10 common misconceptions in proctology: hemorrhoid myths and facts

It is hard to talk openly about proctological complaints. Because they are embarrassed, people take advice not from a doctor but from a neighbor, a pharmacy or the internet, and accept what they hear without checking it. That is how wrong ideas are passed from one generation to the next. As a result, treatment of a problem that could have been solved in a simple way is delayed for months, sometimes years, and the condition gets worse. Sometimes such advice is plainly harmful: one of our patients, who listened to acquaintances saying "don't go to the doctor until there's bleeding," ended up having to be taken into surgery in the evening with bleeding. We have heard each of the ideas below many times at appointments.

In fact: hemorrhoids are the enlargement and downward slipping of the blood-vessel cushions of the anal canal. After a flare-up, pain and bleeding can settle for a while, and this looks like healing. But enlarged lumps do not return to their former state on their own. As long as the causes (constipation, straining and sitting for a long time) remain, the condition can progress from stage I to stage IV. In stage I, the lumps bleed but don't come out. In stage II, the lumps come out during a bowel movement and go back in on their own; in stage III, they have to be pushed back by hand; and in stage IV, they don't go back.

The good news is that in the early stages, treatment is often non-surgical: correcting diet and toilet habits, and products prescribed by a doctor. A small external lump that causes no complaints sometimes needs no treatment at all. The doctor tells you this after an examination. Stages and treatment options: hemorrhoid treatment.

In fact: although hemorrhoids and anal fissure are the most common causes of anal bleeding, they are not the only causes. Polyps, inflammation of the rectum (proctitis), inflammatory bowel disease and colon cancer can also cause similar bleeding. You can't tell the cause at home from the color or amount of blood, or from whether there is pain. Blood mixed with the stool, dark blood, or blood that comes with mucus, abdominal pain or weight loss needs special attention.

In patients who wait for months, telling themselves "it's hemorrhoids," a more serious condition is sometimes found at a late stage. That is why every anal bleed needs an examination. After age 45–50, when there is bowel cancer in the family, or when bleeding comes with weight loss, anemia or a change in bowel habits, colonoscopy is recommended. More: blood on toilet paper.

In fact: recurrence is possible, but it is not inevitable. The chance of it depends on the stage of the disease, the method chosen and, most of all, on whether the causes that created the condition remain.

If constipation continues after surgery, the habit of sitting long and straining on the toilet stays or you lift heavy loads, the risk rises. A fiber-rich diet, enough water, movement and good toilet habits lower the risk considerably. Coming to follow-up examinations matters too, because it lets us see changes early and act in time. Among our patient stories, there is a case in which no recurrence was found at a check-up four years after a complex operation, but every patient's situation is individual. We explain which method suits you better, and its strengths and weaknesses, after an examination: hemorrhoid treatment.

In fact: the operation itself is done under anesthesia, so no pain is felt during it. Depending on the type of operation and the patient's condition, local, spinal or general anesthesia is chosen.

In the first days after surgery, especially at the first bowel movements, there may be some pain and discomfort. This pain is kept under control with painkillers prescribed by the doctor, warm sitz baths and a diet that keeps the stool soft. We discuss separately with you before surgery how pain will be managed. After less traumatic methods, for example laser treatment, pain is usually less and recovery is shorter. Many of our patients say afterward that the operation was not as hard as they feared. More: laser treatment.

In fact: there is only part of the truth here. It has not been proven that spicy food by itself causes hemorrhoids. The main causes of hemorrhoids are chronic constipation or diarrhea, straining and sitting for a long time on the toilet, a sedentary life, heavy lifting, pregnancy and heredity.

But in some people, spicy and heavily seasoned food and alcohol increase burning and irritation in the anal area after a bowel movement, especially when there is an anal fissure and after surgery. That is why it is advisable to limit these foods during a flare-up and during the weeks of healing. More important than banning spicy food entirely is preventing constipation: fiber, water and movement. More: constipation treatment.

