Public announcement for hemorrhoid sufferers

Since I seem to be on a roll writing about rear ends (politicians and fatty stools) I might as well go ahead and post this piece now that I’ve gotten all the results in. As near as I can figure, I’ve got about 7,000-8,000 people reading this blog daily, so given the percentage of people who are afflicted with hemorrhoids, this should be of interest to at least a couple of thousand. If you don’t have a hemorrhoid, if you don’t know anyone who has a hemorrhoid, and if you don’t think you will ever get a hemorrhoid, you can quit reading now.

When MD and I were in Dallas a month of so ago visiting our kids, I went to visit (as I usually do when in Dallas) a friend I’ve known for years (let’s call him Jack, not his real name). As we were talking he was squirming around on his couch, looking like he was in some kind of discomfort. I asked him if he was having a problem, and said no. At that point his wife, who was bringing us some coffee, said, “Tell him; he’s a doctor for God’s sake.” Jack then sheepishly told me that he had a bad hemorrhoid that was intensely painful. I asked him all the appropriate questions and diagnosed him as having a thrombosed hemorrhoid that needed treatment.

Jack said he would call is doctor and try to get in. I told him that I had fixed countless thrombosed hemorrhoids, and that if I had the tools I needed, I could fix it for him in a flash. I made a couple of calls and found out that I could get all the necessary equipment at a drugstore nearby. Off we went to gather the stuff. We returned with a latex gloves, a scalpel, a couple of syringes and needles, a bunch of gauze 4X4s for packing after the surgery, and a bottle of xylocaine (an injectible local anesthetic). I recruited Jack’s wife as my assistant, and we got him down on the bed. I had his wife spread his cheeks so that I could get to work. I immediately realized that I had made one of the cardinal errors of doctoring: I had failed to examine the patient before I made the diagnosis.

There are two types of hemorrhoids and two things that can happen with a hemorrhoid. There are internal and external hemorrhoids and these hemorrhoids can be inflamed or thrombosed. Inflamed hemorrhoids are typically kind of tender and itchy–those are the ones that Preparation H and the other topical agents work for because all that needs to be done is to reduce the inflammation and the symptoms pretty much go away. Often, though, the hemorrhoid is thrombosed, which means that it has a blood clot in it. Hemorrhoids are little sacks of tissue around the anal area and just inside, and these sacks contain blood. If the blood clots, the hemorrhoid becomes extremely painful and hurts all the time. It doesn’t really itch as much as it just hurts like the devil.

Here are the two types of hemorrhoids.

hemorrhoid-blog-size.jpg

I’ve treated so many thrombosed hemorrhoids in my career that I could probably do one in my sleep. To treat them you inject them with a local anesthetic, then slice open the hemorrhoid with a scalpel and remove the clotted tissue with forceps or fingers or a cotton tipped applicator (a Q-tip in non-medical parlance). Once the clot is gone, you pack a bunch of 4X4s into the butt to absorb the blood, and let it heal. The patient gets almost immediate relief and other than a little bleeding for a day or so, the problem is gone.

Once I had  Jack’s cheeks spread, I realized that what he had was not a thrombosed hemorrhoid, but a giant inflamed external hemorrhoid along with a giant inflamed internal hemorrhoid that was strangulated out through his anus. I realized then that I couldn’t fix it with the tools at hand and that he would need see someone skilled in dealing with internal hemorrhoids that usually need to be banded, which is a pretty painful procedure. The doctor puts a little tight band around the base of the hemorrhoid that cuts off the blood supply and the hemorrhoid basically rots off. Had I examined my friend before gathering all the materials I needed, I could have saved him the $20 or so it cost to get it all.

To atone, I told Jack I would find him a doc so that he wouldn’t have to go through going to his primary care doctor, then get referred to someone else to do the banding and spend several days in agony while all the waiting for appointments went on. I looked in the phone book and found a couple of centers specializing in the treatment of hemorrhoids using a technique called infrared coagulation (IRC). I had never heard of this, so I got on Jack’s computer and started searching the medical literature to see what it was all about. I found a bunch of papers including one just recently published in the Journal of the American College of Surgeons that after evaluating all methods available concluded that IRC was the treatment of choice. IRC has equivalent efficacy as compared to banding, but is painless.

