Are You Sure the Problem is Hemorrhoids?

Seventy percent of patients referred to the Pezim Clinic with a diagnosis of ‘hemorrhoids’ are actually suffering from something else. Why does this happen? The most common reason is that the patient made their own diagnosis incorrectly, told their physician they had a hemorrhoid problem, and their physician just accepted it and referred them to a ‘hemorrhoid clinic’. In many cases they weren’t even examined. Whether due to the physician’s busy schedule, a ‘virtual’ appointment, inadequate training or equipment, most primary care physicians are not able to examine an anorectal patient adequately. So if Uncle Charlie had ‘hemorrhoids’ and has convinced you that you have the same, or you saw some misinformation online that caused you to label yourself as a hemorrhoid sufferer, chances are that you have been misdiagnosed.

How common are hemorrhoids?

The first thing that patients need to know is that hemorrhoids are NORMAL anatomy. We all have them. The fact that you have hemorrhoids does not mean that you need hemorrhoid banding. At the Pezim Clinic all patients are carefully examined to determine the correct diagnosis and treatment plan. The patient is then re-examined on each follow-up visit to assess treatment progress and to ensure that the diagnosis continues to be correct.

What else could it be?

There are numerous anorectal and colon issues that can masquerade as hemorrhoids. A partial list would include; perianal hematoma, anal fissure,
anal fistula, prolapsing hypertrophied anal papilla, abscess, lower GI bleed, perianal dermatitis, ulcerative colitis or proctitis, rectal prolapse, Crohn’s Disease, ischemic colitis, sexually transmitted infections such as chlamydia proctitis, fecal or mucous leakage, fecal incontinence, anal trauma, proctalgia fugax, solitary ulcer of the rectum, precancerous and cancerous perianal and anal lesions, bleeding polyps, rectal cancer or even colon cancer. We have, unfortunately, seen every one of these conditions treated elsewhere as ‘hemorrhoids’.

The problem with ‘banding mills’

The problem with a misdiagnosis of hemorrhoids is that it invites and legitimises inappropriate treatment, usually rubber banding (see Rubber Banding for Hemorrhoids). This exposes the patient to the possibility of significant post-banding complications while at the same time delaying proper and sometimes life-saving diagnosis and treatment. In fact, there are clinics in the Lower Mainland where the sole focus of the practice is to band hemorrhoids. We call these ‘banding mills’. Unless they find some overwhelming reason not to, they are going to treat you as a hemorrhoid patient and band you, likely several times over weeks, whether that diagnosis is correct or not. Of course, they get paid for every visit and every band. The irony is that when the banding mill reports back to the referring doctor that they banded the patient’s hemorrhoids, that confirms the doctor’s sense of having made the correct diagnosis and encourages them to refer more patients to that banding mill. So everyone is happy, except the patient. There are also naturopaths that charge patients thousands of dollars to do what a specialist MSP General Surgeon or Colorectal Surgeon would do for you and charge you nothing.