What are options for 10-month-old external hemorrhoid?

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What are options for 10-month-old external hemorrhoid?

Postby William » 08 Nov 2010, 18:37

My fissure seems to be long gone, but still have my very painful what-appears-to-be an external hemorrhoid that I got while on nitro. Actually, it's steadily gotten worse, so I have to get something done to it to be able to function normally (I can hardly sit down for hours after a BM).
I'm going to my GI on Wednesday to find out what can be done. I've been to her before about it, but it wasn't as bad then so I was hoping it would go away on its own. She told me that she would have to put me under for banding, but I'm pretty sure that it's external so that's not an option anyway (right?). Does anyone have any advice on what options there are for such a problem, or what I should ask her? Thanks in advance.
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Re: What are options for 10-month-old external hemorrhoid?

Postby Guest » 08 Nov 2010, 18:57

Hey there,
Sometimes a skin tag can develop with a fissure and resembles an external hem. when it swells. I had one removed with my lis. It was actually diagnosed as a hem. by a Colorectal Surgeon once, but then I went to another CRS in the same office who did my surgery and she said it was a skin tag from the fissure. When they swell, they look and feel just like a hem.
I'm not sure but I don't think they can band and external hem., either... Hopefully someone else will know.
I don't like to sound like a know it all either but I personally wouldn't use a GI for hems or any butt problems. I would find a good CRS. This is what they specialize in. My GI sent me to one.
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Re: What are options for 10-month-old external hemorrhoid?

Postby William » 09 Nov 2010, 07:52

I'll ask my GI about a CRS. There's only one within 30 miles on my health plan, though.
When I first got this "thing", I would get a thick bright red streak on my stool. At the time,I was thinking it was a new fissure. It's certainly in a different position from my really bad fissure from last year. But when I look at it in a mirror, it looks like a little balloon that expands from the wall outside of the anal sphincter. A couple of weeks ago when it was really bad, I could swear that I could see a bright red vein, but it's hard to get a good look.
It mainly hurts for about 6-8 hours after a BM when I sit down. It's really hard to function sometimes because of the pain. After that, it doesn't bother me too much. But I have to take lots of Advil and use the max strength Prep H, or it's really bad. When it hurts, it literally feels like it's on fire.
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Re: What are options for 10-month-old external hemorrhoid?

Postby Guest » 09 Nov 2010, 09:03

Hey William,
when mine was swollen, it covered the whole anal opening. I couldn't stand to look. My husband looked and at first he thought a thrombosed hem., but I don't remember seeing any veins. Goodness I really feel bad for you. That's a long time to have pain after a bm. I just rememeber when mine was at it's worst, I couldn't even walk without holding my butt cheeks apart. I just kept taking hot baths and I did use the prep-h, but my GI and CRS both told me to stop the prep-h because it thins the skin after prolonged use (2 weeks) and ulcerates the anal skin. I used vaseline and it seemed to help, not with the swelling though. Mainly hot baths about 3x's a day for 20 min each, because that helps the blood flow, and ice packs about 20 min. every hour. I hope you get it taken care of soon and get some relief. I know how miserable it can be.
ps...I live in a very small one horse town and had to drive an hour to my CRS and GI but it's well worth it to get good medical care. Our towns so small, there are only a few doctors (family ), NO specialist ....LOL
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Re: What are options for 10-month-old external hemorrhoid?

Postby afugh!! » 09 Nov 2010, 15:11

As long as you have no fissure you can place ice cubes on it.That should bring the swelling down a bit and provide quick comfort.I know how much external hemmys suck and that was one way for me to get quick relief when it would swell or itch real bad.Is advil an Ibuprofen?Iburofens are good to take because they are blood thinners and should help with the pain and swelling.
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Re: What are options for 10-month-old external hemorrhoid?

Postby William » 10 Nov 2010, 12:41

Ok, what the hell was that about? I just got back from seeing my GI about this. She seemed to think it was a fissure at first. When I told her that I can see what appears to be an external hemorrhoid and that the symptoms are different that when I did have a fissure, she looked and couldn't see anything. I can easily see this thing every time I look. Maybe it was because I was on my side, by jeez. So she decided that I just need hydrocortisone and some drug to relax me (as in some drug like valium) to help relax things down there, since her digital exam was painful for me. Gee, I wonder why. I told her that I don't feel tight down there anymore, so I don't think that's the problem. Even though I've had this thing for 10 months now, she seemed to think HC would take care of it, even though I've already tried that (although only 1%, not 2.5%).
Well, at least I got a referral to a CRS.
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Re: What are options for 10-month-old external hemorrhoid?