In fact: suppositories and ointments sold at the pharmacy can reduce pain, itching and inflammation for a while, but they don't remove enlarged lumps. Using them without a diagnosis creates a bigger problem: by easing the complaints temporarily, they hide an anal fissure, a fistula, a polyp or a tumor and delay the right treatment. Folk methods such as garlic, various oils and herbal baths at best give passing relief and don't remove the root of the disease.

This doesn't mean suppositories and ointments are useless. After a correct diagnosis, for example in the early stage or after surgery, when used as your doctor prescribes, they are a useful part of treatment. It is just that a doctor should choose them, not a neighbor or an advertisement. More: surgical and conservative treatment.

In fact: an anal fissure, a tear in the anal lining, often heals without surgery in the early stage. In a fresh (acute) fissure, the main aim is to soften the stool and reduce spasm of the sphincter (the ring-shaped muscle that closes the anal canal). For this, a fiber-rich diet and enough water, warm sitz baths and creams prescribed by a doctor are used.

If a fissure lasts more than 6–8 weeks, its edges harden, a skin tag can form next to it and it turns into a chronic fissure. Even with such a fissure, medication treatment is tried first. If it gives no result, a short, less traumatic operation is offered, for example lateral internal sphincterotomy (LIS, a small cut that relieves spasm in the internal sphincter) or laser treatment. Such an operation usually takes 15–20 minutes. More: anal fissure treatment.

In fact: colonoscopy is an examination of the colon from the inside with a thin, flexible camera. Modern colonoscopy is often done under sedation, that is, a short medication-induced sleep, so most patients feel no discomfort during the examination. Afterward, there may be bloating and a feeling of gas for a while, and this passes quickly. For the quality of the examination, it is important to follow the preparation rules correctly. We explain these rules to you separately in advance.

As for the gut flora: the bowel cleansing before the examination changes the flora temporarily, but it usually recovers on its own within a few weeks. The benefit of colonoscopy is great: it shows the cause of bleeding, lets polyps be removed during the same examination and helps find bowel cancer at an early stage, even prevent it. More: colonoscopy.

In fact: after childbirth, hemorrhoids, anal fissure, rectocele (a bulging of the front wall of the rectum toward the vagina), urinary leakage when coughing and laughing and a loose vagina are very common. But the fact that these problems are common does not mean they are normal or must be put up with for life.

In mild cases, pelvic floor exercises and treating constipation can help. If needing to help with your hand to have a bowel movement, a feeling of incomplete emptying or urinary leakage continues, surgical treatment is considered, for example rectocele surgery or, for stress urinary incontinence, the TOT (sling, placing a thin tape under the urethra). If your health allows, several problems can be solved in one session. It is often easier to talk about these subjects with a female doctor. More: aesthetic proctology and 5 intimate problems after childbirth.

In fact: for you, this may be the most personal subject there is; for a proctologist, it is everyday work. The examination takes a few minutes, is often done lying on your side, the rest of your body stays covered and everything is kept confidential. When there is pain, a numbing gel is used.

Embarrassment is expensive: among our patients, there are people who put off coming for 15, 25, even 30 years. Over those years, a problem that could have been solved with simple treatment grows. Having a female doctor and a female team makes it easier for many patients to take the first step. We wrote about how the first examination goes, step by step, in our article what is a proctologist, and you can read real experiences in the patient stories.

Your body's signals are a more reliable guide than myths. In these cases, don't delay seeing a proctologist:

• anal bleeding, even if it is a small amount and happened only once;
• pain during or after a bowel movement that lasts more than a few days;
• a lump that comes out after a bowel movement or doesn't go back in;
• constant itching, moisture, a mucus-like or pus-like discharge;
• constipation, diarrhea or a change in the shape of the stool lasting more than a few weeks;
• needing to help with your hand on the toilet or a feeling of incomplete emptying;
• after age 45–50, especially if bowel cancer runs in your family, even without complaints.

If you have a painful swelling growing in the anal area with a fever, or heavy or non-stop bleeding, don't wait; seek urgent care.