Brief overview
- Which doctor? Family doctor, proctologist, coloproctologist, gastroenterologist, dermatologist, surgeon, gynecologist, urologist
- How does the examination proceed? Anamnesis, inspection, rectal digital examination, proctoscopy, rectoscopy, colonoscopy
- What does a doctor prescribe? Basic therapy (dietary adjustments, exercise, regulated bowel movements), ointments/creams/suppositories to combat the symptoms, depending on the severity, for example sclerotherapy or surgical procedures.
- When to see a doctor? A visit to the doctor is particularly important in the case of blood in the stool or persistent complaints over one to two weeks.
Which doctor do you go to with hemorrhoids?
Blood in the stool, swelling, itching or burning in the area of the anus are common – but also non-specific – complaints of enlarged hemorrhoids. If you suspect that you are suffering from hemorrhoids, your family doctor is usually the first person to contact. Many people find it easier to talk about this with a trusted doctor.
After the initial consultation, it is possible for your (family) doctor to classify the complaints in more detail. Depending on how pronounced and advanced the hemorrhoidal condition is, your doctor will then discuss possible treatment options with you. Mild hemorrhoids are usually treated by your family doctor himself.
Referral to specialist
If the hemorrhoids are severely enlarged, your family doctor will usually refer you to a specialist who will initiate further examinations and treatment. The same applies if you suspect a more serious disease of the anal area – such as anal vein thrombosis or anal cancer (anal carcinoma).
Doctors from the following specialties specialize specifically in the treatment of hemorrhoidal conditions, as well as the diagnosis and treatment of other anal conditions:
- Proctology: The proctologist (lat. proctum = rectum) specializes in diseases of the rectum, anus and pelvic floor. There is also the specialty of coloproctology, which additionally deals with the lower small and large intestine.
- Gastroenterology: Gastroenterologists are specialists in the treatment of gastrointestinal diseases. They also clarify complaints of other internal organs – for example, in the case of disturbed function of the liver, gall bladder or pancreas.
- Gynecology: Affected women can have the complaints clarified by a specialist in gynecology and obstetrics.
- Urology: Affected men can also consult a specialist in urology for a possible hemorrhoidal condition.
- Dermatology: Since hemorrhoids belong to the external skin changes, a dermatologist – as a specialist in skin and venereal diseases – is also a suitable contact.
- Surgery: In more advanced stages often only surgical intervention helps. Surgical removal of hemorrhoids is usually performed by a specialist surgeon.
Which specialist for hemorrhoids is the right one in an individual case depends on the symptoms and possible concomitant diseases. Ask your family doctor for a recommendation as to which specialist in your area would be suitable.
How does the examination proceed?
The examination in the area of the rectum usually proceeds in a similar way. At the beginning, you describe your complaints to your doctor. This is usually followed by physical examinations. In the following, you will learn more about how the respective stages of medical diagnostics proceed.
The anamnesis conversation
First of all, the doctor will offer you a detailed consultation. You will describe your complaints as precisely as possible. The purpose of the discussion is to obtain a medical history. This provides your doctor with initial information about the nature of your complaints, their progression over time and possible causes.
You do not need to be inhibited in this conversation. Even if the topic often makes patients embarrassed or uncomfortable, your doctor is professionally familiar with it. Remember: For the doctor, the anal area is a body part like any other. The ultimate goal is to heal the patient – regardless of the part of the body where the problem is located.
Some of the questions your doctor will ask you are:
- What complaints do you have and since when?
- Do you have itching, burning or pain in the anal area? Do you have stool soiled underwear? Do you have blood in your stool or on toilet paper?
- Are the complaints permanent?
- How often do you have bowel movements? What is the consistency (diarrhea/constipation)? Do you have to push hard during bowel movements?
- Have you already treated your complaints yourself with over-the-counter medicines from the pharmacy? If yes, with which ones?
