat pregnancy hemorrhoids, patients should consult a colorectal specialist or surgeon.

Evaluation of Hemorrhoids Treatment

As a leading expert in hemorrhoids treatment, Dr. Perryman, a board certified colon and rectal surgeon, is well qualified to evaluate your condition and provide the treatment and relief you need. Hemorrhoids are a common condition we see in the office. We treat each patient according to their unique situation and needs. If you decide to come to our office for evaluation, Dr. Perryman will conduct a private consultation and gentle exam. She will then discuss her findings, the treatment options available, the pros and cons of each, make recommendations, answer all of your questions, and help you to make an informed decision on what is the best option for you.


Hemorrhoid Treatments – what options are available?

A variety of non-surgical, painless treatments can be performed in our office to treat symptomatic internal hemorrhoids. These treatments are quick, effective, result in minimal to no discomfort, and no prolonged recovery time is needed. Most patients can return to work the same day, and the treatments are covered by most insurance plans.

Dr. Perryman can perform an exam and then discuss with you the type and size of hemorrhoids you have, which will then determine what treatment options would be most suitable.


Rubber band ligation is a painless procedure where a small rubber band is placed around a hemorrhoid which cuts off the blood supply to the hemorrhoid so it dies and falls off.  Rubber band ligation is effective for grade 2 and 3 internal hemorrhoids.


Infrared coagulation (IRC) is another technique to shrink internal hemorrhoids by applying a controlled amount of infrared energy to the hemorrhoid.  This coagulates the vascular tissue of the hemorrhoid, causing it to shrink.   IRC is best suited for bleeding grade 1 internal hemorrhoids.  Usually, only one treatment session is required.


A thrombosed external hemorrhoid is a very painful condition in which blood clot and swelling develops in an external hemorrhoid.  The patient feels a firm, tender lump by the anal opening.  Removal of the external hemorrhoid is usually recommended within the first three days of the onset of symptoms.  Removal can usually be performed in the office and results in a significant decrease in pain faster than letting the hemorrhoid resolve on its own.  External hemorrhoids cannot be treated with IRC or rubber band ligation.  It is best to see a colorectal surgeon for treatment of this condition. For more information on thrombosed external hemorrhoids, click here.


Surgical treatment of internal and external hemorrhoids is reserved as a last option treatment.  Most patients with symptomatic hemorrhoids do not need a formal hemorrhoidectomy performed in the operating room.  If needed, however, Dr. Perryman does offer this service and will discuss the procedure and recovery with you in detail before proceeding.