Jack called the center, the lady who answered the phone set him up with an appointment that afternoon. I went along as an extremely interested observer.

The center was the epitome of efficiency. A nurse came in and explained the process to Jack and me. The doctor then came in and asked a few pertinent questions about medical history, allergies, bowel habits and history, etc. and took us step by step through the procedure my friend was going to undergo. It was off to the treatment room where another nurse told Jack to take off his pants and shorts, put on a gown and get up on the exam table. The doc came in, got Jack on his side, and performed a digital exam of his rear end. She (the doc was a she) inserted an anoscope, a clear plastice cone-like device open on both ends into Jack’s rear end so that she could see both hemorrhoids. Grabbed a little infrared probe from the machine next to her, stuck the end of it to the base of the hemorroid for just a few seconds, and that was it.

Jack said it felt a little warm but not uncomfortable at all; it was essentially painless. She told him that it took several treatments and that he should feel a little better after each one. He felt significantly better after the first treatment, and now 4 or 5 treatments later, he is cured.

I’m passing all this along for a couple of reasons. First, I want to let anyone with hemorrhoids know that there is a painless alternative. Second, since I only have a database of one, I would like some feedback from anyone else who has had IRC treatment or who knows anyone who has so that I can feel more comfortable recommending it. If my friend’s experience wasn’t the norm, I would like to know.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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29 thoughts on “Public announcement for hemorrhoid sufferers

  1. If people from Poland take Polaroids
    Do people from Hemel Hempstead take Haemoroids ?

    An oldie but a goldie !

  2. Doc,
    Great post as usual. Big fan of your work. Any idea what causes hemorrhoids in the first place? and whether diet or certain foods are to blame? Not sure if it was coincidence or not, but experienced some discomfort myself around the time I bought a bulk order of grass-fed meat. I wonder if there is any relation…

    Hi Steve–

    No one knows for absolute certain what causes hemorrhoids, but most are pretty sure that straining during bowel movements makes them worse.  Anything that increases pressure in the abdominal area can make them pop out, i.e. lifting a heavy weight, pregnancy, constipation and straining, etc.  I don’t think that in your case grass-fed beef would have had anything to do with it.

    Hemorrhoids before they are hemorrhoids are little sacks that encircle the lower rectal area just above the anus.  When we strain – say, to lift something heavy, for example – the internal pressure generated fills these little sacks with blood and they puff out, occluding the tube so that we don’t soil ourselves.  If they weren’t there, we would have quite the little social problem.  When they get over stretched and become little hanging bags full of blood, then they are hemorrhoids.

    Cheers–

    MRE 

     

  3. Wow, that was interesting. I’m almost sorry that I don’t have any hemorrhoids.

    Now I have to google to find out what causes hemorrhoids.

    I do have a friend who uses Preparation H under his eyes to minimize the bags.

    Hi Marly–

    Preparation H under the eyes is an old theater and film trick to reduce bags quickly.  Everyone says it works, but since I don’t have bags, I’ve never tried it.  I’ve heard the director of our TV show talk about it as a real ‘cure’ for those who do.

    Cheers–

    MRE 

  4. My husband had several internal hemmoroids done with the laser. He is super sensitive and does not get much relief from things like lidocaine etc. He said his felt like a hot rubber band was snapped against his skin every time the laser went off. On the plus side he hasn’t had any problems with them since!

    Hi Sarah–

    I didn’t mention laser therapy, also called sclerotherapy, in the post, but I should have.  Sclerotherapy, like banding, can be a fairly painful procedure.  If your husband ever has a recurrence, have him google whatever your town is and ‘infrared coagulation treatment’ to find someone who does the procedure I described.

    Best–

    MRE 

  5. Mike, I had annoying hemmoroids for years. Not really serious enough to seek treatment. Well really you know what it’s like. They would have had to been really bad for me to go to someone. Anyhow I noticed that after low-carbing for about 2 yrs they seemed to be getting a lot better and now after 6 years no problems at all. I used to suffer a lot from constipation but now never do. It would be interesting to hear if anyone else has had this sort of relief after starting low-carb.
    Cheers;

    Hi John–

    I’ve had a number of patients with the same experience.  It works often on inflamed hemorrhoids–once they’re thrombosed, they need to be fixed.

