What the front desk
should know.
Callers describe symptoms in their own words, mention treatments they have already tried, and ask how this compares. This page covers the condition, the words patients actually use, and the full treatment landscape, so the team can follow a conversation without ever having to diagnose.
Understanding is not diagnosing. Everything here exists so the team can follow a caller and answer plainly. Deciding what a patient has, what grade it is, or which treatment suits them is the surgeon's job at the consult, every time.
What a hemorrhoid actually is.
Everyone has hemorrhoidal cushions. They are normal, and they help with continence. The problem starts when they swell, bleed, or slip out of position. That is what people mean when they say they "have hemorrhoids."
Internal
Above the dentate line, inside the anal canal. There are few pain nerves up there, so internal hemorrhoids more often show up as painless bleeding or as something bulging out, rather than as pain.
External
Below the dentate line, under the skin around the opening. This area has plenty of pain nerves, so these are the ones that hurt, especially if a clot forms (thrombosed).
A caller saying "it doesn't hurt, there's just blood" and a caller saying "there's a painful lump" may be describing two different things. Do not sort it out on the phone. Note what they said, and let the surgeon examine it.
What callers describe.
The five things people ring about, and a sense of what each usually means.
Bleeding
Bright red blood on the paper, in the bowl, or on the stool. The single most common reason people call, and usually painless.
"There's blood when I go."Prolapse
Something bulges out during a bowel movement. It may go back on its own, need pushing back, or stay out. This is what grading measures.
"Something comes out."Itching or irritation
Ongoing itch, burning, or dampness around the area. Common, and often the symptom people are most embarrassed to name.
"It itches constantly."Pain
More typical of external hemorrhoids. Sudden severe pain with a firm lump can mean a clot has formed.
"I can't sit down."Feeling of fullness
A sense that the bowel has not fully emptied, sometimes with mucus or seepage.
"It never feels finished.""I've tried everything"
Creams, fiber, maybe banding that did not hold. This caller is often the best fit for a consult, and the most frustrated.
"Nothing has worked."Heavy or continuous bleeding, dizziness or faintness, severe unrelenting pain, or fever. Do not book a routine consult. Advise prompt medical care and flag it to the clinical team straight away. The same applies to anyone who mentions a change in bowel habits or unexplained weight loss, since bleeding has causes other than hemorrhoids and only a clinician can tell them apart.
How clinicians describe severity.
Internal hemorrhoids are graded I to IV by how far they prolapse. A caller may know their grade from a previous diagnosis. Note it if offered, and leave the judgement to the surgeon.
"That's exactly the kind of thing the surgeon will look at during the consult." Grade never decides a booking on the phone. Someone with symptoms who wants treatment and clears the qualifying checks gets offered a consult.
Every option, and where ours sits.
Callers have usually already tried something, and often ask how this compares to what their last doctor offered. This is the map. Read it so the conversation makes sense, not so it can be recited.
| Treatment | What it is | Typically used for | Worth knowing |
|---|---|---|---|
| Start here · almost every patient begins with these | |||
| Diet and lifestylefiber, fluids, habits | More dietary fiber, more water, and less time and straining on the toilet. | Every grade, as a first step and alongside anything else. | Clinical guidance is that treatment almost always starts here, whatever comes next. |
| Over-the-countercreams, ointments, suppositories, sitz baths | Pharmacy products that calm the symptoms. | Mild or flaring symptoms. | These soothe. They are not aimed at the underlying hemorrhoid, which is why symptoms often return. |
| In-office procedures · no hospital stay | |||
| Rubber band ligationbanding · RBL | A small band is placed at the base so the tissue is cut off from its blood supply and drops away. | Lower grades. | The most common office treatment today. Often has to be repeated over several visits. |
| Sclerotherapyinjection | A solution is injected to shrink the hemorrhoid. | Lower grades. | Often chosen when a patient has a bleeding disorder or takes blood thinners. |
| Infrared coagulationIRC | Infrared light creates scar tissue that cuts off the supply. | Lower grades. | Quick to perform, often needs more than one session. |
| Hemorrhoidal energy therapyHET | Gentle compression combined with heat. | Lower grades. | A caller who has researched online may raise this one by name. |
| Thermal submucosal hemorrhoidopexyTSH · our procedureOurs | Thermal energy is applied to the tissue just above the hemorrhoid. The tissue contracts and the hemorrhoid is drawn back into its normal position. Nothing is cut or removed. confirm: mechanism wording | Grades II and III in the published study. | Done by a surgeon in a single office visit. Published follow-up at five years reports most patients symptom-free. |
| Surgical · operating room | |||
| Excisional hemorrhoidectomyMilligan-Morgan | The hemorrhoid is surgically removed. | Higher grades, external and mixed disease, and cases that have come back. | The long-standing reference standard. Usually general anesthesia, with a longer and harder recovery. |
| Stapled hemorrhoidopexyPPH | A circular stapler lifts and fixes the tissue back into position. | Prolapse-dominant cases. | Less post-operative pain than excision, with its own specific risks the surgeon discusses. |
| Doppler-guided artery ligationHAL-RAR · THD | A Doppler probe locates the feeding artery, which is then stitched closed. | Lower to middle grades. | The closest modern relative to our procedure in intent: both target the problem without removing tissue. |
Describe our procedure on its own terms and never rank it against another treatment by name. Comparative claims are off-limits, and this table exists to help the team follow a caller, not to argue with one. Where a caller wants a comparison, the answer is always the same: "The consult is the best place to compare the options for your situation." The clinical detail here still needs sign-off. confirm: clinical review of the matrix
+ Where our procedure sits in the landscape Expand
Two broad families exist. One removes the hemorrhoid, which is surgery. The other treats it in place, which is everything done in an office.
Within the in-office family, our procedure is the one performed by a surgeon in a single visit, with published five-year follow-up behind it. That is why patients and physicians describe it as sitting between repeat banding on one side and an operation on the other. That framing is fair to say. Claiming it is better than either is not.
If a caller has already had banding that did not hold, they are describing exactly the situation this procedure was studied in. That is still a consult conversation, not a phone diagnosis.
What they say, what it means.
People rarely use clinical words for this. Recognising the everyday version keeps the conversation comfortable, and there is no need to correct anyone's language.
The few work terms used in this kit.
Not clinical, but they appear on the other pages.
+ Terms from the rest of the kit 6 terms
TSH
Thermal submucosal hemorrhoidopexy, the full clinical name of the procedure. On a call, say "the procedure" rather than the acronym.
Consult
The short appointment where the surgeon confirms whether the procedure fits, and answers every clinical question. It is the goal of every conversation.
Qualified lead
A real person who can get to the clinic, can pay through commercial insurance or self-pay, has symptoms, and wants them treated. The checklist is on page 02.
Nurture
Interested but not ready to book. Keep the door open with light follow-up, never pressure.
Disposition
The outcome recorded for a lead: booked, nurture, or passed, plus the reason.
PHI
Protected health information: any health detail tied to an identifiable person. Collect the minimum needed to reach and schedule, and leave the history to the consult.
Enough understanding to follow the conversation.
Never enough to diagnose, and never a reason to skip the consult. When a new word or question keeps coming up on calls, add it here.