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Silent No More: Get Help for Your Hemorrhoids

It's a problem lots of people deal with but no one talks about. How do you cope with hemorrhoids? Or, even better, how can you avoid getting them in the first place?

At-Home Hemorrhoid Treatments

Treating hemorrhoids with medication won't make them go away, but most of the time it alleviates symptoms. "Basic medical treatments are a variation of witch hazel, such as Preparation H or Tucks pads," says Raymond. "Witch hazel dehydrates and shrinks them but doesn't make them go away. My preference is Tucks pads, which have a lot of witch hazel. You tuck them in the vicinity."

Raymond tells WebMD that "when hemorrhoids are painful, don't use dry toilet paper. It's like using sandpaper." She advises using hypo-allergenic baby wipes or flushable Cottonelle. "If itching is a problem, diaper ointment can provide relief."

Good hygiene is also very important since fecal matter or mucus drainage irritates the skin and hemorrhoid area. Too much wiping can worsen discomfort, so the American Gastroenterological Association suggests that a bath or shower can be used as an alternative to wiping after a bowel movement.

Ointments containing lidocaine, hydrocortisone creams and suppositories, and warm sitz baths can also provide hemorrhoid relief.

When Home Remedies Don't Help

Various nonsurgical treatments are available to remove internal hemorrhoids. Luca Stocchi, MD, of the Cleveland Clinic, explains that hemorrhoids are graded according to severity from I to IV. Surgery is used on grade IV hemorrhoids and sometimes on grade III. Nonsurgical procedures are typically performed in a doctor's office without anesthesia and can be used to treat hemorrhoids from grades I to III. They include:

Injection sclerotherapy: This treatment is sometimes used for smaller bleeding hemorrhoids. The doctor injects a special solution to shrink the hemorrhoidal tissue. Success rates vary.

Rubber band ligation: Several sessions may be required for rubber band ligation, which is used for larger internal hemorrhoids or those that fail to respond to injection sclerotherapy. A rubber band is put round the hemorrhoid to choke off its blood supply. The hemorrhoid eventually falls off on its own. Recurrence may be as high as 68% after four or five years, but symptoms usually respond to repeat procedures. Pain following the procedure is generally minor and can be relieved with sitz baths and pain medications. "Complications are minimal, and patients can return to normal activities the same day," says Stocchi, a colorectal surgeon.

Infrared photocoagulation: Some doctors use infrared photocoagulation to treat small internal hemorrhoids, hemorrhoids that cannot be treated with rubber band ligation because of pain sensitivity, or hemorrhoids that are not cured with rubber band ligation. A probe focuses infrared radiation on the hemorrhoid, burning it. The procedure requires multiple treatments, and the recurrence rate can be high.

Do You Need Surgery?

Surgical hemorrhoidectomy is performed when more conservative treatments fail. "Tissue that includes blood vessels is excised, so there is bleeding," says Stocchi. Most patients can go home the same day, but the need for catheterization may require an overnight stay.

Stapled hemorrhoidectomy was introduced in 1998 as an alternative to traditional surgical hemorrhoidectomy. A stapling device is used to attach the hemorrhoid to rectal muscle. "It's advocated as a less painful alternative for grades I through III, and when appropriately done it's as effective as hemorrhoidectomy," says Stocchi. "But the long-term outcomes regarding recurrence are unknown."

Patients can expect pain that makes it difficult to sit after surgery, says Stocchi. But they can resume normal activities in a few days, and some do so immediately. "One patient resumed her marathon training a week after surgery."

Complications can include impacted stool, especially in elderly patients, or infection. "It's important for patients to use a stool softener, or it could require another trip to surgery," Stocchi tells WebMD.

While surgery is generally reserved for internal hemorrhoids, Stocchi says that thrombosed external hemorrhoids may require prompt attention.

Raymond advises patients to try to avoid surgery by making lifestyle changes and using over-the-counter remedies to soothe hemorrhoids.

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Reviewed on October 11, 2007

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