What can you suggest for chronic internal hemorrhoids?

June 2, 2011 2:13 PM

Those who suffer long-term from internal hemorrhoids: do you have any suggestions for me? (what I have is not your run-of-the-mill flare up)

Some key points about the progression of my condition:

I eat a vegeterian diet, rich in beans, whole grains and other natural fiber sources.

I dealt with my first minor hemorrhoids (external) about 10 years ago

Since then the incidence and severity has steadily increased, and the nature of the flare-ups has changed to primarily internal 'roids. In addition, where flare-ups used to involve little pain and some blood on the toilet paper, I almost never see blood any more, and mostly just notice the pain and swelling.

For the last 2 years I have had zero days that were totally free of pain/discomfort.

I've tried the following standard treatments:
-Sitz baths (sometimes helpful, never complete relief)
-Eating supplemental fiber as ground psyllium husk (I typically poop quickly and with no straining, even without the fiber. It doesn't seem to make any difference.)
-Getting more exercise (sometimes difficult to stick to this due to the pain)
-Ibuprofen (temporary relief, even big doses don't completely eliminate the discomfort)
-Tried this supplement for several weeks: http://www.hemorrhoidtreatmentonline.com/, didn't notice any significant improvement as a result
-Working at a standing desk instead of sitting all day (I am a full-time software developer. This makes really bad days more tolerable by putting less pressure down there, but fails to move me in the direction of healing.)
-Yoga poses and other stretching designed to drain blood out to my extemeties (this I have the hardest time sticking with, and has only given me inconsistent slight improvements)

In February of this year I had $8,000 worth of surgery ($2k out of pocket) to remove a large swollen hemorrhoid. The post-op was the most painful thing I have ever experienced, and lasted a full week, severely disrupting my work and private lives (doctor said I MIGHT experience mild discomfort for a couple days - complete fucking bullshit, so obnoxiously wrong.) During that time I had anal stenosis (inability to relax the sphincter at all) and pencil sized poops. After about 11 days, my stools had returned to normal, the intense post-op pain was gone and it seemed I was healed. On the 12th day after the surgery, right when I was feeling "healed", I got a brand new flare up which has lasted until today without relenting for a second.

I am now in more pain, on a daily basis, than I was before the surgery

I no longer trust a for-profit health care system that seems unconcerned with addressing the root cause of this issue and would rather just throw more expensive/painful surgery at me (cha-ching!)


Thanks for reading! Now, any suggestions?

posted by cbecker333 to Health & Fitness (11 answers total)

The treatment for internal hemorrhoids can be different from external. If you had surgery, was it on an internal one that had prolapsed or external? If you have internals that haven't prolapsed, ligation (rubber banding) is very quick and painless (er, I hear). I understand that the surgery is hell on earth, though.
posted by Addlepated at 2:36 PM on June 2, 2011

Oh, and several old threads on the subject claim that eating a dill pickle daily will cure what ails you. It sounds a little hand-wavey to me, but sometimes those crazy methods start sounding not so crazy when you've been dealing with this crap (sorry) for years.
posted by Addlepated at 2:38 PM on June 2, 2011

The "surgery" I spoke of, was band ligation (banding), which everybody says should be both simple and relatively painless. In my case this happened in the OR with me under anesthesia because when we attempted it in-office we discovered my tissues were too sensitive (I'm told my nerves are denser than your average bear.)

I was in such pain after the banding that I moaned into my pillow for about 2 days straight. The doctor seems to think I was just being a big baby, and only reluctantly gave me a prescription for vicotin to get me thru the first night (of which i only took 2 because I didn't want the opiates to lead to constipation.)
posted by cbecker333 at 3:10 PM on June 2, 2011

I love dill pickles, and eating one every day sounds good for morale even if it doesn't help.

In general, I hold out little hope for any dietary solution given that I have what appear to be healthy bowel movements with almost no straining ever.
posted by cbecker333 at 3:13 PM on June 2, 2011

Internal v. External: This was an internal one, which occasionally would prolapse. The latest flare-up has yet to prolapse (it is way the fuck up in there.)
posted by cbecker333 at 3:15 PM on June 2, 2011

Wow, that's awful about the banding. My doc sent me home with a script for 40 Vicodin afterwards! (And orders to use stool softeners as needed.) Maybe you just had a terrible doctor experience? One thing I've found with doctors is that asking docs I like for a recommendation is always much, much better than randomly picking someone out of my insurance provider list.

You also don't mention whether you're extra careful not to linger on the commode for longer than necessary. That means no reading in the bathroom, ever!
posted by Addlepated at 4:08 PM on June 2, 2011

Apparently hemorrhoids are very common in western countries, less common in developing countries, and virtually unheard of in tribal communities. The implication is that toilets create an unnatural position for pooping, and that squatting is the natural and healthy way to go.

I suggest you do some research about this and look into products that can help you use your current toilet in more of a squatting position. Here is the most friendly-looking one I've found, but there are dozens out there.

Also, there is a portable bidet called the travel washlet by a Japanese company called Toto. You can order them online in various places, and some larger plumbing businesses might even carry them in store. They will run you at least $60, but are completely worth it. I understand that yours are not external, but in my experience the less you have to wipe externally, the better you feel overall.

I hope that you find some relief soon.
posted by Brody's chum at 6:18 PM on June 2, 2011

Stay away from Cottonelle wipes if that's what you use. They are drying according to my doctor. You need something with witch hazel like Preparation H wipes.

For what's it's worth, I had three internal 'roids banded this year (two weeks apart). Had each one of them done on my lunch hour and went back to work.

You have my sympathy...
posted by qsysopr at 6:18 PM on June 2, 2011

Seconding the squat toilet suggestion.
posted by flabdablet at 6:42 PM on June 2, 2011

Have you used cortisone suppositories to bring the swelling down?
posted by hanoixan at 8:38 PM on June 2, 2011

After reading these two articles recently I decided to give squatting a go, even though I've never had any issues with hemorrhoids. Before you up and buy some fancy squatting toilet adapters, you can just try squatting on the toilet itself. Here's some things I've learned in the past couple of months:

1. Squat on the rim, with the seat up. I find having one hand on the wall or sink help me feel plenty stable.
2. The first few times you squat, strip off your pants and your underwear. I found it easier not having to worry if I would get pee on my pants. Once you're comfortable balancing, you can leave the pants and underwear on. If you've got junk down there, I've found pushing my pants forward so my twig is under them works fine as long as I'm pointing down and not out.
3. Wiping in this position seems to expose more of the bunghole than sitting, but also means you can be more targeted since your buns are more spread out.
4. To aid wiping, I keep a pump container of moisturizer on my sink that's accessible from the toilet. A dab on the TP allows me to get things cleaner without abrading.

Hope that helps!
posted by the real deal at 2:00 AM on June 3, 2011