    Cheers–

    MRE 

  6. A while back I had my first hemmorhoid and took vitaminC with bioflavenoids and it went away. My reasoning was that the bioflavenoids might strengthen the blood vessels.

    Based solely on this one incicdent I take issue with the”mechanical” explanation of straining being the only cause because I had no history whatsoever of straining. I bet that while straining might be a contributing factor, in many cases there is an underlying biochemical imbalance of some sort.

    But here’s the thing. I recently got another hemorrhoid. Took C with bioflavenoids. It stopped itching. thought it went away because I had no discomfort whatever. But if I probe there is a little sack which is firm to the touch.It hangs out. Should I bother to have it looked at? Should I bypass my internist and go straight to the infared coagulation?

    Hi Ellibellie–

    An internist typically doesn’t treat hemorrhoids, so if you went there, you would be referred somewhere else.  If the problem isn’t bothering you, I wouldn’t worry about it.  If it is, I would head to the place that does infrared coagulation treatments.  The treatments are pretty pricey, but most insurance plans pay for them. 

    Keep me posted.

    MRE 

  7. I currently have a hemorrhoid that isn’t responding to the doctor prescribed treatment of Proctosol and warm baths (along with lots of fiber and liquids). It’s been about the size of a garbanzo bean now for almost 2 weeks (though I can’t tell if it’s bluish or anything, it is rather firm to the touch). I did see my primary doc during this time who said it didn’t look thrombosed, and that external hemorrhoids (which this is) do not thrombose (this threw me for a loop since I’d read all about externals thrombosing). I do have a referral sent out to the surgery clinic but that could several more days as I wait for them to call me back to schedule an appt. Like I said, this is just distressing and uncomfortable (pain, some itching, and discouraging too since it’s not showing any sign of going away. Advice? Should I seek the quick outpatient surgery?

    Hi Distressed–

    You can certainly give one of the outpatient infrared treatment centers a try.  The treatment doesn’t work immediately–it takes a few visits before the problem is totally solved.  But they do provide some relief fairly quickly.  The surgeon will probably open it if it’s thrombosed.  And external hemorrhoids can definitely be thrombosed–I’ve treated many many of them.  From your description, it sounds like it may be thrombosed.

    Good luck.  Let me know what happens.

    MRE 

  8. I am seriously considering this procedure, but my insurance only covers 50%. How much would this cost (generally) if you have both internal and external hemmorhoids, but internal is thrombosed?
    Thank you,
    Joyce

    Hi Joyce–

    The center I went to with my friend charged about $500 for the initial visit and $300 for each follow up visit.  His insurance paid almost all of it, so I would assume that most treatment regimens for hemorrhoids would end up costing about the same since insurance companies typically reimburse that way.  He had both internal and external hemorrhoids, and the charge was the same as if he had had only one.

    Cheers–

    MRE 

  9. Read this on Wikepedia…” Use of Squat Toilets
    Based on their very low incidence in the developing world, where people squat for bodily functions, hemorrhoids have been attributed to the use of the unnatural “sitting” toilet.[5] [6] In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets.[7] Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. This chart summarizes the results.

    No follow-up studies have ever been published. The American Society of Colon & Rectal Surgeons is silent regarding the therapeutic value of squatting…” Seems plausible.

    Does seem plausible but I don’t see a lot of people switching to squat toilets.

    Cheers–

    MRE

  10. I am a 54 year old man and have been suffering from haemoroids for many years. I go to the bathroom every morning and almost every time I get blood on the toilet paper. Afterwards it itches a lot and burns also even though I make some ointment (Germoloids). One day in a week, mainly on a saturday, I skip my bathroom routine and on that particular day I don’t feel any pain at all. I am very much afraid of surgery because they say that afterwards it is very painful and they could come back. Is that true?
    Thanks

    John
    (Malta – Europe)

    Hi John–

    They do indeed sometimes come back. I would look into the treatment mentioned in the post.

