Your first stop for hemorrhoids is your primary care doctor. They can diagnose most hemorrhoids with a physical exam and start treatment the same day, no specialist needed. Most cases improve with basic care, but if yours are severe or persistent, your doctor will point you toward the right specialist from there.
Start With Your Primary Care Doctor
A primary care physician can diagnose external hemorrhoids just by examining the area around your anus. For internal hemorrhoids, they’ll perform a digital rectal exam, using a gloved, lubricated finger to check for tenderness, blood, lumps, or internal hemorrhoids that may have slipped down through the anal opening. The whole thing takes a few minutes.
Your doctor will also ask about your eating habits, toilet habits, and whether you use laxatives or enemas. This helps them figure out what’s contributing to the problem and rule out other conditions like anal fissures (small tears that cause similar symptoms). For many people, this visit is all that’s needed. Your doctor can recommend dietary changes, topical treatments, and other conservative measures that resolve hemorrhoids within a week or two.
If your doctor needs a closer look at internal hemorrhoids, they may use an anoscope, a short, smooth tube with a light that lets them see the lining of your anal canal and lower rectum. The exam uses a numbing gel applied about 10 minutes beforehand, and you’ll lie on your side with one knee bent. It’s quick and done right in the office.
When You Need a Gastroenterologist
If home care and your primary doctor’s initial treatments aren’t working after a few weeks, a gastroenterologist is typically the next step. These specialists focus on the entire digestive tract and handle hemorrhoids that need more than basic care but don’t yet require surgery.
Gastroenterologists can perform several in-office procedures that don’t involve an operating room:
- Rubber band ligation: A tiny band is placed around the base of an internal hemorrhoid, cutting off its blood supply. It shrinks and falls off on its own within a few days.
- Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it and stop bleeding.
- Infrared coagulation: A device uses infrared light to heat and shrink hemorrhoidal tissue. It’s painless, bloodless, requires no hospital stay, and is one of the most widely used office treatments for hemorrhoids worldwide.
All three are outpatient procedures, meaning you walk in, have it done, and go home the same day. If these approaches don’t resolve the problem, a gastroenterologist will refer you to a colorectal surgeon.
When You Need a Colorectal Surgeon
Colorectal surgeons specialize in conditions of the colon, rectum, and anus, including advanced hemorrhoids. You’d see one if your hemorrhoids are large, prolapsed (bulging out of the anus), or haven’t responded to less invasive treatments. Your primary care doctor or gastroenterologist will make this referral.
Surgical options range from the same banding procedures a gastroenterologist performs to more involved operations. A hemorrhoidectomy, the most thorough surgical option, physically removes the hemorrhoid tissue and is used for severe or prolapsed cases. A stapled hemorrhoidopexy repositions the tissue rather than removing it, with a somewhat faster recovery. Another technique uses Doppler ultrasound guidance to locate and tie off the arteries feeding the hemorrhoids, reducing their blood supply.
Recovery from surgical hemorrhoid removal typically takes a few weeks, and post-operative pain is the main concern. Your surgeon will discuss which approach makes sense based on the size, location, and severity of your hemorrhoids.
Can You Go to Urgent Care?
Urgent care centers can evaluate hemorrhoids and provide temporary relief, but they generally aren’t equipped to perform procedures like draining a clotted hemorrhoid. If you’re dealing with sudden, intense pain from a thrombosed hemorrhoid (one with a blood clot), urgent care can help manage pain and direct you to the right provider. For anything beyond basic assessment, though, you’ll still need a follow-up with your primary doctor or a specialist.
When to Go to the Emergency Room
Most hemorrhoids don’t require emergency care. But head to the ER if you experience large amounts of rectal bleeding, or if you feel lightheaded, dizzy, or faint alongside bleeding. These symptoms can signal significant blood loss that needs immediate attention.
Bleeding during bowel movements that doesn’t improve after a week of home care warrants a call to your doctor, but not necessarily an ER visit. The ER is for situations where the volume of bleeding or your physical symptoms suggest something more urgent.
Do You Need a Referral?
Whether you need a referral to see a specialist depends on your insurance plan. Many HMO plans require a referral from your primary care doctor before they’ll cover a gastroenterologist or colorectal surgeon visit. PPO plans often let you book directly with a specialist. Check with your insurance before scheduling to avoid surprise bills. Either way, starting with your primary care doctor is practical since they can handle most hemorrhoid cases, and if you do need a specialist, their referral streamlines the process.
What to Know About Rectal Bleeding
One important thing doctors watch for: rectal bleeding isn’t always from hemorrhoids, even when hemorrhoids are present. Having a visible hemorrhoid doesn’t rule out something more serious further up the colon. Older patients with new rectal bleeding are typically sent for a colonoscopy or flexible sigmoidoscopy to check for other causes. Younger patients at low risk may only need a sigmoidoscopy, which examines the lower portion of the colon. If you have a family history of colorectal issues or other concerning symptoms alongside bleeding, your doctor will likely recommend a full colonoscopy regardless of age.
Persistent symptoms that don’t resolve with treatment also call for further investigation, even if hemorrhoids seem like the obvious explanation.
How to Prepare for Your Appointment
For a standard hemorrhoid evaluation with your primary care doctor or a gastroenterologist, there’s no special preparation. Eat and drink normally before your appointment so you don’t feel lightheaded during or after the exam.
If your visit involves a flexible sigmoidoscopy, you may be asked to do a bowel prep beforehand to clean out your lower colon. Your doctor’s office will tell you whether to do this at home or in the clinic, and not all sigmoidoscopies require it. If you’re actively bleeding, for instance, a prep may not be necessary. If you take blood thinners, let your doctor’s office know ahead of time since these medications can affect how procedures are done.
Before your visit, it helps to note how long you’ve had symptoms, whether you see blood on the toilet paper or in the bowl, what makes the discomfort worse, and what you’ve already tried at home. This gives your doctor a clearer picture and speeds up the appointment.