Frequently Asked Questions

How do I know that my problem is hemorrhoids?
It can be difficult for most people to tell. Many of the patients referred to us with the diagnosis of hemorrhoids are actually suffering from something else. If your main problem is itching, the cause is likely a skin problem. Pain or burning or tearing during or after a bowel movement usually signifies a fissure, not hemorrhoids. A painful blue lump at the edge of the anus developing after physical exercise or straining may be a perianal hematoma resulting from a ruptured blood vessel. A foul smelling discharge can indicate a fissure or possibly an abscess. Multiple small lumps can be simple skin tags or possibly anal warts. A single tender firm skin tag is usually an indicator of a fissure beneath it. Staff at the Pezim Clinic have seen over 350,000 patients with anorectal disorders. We can diagnose your problem usually within a few minutes, and provide you with a treatment plan designed specifically for your needs.

What is the difference between an internal and an external hemorrhoid?
Internal hemorrhoids are the classic hemorrhoids that we direct most treatment to. They reside up in the anal canal but can sometimes prolapse out. They are covered by insensitive bowel lining (mucosa) and so rarely itch or cause pain. Because they are relatively insensitive, we can band them or cauterize them with an infrared photocoagulator without the need for local anesthetic. They can bleed and very rarely they will thrombose (clot), leading to serious pain and swelling for several days.

External hemorrhoids are not really hemorrhoids at all. They are mostly skin tags or broken blood vessels under the skin adjacent to the anus. External hemorrhoids live in the outer skin-covered area of the anal canal and the skin surrounding the anal opening, so they are very sensitive. They cannot be banded or cauterized without causing severe pain.

Do I need a physician’s referral in order to be seen at the Pezim Clinic?
Yes, because Dr. Pezim is a specialist. In British Columbia, a specialist is only permitted to see patients by referral. Your Family Physician or a physician at a walk-in clinic should be able to refer you to us. Consultations on referred patients are covered by MSP. We can see patients privately if you do not have a physician or do not wish to obtain a referral. But a consultation without a referral would not be covered by MSP and would be billed privately.

How long does it take to be seen at the Pezim Clinic?
We try to manage the Clinic in such a way that we are able to see most patients within a week or two.

What if my problem is urgent?
We regularly fit patients in who have urgent or very painful conditions. Call and speak to our receptionist and we will try to help you as quickly as possible.

What is the cost of consultation and treatment?
If you have MSP coverage and are referred by a licensed physician, the cost of your consultation, examination and treatment are all covered by MSP, except in the case of cosmetic anal surgery.

Do I need to prepare for my first visit with an enema?
No. We would prefer that you not take any enemas or other preparations prior to your consultation or follow-up appointment at the Pezim Clinic unless you have been specifically asked to do that by Pezim Clinic staff only. You should try to have a bowel movement prior to your appointment if possible.

What happens at a consultation?
At your initial consultation you will be greeted by the receptionist and asked to complete a questionnaire about your general health. When the doctor is ready to see you, you will be moved into an examining room and asked to disrobe from the waist down and sit in a patient chair. A paper drape will be provided to you to wrap around yourself. The physician will then enter and take your history and then examine you. The examination may be carried either on a flat examination table or on a special ‘tip table’ used for rectal examinations. The examination of the rectum will consist of a digital finger examination, and a limited examination of the inside of the anus with a small scope called a sigmoidoscope. If your problem is a painful one, a special very small pediatric scope may be used in order to obtain an accurate diagnosis without hurting you. When the examination is completed, you will be asked to return to the patient chair and the physician will discuss his findings including diagnosis and suggested treatment. You will have an opportunity to ask questions.

Is the examination painful?
The examination is unpleasant but usually not painful. It depends what the problem is. If it is a painful problem then examination is done very carefully, and with pediatric instruments if necessary, in order to minimize discomfort. Most patients do not find the examinations at the Pezim Clinic to be painful. If you have had a painful examination elsewhere it does not mean that it will be painful at the Pezim Clinic. We specialize in this type of examination and have the experience and equipment to make it comfortable for most patients.

What about sterilization of equipment at the Pezim Clinic?
Infection control is a very high priority. We conform to the highest standards of reprocessing and sterilizing.

Is there parking at the Pezim Clinic?
There is parking at Fairmont Medical Building as well as metered street parking and pay parking lots in the area.