    Cheers–

    MRE

  11. I have just had the bands done on internal haemoroids , along with a couple of polyps removed (3 days ago ) and I am still sore and it is uncomfortable to go to the toilet, can you tell me how much longer it will be uncomfortable for?
    Thanks
    Julie

    Hi Julie–

    I haven’t had a lot of experience with banding internal hemorrhoids, so I can’t tell you for sure. But procedures such as the one you had usually cause some discomfort for a week or so. I imagine the worst is about over.

    Best–

    MRE

  12. I have a hemorrhoid, I think an external one. It is very very painful and about the size of a cherry. It is dark blue. I have had it on and off for about 3 weeks now, it comes and goes. I am (not to boast, just to point out) extremely healthy – running loads, working out often, eating very very organically and nutrisiously, so I don’t know what caused this. I am way too embarrassed to go to the doctor about this.

    Hi JSS–

    Sounds like a thrombosed hemorrhoid to me, and those are painful and usually require a trip to the doc to get treated. You can try Preparation H and other OTC products, but I doubt they will do much good. I know it’s no consolation, but whatever doc you go to will have seen countless hemorrhoids and yours will just be another in a long list.

    Good luck.

    MRE

  13. I believe I also have a thrombosed external hemorrhoid. It just appeared suddenly three days ago. It is also about the size of a cherry, and it has traces of dark blue in it. It ranges from uncomfortable to downright excruciating. Topical solutions have had no effect. I just contacted my doctor, who recommended that I see a proctologist to possibly have it excised/drained of the clot. However, I have read on the internet that if a thrombosed external hemorrhoid is over 72 hours old, doctors usually conclude that it is not worth excising it, as the pain from the recovery is worse than just leaving it alone to naturally heal.

    Here are just a few places where I have read that:

    http://books.google.com/books?id=xK77Y7BKuNAC&pg=PA163&lpg=PA163&dq=thrombosed+hemorrhoid+72+hours&source=web&ots=M2qvH73qyA&sig=MpNI-BfesOEMrh1UjcqMxQQLm6A

    http://meriter.staywellsolutionsonline.com/Library/Encyclopedia/3,85293

    Have you also found that to be true?

    Thanks.

    Joe G. in NYC

    Hi Joe–

    Sounds like a thrombosed hemorrhoid to me and I’ve taken care of a lot of them. Were I you, I would get it treated.

    Good luck.

    MRE

  14. I am a student and have been having what I think are both external and internal hemorrhoids, one of each. Its pretty uncomfortable and painful at times. I have just now noticed they bleed often. Do hemorrhoids get infected?

    I’ve never seen an infected one. They are so vascular that they shouldn’t get infected.

    Best–

    MRE

  15. Hello Michael,
    Thanks for the information…I couldve used it about 9 years ago before I had the most painful experience of my life, aka a hemorrhoidectomy! Now, believe it or not, I have them again…my doctor said he is going to do something called injection sclerosis, and after several treatments, that should take care of the internal ones.
    But I think I have external ones too-however every doctor who looks at the area says I don’t, though I feel skin flaps in the area that sometimes flare up after a BM. My questions are: can a doctor not always see the external ones? And also, is there a way I can find a doctor who specializes in Infared coagulation in the L.A. area? Any help is GREATLY appreciated. Thanks again.

    Hi Jay–

    Google IRC (Infrared Coagulation Technology) hemorrhoid and Los Angeles and you should find all the info you need.

    Cheers–

    MRE

  16. I think I have had thrombosed external hemorrhoid for about seven days now.
    After home treatments of topical creams and witch hazel compress upon doctor’s advice, the pain has subsided after few days. There were some bleeding but the swelling hasn’t gone down. Will it shrink away naturally or would I need a medical procedure?
    I would appreciate your advice. Thanks.

    Based on my experience, you’ll probably need a medical procedure to get rid of the clot if what you have is truly a thrombosed hemorrhoid.

    Good luck.

