What are hemorrhoids?

Hemorrhoids, or piles, are painful, swollen veins in the anus and lower rectum. These veins swell and stretch in a similar manner to varicose veins. Hemorrhoids can be either external or internal. External hemorrhoids occur under the skin around the anus, while internal hemorrhoids develop inside the rectum.

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Hemorrhoid treatment

Generally, when you see a doctor for hemorrhoids, they can prescribe ointments, creams, suppositories, or pads to relieve the pain and itching until the pile disappears.

However, if the hemorrhoid tissue does not improve on its own or the pain gets worse, you should see a hemorrhoid surgeon. 

Hemorrhoid Symptoms

Internal Hemorrhoids

Usually, people who develop internal hemorrhoids do not notice any discomfort. In fact, by the age of 50, about half of all Americans will develop hemorrhoids. Even though many go unnoticed, the most prominent symptoms include:

  • Blood after a bowel movement on the toilet paper
  • Blood in the toilet bowl after a bowel movement
  • Bulges outside of the anal sphincter, called prolapses
  • Pain and irritation around the prolapse
External Hemorrhoids

Because external hemorrhoids form under the skin around the anus, they are more noticeable and cause more discomfort. Main symptoms include:

  • Painful lumps
  • Itching and irritation
  • Bleeding
  • Painful bowel movements
Thrombosed Hemorrhoids

Usually, cases of hemorrhoids are mild enough for the piles to go away on their own. However, if a blood clot forms in an external hemorrhoid, it will become thrombosed and present more aggravated symptoms including pain, swelling and inflammation.


Advanced Hemorrhoid Removal

Rubber Band Ligation

Used for internal hemorrhoids, rubber band ligation or banding, is an easy procedure with no pain. During this procedure, a doctor will place a tight rubber band around the base of the swollen vein to cut off its blood supply. With the blood supply cut off, the tissue will atrophy and fall off painlessly. 

Typically, patients will need to schedule two appointments about two months apart to ensure the complete effectiveness of this treatment. This procedure is generally not a good option for patients who are taking blood thinners.


Because hemorrhoids behave similarly to varicose veins, sclerotherapy is another effective treatment option. Sclerotherapy involves injecting a chemical solution into the swollen blood vessel to block off the blood flow. With no more blood flowing through the vein, the hemorrhoid will shrink and prevent further bleeding.

As with varicose vein treatment, sclerotherapy is a good option for patients taking blood thinners due to the lowered risk of excess bleeding. Note, however, that sclerotherapy may take a few treatments in order to be effective.


Coagulation therapy focuses on shrinking hemorrhoids by applying energy to the swollen vein. A hemorrhoid surgeon can use radiofrequency heat energy, infrared light, or extreme cold to remove the hemorrhoid. 

Usually, coagulative therapy is performed at the same time as an anscopy, in order to allow your doctor to visualize and remove the hemorrhoids.

Hemorrhoid Removal Surgery


Hemorrhoidal Artery Ligation and Rectal Anal Repair (HAL RAR)

This procedure is a slightly more invasive procedure, but it is highly effective at addressing the root cause of hemorrhoids. During this procedure, a miniature doppler radar is inserted into the anus and slowly rotated to identify the largest hemorrhoids. Once identified, a surgeon will suture off the arteries and cut off the blood flow.

With the blood flow cut off, the hemorrhoids will immediately shrink and disappear.


If a patient has more advanced hemorrhoids, or prolasped piles in the anal canal, a hemorrhoid surgeon in Nashville can perform recto anal repair (RAR) to pull the prolapses back into place with sutures.


This is the next step for hemorrhoidal disease treatment if non-surgical or less invasive procedures do not relieve a patient’s symptoms. Additionally, this is the most common surgery for hemorrhoids.

Before receiving a hemorrhoidectomy, you will need to consult with a hemorrhoid surgeon at The Surgical Clinic to discuss your symptoms, your risk factors, your medical history, and how well you respond to anesthesia. During the procedure, you will be put under either general anesthesia or another type of anesthesia and your board-certified surgeon will cut out the hemorrhoids and repair the tissue around them with sutures.


This procedure is another method of hemorrhoidectomy, except instead of using surgical sutures to fix the swollen arteries in place, a surgeon will use surgical staples.

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Recovering from hemorrhoid removal treatment or surgery usually lasts for about two weeks. Patients should expect to avoid heavy physical activity and prepare to change their diet during their recovery period. Make sure to eat a balanced diet with plenty of fiber and drink plenty of fluids. Your doctor or surgeon may recommend taking a stool softener so you don’t have to strain during bowel movements.

Recovering from hemorrhoidopexy is often shorter and less painful than recovering from hemorrhoidectomy. 

Side effects may still include some pain and irritation in the anal area, but can be managed with sitz baths, pain relievers, and avoiding heavy activity.

Find a Hemorrhoid Surgeon

If you’re looking for a hemorrhoid doctor near you (in Nashville or Middle Tennessee), schedule a consultation at The Surgical Clinic to meet with one of our board-certified general surgeons who provide hemorrhoid surgery, advanced hemorrhoid repairs like HAL-RAR, or hemorrhoid removal.

Hemorrhoid Treatment

HAL-RAR PATIENT TESTIMONIAL, Dr. Willie Melvin at TSC Rutherford

“I’m able to hike in these beaufitul mountains today thanks to Dr. Willie Melvin in Smyrna, TN. He’s a surgeon who knows about the HAL-RAR procedure, which is a hemmorhoid procedure. I dealt with hemmorhoids for about 10 years and was miserable not being able to hike or play tennis like I wanted to do. My doctors in Memphis said it was time for surgery. So I looked into the surgery and it was going to be a lot of cutting and cauterizing and it seemed like there should be a better way. After searching online, I found out about the HAL-RAR procedure and called The Surgical Clinic who put me in touch with Dr. Melvin in Smyrna, TN.”

About TSC Rutherford

TSC Rutherford is a proud affiliate of The Surgical Clinic, located in Smyrna, TN (Rutherford County). The board certified surgeons at this location specialize in general surgery, robotic surgery, specialized hemorrhoid prcerdures like HAL-RAR, scarless thyroid surgery as well as vascular and endovascular surgery. Get to know more about Dr. Willie Melvin, Dr. Joshua Taylor and Dr. Todd Wilkens by visiting our TSC Rutherford page.