by 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.