    MRE

  17. Thanks for your comment.
    There is no longer any pain and clot is gone after some bleeding, which also has stopped.
    However, there is a sizeable flap of skin that still remains.
    Is there anyway to get rid of this? What specific procedure would be best (ligation, hemorrhoidectomy, etc) and would insurance cover it? Thanks again.

    Hey Ken–

    If it doesn’t bother you, I would give it some time to see what happens before I signed up for a procedure. Maybe it will resolve. And I don’t have a clue as to whether insurance would cover such a procedure or not – I would imagine that it would.

    Best–

    MRE

  18. I have has a “growth” on my rear for a few years now. It is hard to the touch and will now has a scab on the top of it (because of the swelling, I think). At first I thought that I might have broken my tailbone, but now this thing has grown from the top of my anus to above my buttocks. Until recently it has not been painful all of the time, only if I fell on it or hit that area or something to that effect. However, now it burns all the time. I am a very active 24 year old guy and now I can not even lay on my back because of the pain it causes. I don’t have insurance and have tried to avoid the doctor. I just want to find out what this is. Is it a hemorroid, tumor, or one of those weird beetles off the Mummy? I read about Thrombosed Hemorrhoids and this seems to be the closest explaination to what I am suffering from. However, I am not totally convinced that this is a hemorrhoid.

    It would be impossible for me to say without seeing it. It could be anything from a hemmorhoid to a fissure to a pilonidal cyst to who knows what.

    You should probably get it looked at.

    Cheers–

    MRE

  19. My father has been suffering from hemorrhoids for years – over ten. He is 67 years old. He has had 2 hemorroidechtomies, a fisure surgery, he’s been to a dermatologist who said he had a fungus, and recently to yet another specialist who said he has some small hemorrhoids near the opening but in HIS opinion nothing that would cause the pain my father describes. The pain he says is like a HOT poker, he tries to avoid all pepper and spicy foods. He bleeds a great deal on occasion, we’re not talking a smear of blood on the tissue, we’re talking lots of red in the toilet. My father thinks he’s crazy because no one seems to believe him or understand. It’s like when you take your car in and they hook it up to their fancy digital machine – if the machine doesn’t show a problem, no one knows what to do. Also recently he has had a cat scan, a colonoscopy, the other type of oscopy when they go down through your throat, and an ultrasound. You seem to understand that’s why I am writing. My dad is in bed today where he’s been for 3 days. He was even reduced to tears last night – he is in so much pain. Obviously the docs could be missing something, BUT WHAT? So far they’ve reported no tumors, no cancer, just mild diverticulitis and a what they described and a small hemorrhoid that shouldn’t cause pain. I would even give you my cell phone if you’d be willing to discuss. I also have the colorful pictures from the ultrasound I’d be happy to send you. I have to help my dad – it is ridiculous for him to live this way. He even went as far as to ask the doc if he could wear a bag so he would no longer have to use the toilet. That’s how bad it is. Thanks much – Patty

    Hi Patty–

    Medico-legally I can’t take on your father’s care over the internet or over the phone. I don’t have a clue as to what’s going on with him since I haven’t seen or evaluated him. And I’m not an expert in colo-rectal diseases. I wrote the post on the hemorrhoid care my friend got because I didn’t know it existed, and I wanted to let others know about it.

    Having said all that, you might want to Google Levator Syndrome also sometimes called proctalgia fugax. It sounds to me from the symptoms that this may be what your father has. If so, you should be able to find someone who can take care of him.

    Best–

    MRE

  20. Thank you Dr. Mike – I know legally you can’t say anything, but just pointing me in another direction was worth sending my email. Thanks much Patty

    Good luck.

