Time for more aggressive hemorrhoids treatment
Q. I am a 58 year old post menopausal female. I have four grown children between the ages of 28 and 38, all of whom were delivered vaginally. I am a small person 4 feet, 9 inches tall and I normally weigh between 95 and 100 pounds. Over the past few years, I have put on about 50 pounds and have had several surgeries, including an umbilical hernia repair, torn meniscus repair, cataract lens implants, a partial thyroidectomy, two cervical fusions and a lumbar discectomy. I also have gastroesophageal reflux disease and irritable bowel syndrome.
I would have thought all of this was more than enough to go through, but this chronic problem (which started after the breech birth of my second child) has now gotten worse. This problem is hemorrhoids and a fissure.
My doctor and my gastroenterologist keep giving me prescriptions for suppositories and creams. I soak in very warm water and try to remember to eat fiber and take a stool softener every day. I keep myself very clean and use special wet wipes. I use only nonperfumed soaps, toilet tissue and pantiliners. I also make sure that the area is always dry.
My dermatologist says not to use the wet wipes because the area gets so irritated, but I have to stay clean. It was so sore for more than a year that he finally gave me an ointment to rub on. It helped, but it continues to get sore, painful and itchy.
A. I don't believe a dermatologist is the best person for the treatment of your hemorrhoids and anal fissure. You should be under the care of your gastroenterologist, who is better equipped to handle the situation.
Hemorrhoids are swollen, inflamed veins in the lower rectum and anus. They may be caused by chronic diarrhea, constipation, straining, pregnancy and more. An anal fissure is a small tear or split of the mucosal lining of the anus. It can be caused by chronic diarrhea; constipation; passing large, hard stools; and decreased blood flow to the area.
For both conditions, it is important to ensure that the affected area is kept clean and dry. Using special wet wipes or pads to cleanse the area is often beneficial, because they reduce irritation from wiping and the pads contain anesthetic and antiseptic components, which reduce pain and lower the chance of infection.
Hemorrhoids that do not respond to these measures may require surgical repair. There are several minimally invasive procedures, including rubber band ligation, coagulation and sclerotherapy. Each uses a different method that results in the size reduction of the hemorrhoid. The more invasive techniques include removal of the offending tissue or stapling to block blood flow to the area of bleeding.
Anal fissures usually heal with time and modest home care. For those that don't, Botox injections or minor surgery may be recommended to relax the anal muscle.