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Medical Forum / General / General / February 2004External Hemorrhoid Questions...
Hi, I am in my late 20's and just got my first hemorrhoid, an external one which I believe to be thrombosed based on my internet research. It is just outside the front of the anus, slightly larger than a pencil eraser, firm to the touch, and a deep shiny blue in appearance. I have had it for about 10 days now with little to no change in size from day 1 when it suddenly appeared. It may be slightly smaller, but not by much. Pictures of thromobosed external hemorrhoids I have found are identical to what mine looks like but without the "severe" pain they say normally comes with such a hemorrhoid. I have little to no itching, sometimes just a slight uncomfortable feeling when sitting but no real pain. The feeling is getting less and less present as time goes on. There was some pain the first day or two, but now it only hurts when wiping and if I touch it, and even then it is not extreme. I have only just now started medicating with Preparation H Cooling Gel with no effect in the last 24 hours. My bowel movements are fairly firm but I haven't been straining that I can remember, am not overweight, and haven't been lifting heavy objects. I do spend much of my works days sitting on a padded seat. I am trying to increase my intake of fiber and fluid intake has always been very good with 10+ cups a day of water. Here are my questions... 1) In my readings some say you can't ever get rid of an external hemoroid without surgery, which per my understanding is only recommended if the pain and suffering of the hemorrhoid is worse than the significant suffer and lost time as a result of the fairly painful surgery. Clearly not the case for me. Is this true? Do I have no hope I shrinking this thing and going back to normal? I assumed over time it would just disappear but so far it seems to have stayed for nearly 1 1/2 weeks and just "disturbs me". 2) Besides sitz baths (I try, but have little time for them), Preparation H (just started this), and ensuring normal bowel movements what can I do short of surgery to make this entirely disappear. It just seems so weird as it is kinda large and tender when washing, and just such a foreign thing. Hate to go to the doctor if this will just clear up in time, how long might this take? While I can clearly live with it just fine if this is as bad as it gets... I want it gone. :-) Thanks for any answers you might have... > 1) In my readings some say you can't ever get rid of an external > hemoroid without surgery Absolutely false. Hemorrhoids rarely require surgery. Truly thrombosed hemorrhoids (and frankly, if yours isn't hurting that much, it's probably not thrombosed) can be relieved with a simple office procedure (technically not a hemorrhoidectomy) by any primary care physician. > 2) Besides sitz baths (I try, but have little time for them), Too bad; they work great. > Preparation H (just started this), and ensuring normal bowel movements > what can I do short of surgery to make this entirely disappear. Try Anusol HC cream (now available over the counter). It contains hydrocortisone, which should help with the discomfort and promote shrinkage of the hemorrhoid. > Hate to go to the doctor if this will just clear up in time, how long > might this take? It might take a few days/weeks to resolve, depending on how aggressive you are in doing the things we discussed above. Again, if it's truly thrombosed, you may wind up needing to see a doctor. > > Preparation H (just started this), and ensuring normal bowel movements > > what can I do short of surgery to make this entirely disappear. > > Try Anusol HC cream (now available over the counter). It contains > hydrocortisone, which should help with the discomfort and promote > shrinkage of the hemorrhoid. Preparation H and Anusol both have versions that contain hydrocortisone. However Preparation H advertises this as being for "itching" and in fact barely mentions it for "hemorrhoids" and makes it clear it has no "shrinking" medicine in it. For example: Prepartion H Hydrocortisone: > > > Preparation H (just started this), and ensuring normal bowel movements > > > what can I do short of surgery to make this entirely disappear. [quoted text clipped - 7 lines] > barely mentions it for "hemorrhoids" and makes it clear it has no > "shrinking" medicine in it. For example: Itching is one of the manifestations of inflammation, and the hydrocortisone is an anti-inflammatory medication. The Anusol part of the Anusol HC is the astringent and causes the "shrinkage". HMc > > Preparation H (just started this), and ensuring normal bowel movements > > what can I do short of surgery to make this entirely disappear. > > Try Anusol HC cream (now available over the counter). It contains > hydrocortisone, which should help with the discomfort and promote > shrinkage of the hemorrhoid. Preparation H and Anusol both have versions that contain hydrocortisone. However Preparation H advertises this as being for "itching" and in fact barely mentions it for "hemorrhoids" and makes it clear it has no "shrinking" medicine in it. The normal prepartion H has medicines in it that list tissue shrinking properties for external hemorrhoids. I want shrinking... does hyrdocortisone do this? > Hi, I am in my late 20's and just got my first hemorrhoid, an external > one which I believe to be thrombosed based on my internet research. It [quoted text clipped - 9 lines] > might this take? While I can clearly live with it just fine if this is > as bad as it gets... I want it gone. :-) It will help to set the stage for healing the acute problem if you a) use astringents (Preparation H, Anusol, etc) b) use stool softeners c) take oral mineral oil with the stool softeners. A thrombosed external hemorrhoid can be very painful. If that is indeed what you have, you basically have four options: 1) do nothing. The thrombosis will gradually resolve over a matter of a couple of weeks and the painful inflammation will subside. The problem with this is that the hemorrhoid is still there and will very likely re-thrombose some day in the future. 2) see your doctor and have the thrombosis incised and clot removed. This will result in a shorter-term decrease in the pain and a faster resolution than above. The problem with this that the hemorrhoid is still there and will very likely re-thrombose some day in the future. 