  21. Dr. Mike. I have a couple of questions for you. First of all I really appreciate the time and work you put into your site. I went to the Doctor because I have two Hemorrhoids…one is pretty big and thrombosed and the other is just a small one. When I say the Hemorrhoid was big it was probably the size of a small blueberry. I returned yesterday from the Doctor after having the Thrombosed Hemorrhoid cut open and the clot removed. The doc told me I was borderline and could either wait it out or have him remove the clot. I chose to have him remove the clot so that hopefully I could heal fast. Aside from the numbing shoot being incredibly painful, everything else went fast and painless. He said he couldn’t do anything with the small one because it looked ok. My question is after removing the clot the skin is still there, will that skin eventually go away? Amazingly after returning home and giving the numbing medicine time to go away I was NEVER any discomfort. Aside from the bleeding everything seemed fine. I am almost worried that it went so well. Also I am curious to know when it is safe to start exercising and working out again. If the skin from the Thrombosed Hemorrhoid does in fact go away on its on, do I need to wait for that to happen. Do I need to wait for the small Hemorrhoid to go away? Those were two questions. I completely forgot to ask my doctor and am glad that I am able to ask you and hopefully you can help me out. Thanks so much.

    The skin issue should resolve on its own. The small hemorrhoid, if not thrombosed, may or may not go away with time. You should be able to start working out any time. I wouldn’t strain during workouts, however.

    Cheers–

    MRE

  22. i am scheduled for laser surgery for my internal hemmoroids i also have external ones but was told i can only have laser on the internal ones the others would need a operation but i am worried about the pain after the laser surg and i did not know it would need more than 1 treatment. i was told this is painful so i”m not sure i want to get this done.

    thanks jeanette

    You might want to see if you can find someone who does the infrared coagulation as described in this post. It works for both internal and external hemorrhoids and is relatively painless.

    Good luck.

  23. I believe I have a thrombosed external hemmoroid as it matcheses the description here. It was very swollen and about two days ago I think it tore open on one side after a bowel movement. It started bleeding and i saw what looked like a blod clot come out of it. now it has been bleeding since that happened and forthe past 36 hours. i have been putting some folded up tissue up there so that it won’t stain my underwear. Is this bleeding normal? Should I go to a walk in clinic? If so, what can i expect they will do for me?

    Thank You,
    Randy

    Sounds more like an inflammed hemorrhoid, which can also bleed. Thrombosed hemorrhoids are typically pretty painful. The bleeding isn’t harmful, but if you’re having symptoms you should probably get someone to take a look at it.

  24. hi, i’ve had hemorrhoid problems off and on for the past couple years. earlier last year i had two incidents with thrombosed external hemorrhoid swhich was beyond painful. the first time i was in a horrible amount of pain for about 2 days, but on the 3rd day i felt remarkably better and within a week of the pain presenting i felt pretty much fine. the second time i went to my doctor and had the out-patient incision procedure done as the pain was just too much to take. a day ago, after a straining bowel movement, i began to experience the same pain and felt the same pea sized lump. where as before my pain would be along the lines of a 9.5/10 in the pain rating, this one was probably closer to a 7 (it is also the same spot as the previous ones, if that makes a difference), i made an appointment to have it treated again fearing it would continue to get worse, but woke up the next day with less pain, maybe a 5 and decided to wait it out as i’m currently without insurance and with school, my income is somewhat limited. my question is this, is it worth going into a doctor and having the incision procedure again or will the pain continue to decrease? my job requires a decent amount of sitting and currently i can’t sit in any position other then on my side without a decent amount of discomfort. i also can’t afford to miss a large amount of school or work, and with the incision procedure i was basically fine after a day or two, but if the symptoms will continue to dissipate i would prefer not to pay the costs of the procedure assuming i can resume a normal lifestyle relatively soon. thank you for any help.

    All I can say is that I don’t know. I’ve seen situations like this get better and I’ve seen them get worse. All you can do is wait and see how it develops for you.

  25. I have an average external hemorrhoid, and have had it for only a couple days. Its generally uncomfortable, obviously, but recently it started to sting and bleed….which I hadn’t yet experienced. On closer inspection, it appears to have a dark red spot, what I’d assume is a scab. I’ve been very careful to be gentle and keep the area clean and dry. I’m not too keen on seeing a doctor..but does this sound like something I need to be concerned about?

    I couldn’t possibly tell without seeing it myself. Generally there is not much that is life threatening about a hemorrhoid, but I don’t know exactly what you’ve got going on.

    Good luck.

  26. Hi,
    I’m looking for experiences about THD Surgery solution!
    I’m an hostess and hemorrhoids for me are big problem because I’m always on move.
    Did anyone experience it?