Hemorrhoids
Hemorrhoids are extremely common. They're also extremely treatable.
Most respond to simple in-office treatments. For more stubborn cases, Dr. Chung offers the full range of minimally invasive and surgical options.
Hemorrhoids are swollen, enlarged veins located in or around the anus and lower rectum. They're one of the most common conditions people deal with, and most cases are manageable with simple conservative treatments. When hemorrhoids significantly affect your comfort or quality of life, Dr. Chung offers comprehensive evaluation and the full spectrum of treatment options.
Dealing with persistent or painful hemorrhoids? You don't have to tough it out.
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Hemorrhoids Are Extremely Common
~75%
of adults will have hemorrhoids at some point in their lives. If you're dealing with them now, you're in very good company.
Internal vs External Hemorrhoids
Hemorrhoids come in two main types, and the difference affects both symptoms and treatment.
Internal hemorrhoids
Location: Inside the rectum, above the dentate line.
What they feel like: Usually painless because this area has few pain nerves.
How you notice them: Bright red bleeding during or after bowel movements. Larger ones may prolapse (protrude through the anus).
Graded I through IV based on severity and whether they prolapse.
External hemorrhoids
Location: Under the skin around the outside of the anus.
What they feel like: Can be itchy, irritated, or painful when swollen.
How you notice them: Often a lump or swelling you can feel near the anus.
Can thrombose (form a blood clot), causing sudden severe pain and a noticeable hard lump.
Grading for Internal Hemorrhoids
Internal hemorrhoids are classified into four grades based on severity. Grading helps determine the most effective treatment approach.
Grade I
Bleed but don't protrude. Usually managed with fiber, hydration, and lifestyle changes.
Grade II
Prolapse during straining but return to position on their own. Often treated with in-office procedures like rubber band ligation.
Grade III
Prolapse and need to be pushed back manually. Typically treated with rubber band ligation, laser, or surgical approaches.
Grade IV
Permanently prolapsed and can't be pushed back. Usually requires surgical treatment for lasting relief.
Common Symptoms
Hemorrhoid symptoms vary based on type, location, and severity. Common signs include:
Painless bright red rectal bleeding, often noticed on toilet paper or in the bowl
Pain or discomfort in the anal area (especially with external hemorrhoids)
Itching and irritation around the anus
Swelling or a lump near the anus
A feeling of incomplete emptying after a bowel movement
Mucus discharge
Severe cases may involve a thrombosed hemorrhoid, meaning a blood clot has formed within the hemorrhoid. This causes sudden intense pain and a firm lump near the anus. Prompt evaluation matters because treatment is most effective within the first 48 to 72 hours. While rectal bleeding is often due to hemorrhoids, it shouldn't be assumed. An evaluation ensures other causes are ruled out.
Causes and Risk Factors
Several factors contribute to hemorrhoid development, often in combination.
Chronic constipation
Straining during bowel movements is the single most common contributor. Hard stool and prolonged sitting on the toilet both increase pressure on rectal veins.
Chronic diarrhea
Frequent loose stools and increased wiping also irritate the anal area and raise risk.
Pregnancy and childbirth
Increased pelvic pressure during pregnancy and the strain of delivery are common triggers. Often resolves after delivery but not always.
Prolonged sitting
Especially on the toilet. Long bathroom sessions (with phone or reading) increase pressure on anal veins.
Age
Tissues that support rectal veins naturally weaken with age, making hemorrhoids more common after 50.
Obesity
Increases pressure on pelvic veins and is associated with higher hemorrhoid rates.
Heavy lifting
Regular heavy lifting, particularly with breath-holding, significantly increases pressure on rectal veins.
Family history
Genetics influence the strength of supporting tissues and the tendency to develop hemorrhoids.
How Hemorrhoids Are Diagnosed
During your consultation, Dr. Chung will review your symptoms and medical history and perform a gentle physical examination to determine the type, location, and severity of your hemorrhoids. This typically includes a visual exam and often an anoscopy, a quick in-office look inside the anal canal. In some cases, additional testing like colonoscopy may be recommended, especially if bleeding is a concern and there's any question about the source.
Conservative and At-Home Treatments
Many hemorrhoids respond well to non-surgical treatment and lifestyle modifications. Increasing dietary fiber, staying well hydrated, and avoiding straining during bowel movements are foundational. Sitz baths (soaking in warm water for 10 to 15 minutes), over-the-counter creams, and oral pain relievers can ease symptoms during flares. These approaches work for most Grade I and many Grade II hemorrhoids, and they help prevent recurrence after procedural treatment.
Procedural Treatment Options
For persistent or more severe hemorrhoids, Dr. Chung offers the full range of minimally invasive and surgical treatments.
Rubber band ligation
Most common for Grades I to III
Small rubber bands are placed around internal hemorrhoids to cut off blood supply, causing them to shrink and fall off within about a week. Quick, in-office procedure with minimal discomfort.
Coagulation therapy
For smaller internal hemorrhoids
Uses laser, infrared, or heat energy to shrink internal hemorrhoids by sealing off their blood supply. Effective without surgery and minimal recovery.
Sclerotherapy
For small internal hemorrhoids
A chemical solution is injected into the hemorrhoid, causing it to shrink and reduce symptoms. Well-tolerated with minimal downtime.
External thrombectomy
For acute thrombosed hemorrhoids
A quick in-office procedure to remove the blood clot from a painful thrombosed external hemorrhoid, offering immediate symptom relief. Most effective within 48 to 72 hours of onset.
Hemorrhoid stapling
For large prolapsing internal hemorrhoids
A stapling device repositions and cuts off blood supply to prolapsed internal hemorrhoids. Faster recovery and less postoperative discomfort than traditional surgery.
Hemorrhoidectomy
For severe or persistent cases
Surgical removal of hemorrhoidal tissue for lasting relief. Dr. Chung performs this under sedation with careful attention to patient comfort. Reserved for cases that haven't responded to less invasive approaches.
Dr. Chung also offers laser hemorrhoidoplasty (LHP) as an advanced minimally invasive option. For detail, see the laser treatment page.
Prevention
Most hemorrhoids can be prevented or kept in check with everyday habits.
✓Eat a fiber-rich diet (25 to 30 grams daily) with fruits, vegetables, and whole grains.
✓Stay well hydrated, especially when increasing fiber intake.
✓Don't strain during bowel movements. If it's hard, stop and come back later.
✓Go when you feel the urge. Holding it makes stool harder to pass.
✓Keep bathroom visits short. Leave the phone outside.
✓Exercise regularly. Movement supports healthy bowel function.
✓Maintain a healthy weight.
✓Use proper technique when lifting heavy objects. Exhale, don't hold your breath.
Recovery and Aftercare
Recovery timelines vary based on the treatment. In-office procedures like rubber band ligation, sclerotherapy, and coagulation therapy typically involve minimal downtime, with most patients returning to normal activities within a day or two. Surgical treatments require more recovery time, which Dr. Chung will discuss specifically based on your situation. In all cases, you'll receive detailed aftercare instructions covering pain management, activity guidelines, bathroom habits, and follow-up timing.
Get real relief
Most hemorrhoids respond well to simple in-office treatment. Dr. Chung offers the full range of options, from conservative care to advanced procedures, and will help you find the approach that fits.
Book a consultation
Call (714) 988-8690