3) see a surgeon and have the thrombosed hemorrhoid completely excised. Depending on the hemorrhoid, this may be able to be done in the office under local anesthesia. This will eliminate the chance that that particular hemorrhoidal vein (which is apparently prone to thrombosis) will thrombose again. The problem with this is that the local anesthesia hurts a lot (albeit briefly) and you would have a fair amount of pain (maybe more than what you are suffering now) for a couple of weeks. 4) see a surgeon and have a complete hemorrhoidectomy. This would markedly decrease the chance of having hemorrhoid problems in the future. The problem with this is that it hurts A LOT, and hurts A LOT for weeks. Some of these options may be more or less adviseable depending on what is seen on examination and from a more detailed history. As you can see, treatment of hemorrhoid problems is a matter of choices, and balancing short term pain against long term resolution. The question always comes down to "At what point does the long term recurrent problem become frequent/irritating/nuisance enough to make it worth the pain of definitive treatment?" Hemorrhoid disease is a non-fatal problem, so only you can answer that question. HMc > 1) do nothing. The thrombosis will gradually resolve over a matter of a > couple of weeks and the painful inflammation will subside. The problem with > this is that the hemorrhoid is still there and will very likely re-thrombose > some day in the future. what does it mean "the hemorrhoid is still there?" is a hemorrhoid is an inflamed vein, then when it shrinks doesn't it return to normal size? Do you mean it is forever damaged and therefore this will keep happening again and again, or will it forever stay large and round? > what does it mean "the hemorrhoid is still there?" is a hemorrhoid is an > inflamed vein, then when it shrinks doesn't it return to normal size? Do you > mean it is forever damaged and therefore this will keep happening again and > again, or will it forever stay large and round? Yes, a hemorrhoid is an enlarged vein. Like a varicose vein of the leg, but in a more inconvenient location. They cause pain, bleeding, itching when they become inflamed. Once the vein is enlarged, it's usually always enlarged. Sometimes, chronic inflammation or repeated acute inflammation with cause the hemorrhoid to fibrose, but probably you can expect to have more problems with this hemorrhoidal vein (or others) throughout the rest of your life. HMc > Yes, a hemorrhoid is an enlarged vein. Like a varicose vein of the leg, but > in a more inconvenient location. They cause pain, bleeding, itching when [quoted text clipped - 3 lines] > more problems with this hemorrhoidal vein (or others) throughout the rest of > your life. ok but what improvement am i expecting? will the small pencil sized bump go away and then appear normal until it potentially flares up again at some point at the future? or is it unless i contemplate surgery this small lump will always exist 24/7 forever? what am i trying to fix at this point because besides extremly mild pain when washing or wiping, the main concern is the strange sensation of this hard firm lump in a less than ideal location. while the pain sympotoms of a thrombosed hemorroid are not there, the size, shape, and appearance are identical to several dozen photos on the net of external thrombosed hemorrhoids i have seen. it is also firm as opposed to soft which i read is an indicator of a thrombosed hemorrhoid. i just want this lump gone!!! also is anusol HC the same thing as Preparation H Hydrocortisone... because the the P-H Hyrdrocortisone lists none of the witch hazel and phenlyephrine that the other P-H's have for "temporarily shrinking hemorrhoidal tissue." i just don't want to buy the hydrocortisone version of P-H for itching that isn't there and up not shrinking this lump... thanks for your help... this is a very embarassing topic despite so many people having it. i am just trying to clear up what kind of improvement i can expect if i don't resort to surgery. basically again, i was hoping for the lump to disappear. > ok but what improvement am i expecting? will the small pencil sized bump pencil "eraser" sized bump i meant... > > Yes, a hemorrhoid is an enlarged vein. Like a varicose vein of the leg, > but [quoted text clipped - 28 lines] > can expect if i don't resort to surgery. basically again, i was hoping for > the lump to disappear. It's more than likely that the eraser-lump will just disappear and become a plain old external hemorrhoid again. As such, it will be prone to periodic flare-ups like this over the years, something you can modify to some extent with stool softeners and spending as little time on the toilet as possible (remove all reading material from your bathroom). The lump is acutely inflamed right now, either due to irritation or due to thrombosis (probably the former). It doesn't matter which, except that a thrombosis will take longer to resolve. When it does resolve, it is likely that the lump will go away. I don't know the relative merits of Preparation H with hydrocortisone vs. Anusol HC, but I usually prescribe Anusol HC over the other. Your body will heal itself. Anusol HC may hasten that healing, and the hydrocortisone will decrease the inflammation, as will hot sitz baths. HMc "It's more than likely that the eraser-lump will just disappear and become a plain old external hemorrhoid again." what is a plain old external hemorrhoid? something you can still see or feel? > "It's more than likely that the eraser-lump will just disappear and become a > plain old external hemorrhoid again." > > what is a plain old external hemorrhoid? something you can still see or > feel? Sometimes yes, sometimes no. It depends on the size of the hemorrhoid, and whether it's truly an external hemorrhoid, or a prolapsed internal hemorrhoid. You would be best served by seeing a doctor. Your questions are passing from general advice into the realm of those that can't be answered without a history and examination. I would recommend that you see your doctor if he/she is well-versed in hemorrhoid diagnosis and treatment. If not, see a general surgeon, or colon-rectal surgeon because they certainly will be, and may be able to provide in-office treatment such as rubber-band ligation of any internal hemorrhoids that may be contributing. HMc thank you. > > "It's more than likely that the eraser-lump will just disappear and become > a [quoted text clipped - 18 lines] > > HMc |
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