- Do you have a predominantly sedentary occupation? Do you do sports?
- How do you feed yourself?
Physical examination – the basic proctological diagnostics
After the initial consultation, the next step is a physical examination by a general practitioner or a specialist. Many people find it unpleasant, but it is necessary so that the exact diagnosis can be made.
A number of examination procedures are available for this purpose, ranging from external inspection to rectoscopy. However, usually only a few examinations are necessary. This means that doctors usually only perform the examinations that are most suitable for the individual case. In most cases, this is already sufficient to make a diagnosis.
The basic proctological diagnosis usually takes only a short time. Try to relax during the examination. Talk to your doctor if you fear pain during the process: If necessary, he will numb the anal area locally with an ointment.
In order for the doctor to have a good view of the affected area, he or she will ask you to assume one of the three postures described below:
- Lithotomy position: In this position, the patient lies flat on his back. The hips are bent 90 degrees and the lower legs lie in raised half-shells with the knees bent. The legs are slightly spread.
- Left side position: For this position, the patient lies on a flat examination couch on his left side and pulls both knees to his abdomen. It may be helpful to pull the right buttock up slightly with the hand.
- Knee-elbow position: To do this, the patient leans forward on his elbows and lower legs in a quadrupedal position.
While you are in one of these postures, your doctor will then use individual of the following examination procedures:
- Inspection: The doctor assesses the anus from the outside and determines whether inflammation, skin irritation, tears or bluish, pressure-painful thickenings (anal vein thrombosis) are visible. Since small hemorrhoids usually only protrude from the anus when pressure is applied, he may ask you to push briefly.
Remember that the examination is routine for the doctor and a fixed part of his daily medical routine. He is familiar with the patients’ worries and sense of shame associated with the examination.
- Digital-rectal examination: In this usually painless, short examination, the doctor carefully palpates the anus and the anal canal with his finger. He looks for changes in the mucous membrane and the tension of the sphincter muscle. Beforehand, he creams the anus and his gloved finger with a lubricant.
- Proctoscopy: In this procedure, the doctor inserts a rigid tube about the thickness of a finger or a flexible examination tube with a light source into the rectum to examine it from the inside. To do this, he fills it with a little air so that the intestine unfolds and the mucous membrane can be better assessed. This is preceded by an enema.
- Rectoscopy (rectoscopy of the rectum): It is similar to proctoscopy. However, the doctor looks not only at the anal canal, but at the entire colon. This examination is necessary if the doctor suspects changes in the colon.
- Colonoscopy (intestinal endoscopy): Colonoscopy is rarely necessary for suspected hemorrhoids. It is primarily used to rule out colorectal cancer.
Read more about the topic in the article Colonoscopy.
What does a doctor prescribe for hemorrhoids?
In the case of hemorrhoids, doctors primarily prescribe you a basic therapy. This includes, among others, the following behavioral measures:
- Dietary adjustment: more fiber, drink adequate fluids, reduce weight if overweight.
- Physical activity: more movement, no sitting for long periods of time
- Going to the toilet: no heavy pressing, regular bowel movements, proper hygiene of the anal area.
In many cases, the doctor will also prescribe ointments, creams, suppositories or anal tampons (suppositories with a gauze insert), which have an anti-inflammatory and/or analgesic effect. In many cases of hemorrhoids with symptoms, doctors also advise sclerotherapy or surgical interventions. What exactly makes sense depends on the severity.
For more on the different severities of hemorrhoids and their treatment, see the article Hemorrhoids.
When is a visit to the doctor important?
Regardless of the cause behind the complaints, the sooner the doctor finds the cause and treats it, the better the chances of success.
A visit to the doctor is particularly urgently recommended if bleeding occurs during or after defecation. There is a particularly high degree of urgency if the symptoms do not subside after one to a maximum of two weeks.
It is only possible for a doctor to assess the exact cause of anal discomfort and clarify it on the basis of examinations.