Postby Guest » 11 Nov 2010, 14:48

Yeah William, I think the referral to a CRS is what you needed. I don't get why the GI couldn't see something that you see?!
I probably wouldn't use anything until you let the CRS look at it. Have you made an appointment with the CRS yet? It usually takes awhile to get in when you find a good one...
The valium will relax you down there if you're having spasms and you still have a fissure...
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Re: What are options for 10-month-old external hemorrhoid?

Postby NeuropathicGuy » 11 Nov 2010, 15:05

Hey William,
I used to have both internal and external hemorrhoids. They would itch and burn like mad and also hurt after I had watery or frequent bowel movements. They all went away after I switched to a fissure-friendly diet (basically lots of veggie soup for fiber and also Miralax every day) for a few months though. IMO in the long term, dietary changes and soft stool are the way to go.
But as far as other treatments, there are still some on the table. The ones that come to mind immediately are:
1. Stronger steroids. You can get 2.5% hydrocortisone as you mentioned, but hydrocortisone is one of the weakest corticosteroids out there. Sometimes other more potent ones like mometasone furoate (moderately potent), betamethasone dipropionate (very potent), or clobetasol propionate (super potent) can be used instead. These are Rx only in the US though, and should be used very sparingly compared to hydrocortisone to avoid skin thinning. But they're orders of magnitude stronger, and if they don't cure it, then basically no steroid will help. You can look up "steroid strength chart" if you want to see the ones available to ask your doctor about.
2. If the hemorrhoid is thrombosed (usually these are the main external ones that would cause really bad pain and should generally feel hard to the touch), it can be surgically removed.
3. Infrared photocoagulation. I've never had this done myself but know it's a popular procedure as an alternative to banding. I don't know if it's usually used for internal or external hemorrhoids but may be something to look into. Supposedly it causes less discomfort than banding.
It *is* a little surprising that the doctor couldn't see anything so obvious though. I think the CRS will definitely have better answers for you. It sounds like your doctor just gave you the standard regimen of "hydrocortisone containing stuff" that doctors love handing out for any kind of butt problem. There's probably a bunch of other hydrocortisone based stuff you can try like suppositories (which contain a boatload of hydrocortisone), Proctofoam (hydrocortisone plus another active ingredient), etc., but my personal experience has been that if hydrocortisone doesn't do the trick after a few weeks, it's probably not going to do much in the long run.
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Re: What are options for 10-month-old external hemorrhoid?

Postby William » 11 Nov 2010, 15:36

dawn: I actually turned down the "relaxers" since I don't feel any spasming. And I'm definitely familiar with that feeling from my fissure last year (holy hell that was bad). BTW, congrats on your successful LIS!
In my GIs defense, I didn't see much of a lump when I looked later. I'm wondering if she pushed in it when she examined me. What it has looked like to me from the beginning is a pouch of separated skin that goes across the sphincter line. But I've definitely seen it purple-ish, as if it's filled with blood. In fact, a couple of times I could swear that I could see it expanding (filling up?) when I spread my cheeks to look. Lately, I've seen a bright red line like a vein in it. Maybe it's a sentinel pile/skin tag like she and dawn also suggested?
Maybe she's right and I have a fissure. But the symptoms are very different than my last fissure. Before, it's was sharp pains and spasms. Now, it's a strong burning sensation when I sit down. I can't wait for the CRS to figure out what it really is. It's hard to know what to do when you don't what the problem is.
I've been afraid to use a lot of hydrocortisone. It seemed like the thinning effect could be counter-productive, and I've wondered if my 2-months internal use (stupid other GI) last year somehow led to my internal sphincter clamp-down that started shortly after I quit using it. But it did help me function and my fissure did get better, so I guess I'll be more aggressive with it (just external and not for as long). I used the 1% HC Prep H today after my BM and it seemed to help with the inflammation, so I didn't have to take as much ibuprofen.
As for my diet, that's the one success story that I have (lately, anyway). But it hasn't seemed to help.
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Re: What are options for 10-month-old external hemorrhoid?

Postby NeuropathicGuy » 11 Nov 2010, 15:48

William, if it makes you feel any better, I used OTC hydrocortisone products on my hemorrhoids for 5+ years :) It wasn't smart but did allow me to just ignore the problem and avoid dealing with it. No real noticeable ill effects, but I was forced to stop when I got my fissure and started with the fissure ointments.
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