Rear end fallout

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Think of grade four hemorrhoids as rectal fallout—and they cannot be pushed back inside.

By Dr. David Gutman, Advanced Hemorrhoid Specialists

How bad can a hemorrhoid get? Grade four. Those are the worst. Grade four hemorrhoids are internal hemorrhoids that come out of the anus and stay there until they’re treated. Think of it as rectal fallout—and they cannot be pushed back inside.

Grade four hemorrhoids typically develop over many years. Longstanding constipation or lots of heavy lifting can result in hemorrhoidal fallout. Whatever the situation, excessive pressure or straining can create grade four hemorrhoids.

Symptoms from grade four hemorrhoids can include the constant feeling that something is “there.” You may have to chronically wear a liner or pad in your underwear because leakage from the anus is staining your clothing. And, surprisingly, grade four hemorrhoids are not always painful. The inside of your butt is simply coming out.

Although many people think grade four hemorrhoids can only be treated with surgery, that is not true. I have good success with treating most patients with grade four hemorrhoids who come to see me. I offer two, non-surgical methods to treat hemorrhoids. One reduces the blood flow that feeds the hemorrhoids, improving inflammation and causing them to shrink. The other is better suited to removing larger hemorrhoids. Both take just a few seconds to do. Since they are performed in an area with no nerve endings, they can be administered right in the comfort of my office without anesthesia.

There is virtually no pain, no prep needed, there are no major restrictions, and you don’t have to take time off of work. Our procedures are also covered by insurance. If you’re ready to put your butt back inside of your butt, give me a call.

To reach Dr. David Gutman of Advanced Hemorrhoid Specialists, call 216-772-4653. He has two office locations: 25200 Chagrin Blvd, Suite 109, in Beachwood; and 2660 W. Market Street, Suite 250, in Fairlawn. To learn more, visit