Conditions
Hemorrhoids: treatment by video in Puerto Rico
Hemorrhoids, also called piles, are swollen and inflamed veins around the anus or in the lower rectum. They cause itching, pain when you sit, or bright red blood when you have a bowel movement. Most get better at home with fiber, water and sitz baths. The doctor evaluates you privately by video and, if appropriate, prescribes treatment.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- You are losing a lot of blood from the rectum
- You are bleeding and feel dizzy, weak or faint
- Black, tarry stool
Help lines
At a glance
Hemorrhoids
Common symptoms
- Itching around the anus
- One or more hard, tender lumps near the anus
- Ache or pain around the anus, especially when sitting
- Bright red blood on the stool, on toilet paper or in the toilet bowl
- A hemorrhoid that pushes out through the anus
- Other names
- Piles
- Treatment
- Fiber, fluids, sitz baths and over-the-counter creams; other treatment when the medical evaluation calls for it
- Possible complication
- External hemorrhoid with a blood clot (thrombosed)
On this page(8)
What are hemorrhoids?
Hemorrhoids are swollen, inflamed veins around the anus or in the lower rectum. External hemorrhoids form under the skin around the anus; internal hemorrhoids form in the lining of the anus and lower rectum. An internal hemorrhoid can push out through the anus (prolapse).
They come from straining, sitting on the toilet for a long time, long-lasting constipation or diarrhea, a low-fiber diet, pregnancy, aging and frequent heavy lifting.
How we treat hemorrhoids by video
You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. We know it can feel awkward to bring up: the visit is private, it is not recorded, and most of it is a conversation about your symptoms.
If the doctor needs to see the area, she asks only during the video call, through the secure link. Never send intimate photos by email, text or WhatsApp.
We evaluate, diagnose and treat. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. Some situations need an in-person exam, and then we refer you: rectal bleeding if you are 45 or older or have other risk factors, and an external hemorrhoid with a blood clot, which is very painful and should be seen in person within a few days.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text See how our online doctor visit works.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer. Choose a private spot.
Get your plan.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If needed, we refer you for an in-person exam.
What a hemorrhoid visit costs
Hemorrhoids are handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note is included. We do not bill insurance. See all prices. The service is run by The Health Initiative, a nonprofit.
Hemorrhoid symptoms
Depending on the type, hemorrhoids can cause:
- Itching around the anus
- One or more hard, tender lumps near the anus
- Ache or pain around the anus, especially when sitting
- Bright red blood on the stool, on toilet paper or in the toilet bowl
- A hemorrhoid that pushes out through the anus
Hemorrhoid treatment at home, and when you need an exam
Many external hemorrhoids get better on their own within a few days. What helps most:
- Eat more fiber and drink water, natural juices and clear soups. A fiber supplement or a stool softener also helps.
- Do not strain, and do not sit on the toilet for long.
- Take sitz baths: sit in warm water for 10 to 15 minutes, several times a day.
- Over-the-counter creams and suppositories (for example with hydrocortisone or lidocaine) ease pain and itching. Use them for 1 week; if symptoms continue, get checked.
If your symptoms are not better after 1 week of home treatment, or if you have rectal bleeding, get checked. Bleeding can come from other, more serious causes, so the doctor asks about your age, your history and your colorectal cancer screening (most people should start at 45), gives you a lab order if needed and refers you for an in-person exam. Procedures such as rubber band ligation are done in person, in a specialist’s office.
In pregnancy: hemorrhoids are common. Tell the doctor before you use any cream or suppository.
When to go to the ER
For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.
- You are losing a lot of blood from the rectum
- You are bleeding and feel dizzy, weak or faint
- Black, tarry stool
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Do hemorrhoids go away on their own?
Is it normal for hemorrhoids to bleed?
Do I have to show the doctor my hemorrhoids?
What is a thrombosed hemorrhoid?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (5)
- Hemorrhoids (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Hemorrhoids (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- Symptoms & Causes of Hemorrhoids (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- Treatment of Hemorrhoids (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- Screening for Colorectal Cancer (CDC) (opens in a new tab) (accessed 2026-10-02)