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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35069
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a large internal hemorrhoid. It's about the size of a

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I have a large internal hemorrhoid. It's about the size of a grape if not bigger. I also have bowel movements almost every 20 minutes sometimes more that I can't control. Every time this happens I have a good amount of leakage and it really hurts. I've also found that I have no energy and am tired a lot. What do I do?

I am sorry about your symptoms.

Since how long are your symptoms?
Did your doctor suggest surgery?
Does the hemorrhoid comes out when you pass motion?
Were any investigations done for leakage and frequent bowel motions?

Dr. Arun
Customer: replied 5 years ago.
I haven't been to the doctor since I don't have health insurance but this has been going on for 6 months now and yes it comes out when i pass motion. I'm pretty sure I'll probably end up needing surgery but how much would that cost?
Hello Shyana,

An hemorrhoid is unusual to cause fecal leakage and significant bowel frequency. So you should consider consulting a general surgeon. The treatment of hemorrhoids is by warm sitz bath, avoiding straining, keeping the stools soft and local application of the ointment like proctosedyl or Preparation-H. Following is the detailed advisory;

1) Eat a balanced, high-fiber diet; Increased dietary fiber of 25-30 grams / day. High fiber cereal can help reach this goal quickly.

2) Drink plenty of water and liquids (about 2 liters a day)

3) Regular exercise; this helps in relieving constipation, if any.

4) Avoid excessive pressure and straining during defecation. Don't sit for extended periods, limit this time as much as possible.

5) Avoid irritant foods, chillies and hot herbs and substances.

6) Warm sitz baths; this is universally soothing for pain and may help decrease the hemorrhoid size. This is done thrice a day for couple of days and then twice a day (15 minutes each time).

7) Local ointments applied in anal canal which contain xylocaine and vasconstrictors (OTC product).

Read here;

The hemorrhoids should respond to these measure in 1-2 weeks. If they do not completely resolve in a week or 10 days, it would be time to seek a personal examination by a physician.

If these measures do not help you may try the non surgical / mild invasive procedures;

1) Rubber band ligation
2) Bipolar, infrared, and laser coagulation
3) Sclerotherapy
4) Cryosurgery
5) Laser hemorrhoidectomy
6) Doppler-guided hemorrhoidal artery ligation
7) Anal stretching or Lord's stretching

These are not expensive procedures and may cost around one thousand dollars. Surgery may be expensive and the cost varies very widely depending on the facility and the surgeon. But if you go to an hospital attached to a medical school; this may cost you less than three thousand dollars. There would be surgeons who may give you a facility to pay some of the amount in installments. But you would need to talk to the surgeon in your area on telephone to know about it and if they are willing to provide to the facility of deferred payment. Your doctor may also consider these investigations, if they think that hemorrhoid is not responsible for the stool leakage and increased frequency;

Following investigations are needed for the identifying the cause;

1) Endoanal ultrasound,

2) MRI,

3) Defecography,

4) Anorectal manometry

5) Anorectal electrophysiology testing

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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