Anorectal Condition
Hemorrhoids are swollen vascular cushions in or around the anus — and they are one of the most common conditions in adult medicine. By age 50, roughly half of all adults have experienced symptomatic hemorrhoids. The reason almost no one talks about it is shame, not rarity.
Here is what we want every patient to know before they walk in:
Most patients tell us they assumed the symptom was minor — or just something they would have to live with. Neither is usually true.
Located above the dentate line, inside the rectum. Often painless but the most common cause of bright-red bleeding. The primary target of office-based banding treatment.
Located below the dentate line. May be visible or palpable. Can become thrombosed (clotted), which produces sharp pain — and is treatable with prompt evaluation.
Both internal and external components. Treatment is sequenced — internal first, external as needed — to avoid unnecessary discomfort.
A clot has formed within an external hemorrhoid. Sudden, sharp pain is typical. Often resolves with conservative care, but can be addressed in-office when severe.
Treatment Approach
Most patients with hemorrhoids improve significantly with behavioral, physical, and minimally invasive treatments — long before surgery enters the conversation. Here is the full toolbox, in the order we typically work through it.
Surgery is one tool in a much larger toolbox. When we do recommend a procedure, it is because we have a specific reason — and we will explain exactly what it does, what it doesn't do, and what recovery actually looks like.
What to Expect
A comprehensive first evaluation with Dr. Johnson. Time to be listened to. In-office diagnostics when possible.
Dr. Johnson has read your intake before you walk in. The conversation starts with the impact on your life — not the textbook.
Performed with explanation at every step. Nothing happens without your full awareness and consent.
Diagnostics are performed in-office where possible to avoid extra appointments.
Every option explained. Pros, cons, and what each one would mean for your week, your work, and your life.
A Patient Story
I waited fifteen years. Fifteen. Dr. Johnson was kinder about it than I deserved. Three short visits, no sedation, no time off work. Done. I cannot believe how long I let it go.
— R.A., treated for symptomatic internal hemorrhoids
Frequently Asked
For the vast majority of patients, no. Internal hemorrhoids are above the part of the anal canal that perceives pain. Most patients describe a sensation of fullness or mild pressure for a day or so afterward — not pain. We discuss what to expect honestly before any procedure begins.
— Lisa L. Johnson, M.D., U.R.P.S.
Most patients are fully treated in two to four visits, spaced several weeks apart. We treat one hemorrhoid at a time on purpose — it is more comfortable and more effective than trying to do everything in one sitting. I will give you the expected number of visits before we start, not as we go.
— Lisa L. Johnson, M.D., U.R.P.S.
Correct. No sedation means no driver. You walk in, you walk out, you drive home — and most patients drive themselves back to work. This is the most common surprise patients tell us about after their first visit.
— Lisa L. Johnson, M.D., U.R.P.S.
This is the question patients are most afraid to ask, so I want to answer it directly. Rectal bleeding is usually caused by hemorrhoids — but rectal bleeding is also the most important early warning sign of colorectal cancer. Anyone with rectal bleeding should be evaluated, and anyone over 45 (or younger with risk factors) should be sure they are up to date on colorectal cancer screening. We will help coordinate that if you need it. More on rectal bleeding →
— Lisa L. Johnson, M.D., U.R.P.S.
Two things. First, you see a fellowship-trained pelvic surgeon — me — not a rotating roster of providers. Second, hemorrhoids almost always coexist with other pelvic floor issues: prolapse, incontinence, constipation patterns, pelvic floor dysfunction. A hemorrhoid-only clinic cannot evaluate or treat those. We can — and we usually do, because that is what actually solves the problem.
— Lisa L. Johnson, M.D., U.R.P.S.
After banding, the treated hemorrhoid typically separates and passes painlessly — usually within seven to ten days. You may notice a small amount of bleeding when it does. This is normal and expected. I tell every patient this in advance so they are not surprised. Full walkthrough →
— Lisa L. Johnson, M.D., U.R.P.S.
For nearly all medical plans, yes. Hemorrhoid treatment is medical, not cosmetic, and is covered as such. Our team verifies your coverage before your first visit.
— Lisa L. Johnson, M.D., U.R.P.S.
For the hemorrhoid we treat, yes — that specific hemorrhoid is gone. New ones can form over time if the underlying causes (constipation, straining, diet) are not addressed, which is why the full treatment plan goes beyond the procedure itself. We address the cause as well as the symptom.
— Lisa L. Johnson, M.D., U.R.P.S.
Yes. Hemorrhoids are not a gender-specific condition, and this practice treats men and women equally. The waiting room is mixed, the conversation is identical, and the procedure is the same. We mention this because patients sometimes assume an “institute” like ours is women-only. It is not.
— Lisa L. Johnson, M.D., U.R.P.S.
OTC products manage symptoms. They do not treat the hemorrhoid itself. For patients with mild, occasional flares, an OTC cream may be all they need. For patients with persistent or recurrent symptoms, the hemorrhoid itself needs to be addressed — and that is what banding does.
— Lisa L. Johnson, M.D., U.R.P.S.
A thorough, unhurried evaluation with Dr. Johnson. You will leave with a written plan — and clarity on what hemorrhoids is doing in your body, and what to do about it.
