Hemorrhoids Salt Water
How can I get rid of a stubborn hemorrhoid without surgery?
I have had a Hemorrhoid ever since I gave birth to my daughter in 2008. It just is determined to stay and make my life hell! I have tried every possible cream and wipes for Hemorrhoids. I really wanna get rid of it without under-going sugery. Being that I don’t have the money for it right now. It is hurting when I try to have any bowel movement, what can I do? I have also soaked in salt-water nothing seems to work. Or maybe I am just not using the stuff as long as I am supposed to or something! If anyone has any ideas let me know PLEASE!
Hi Rebecca,
Well first you must understand what a hemorrhoid is (in case you do not that). Simply put a hemorrhoid is an engorged set of veins that have prolapsed (the word literally means “to fall out of place”). You can think of them as varices of the anus instead of the legs. Now there are technically internal and external hemorrhoids. Internal hemorrhoids are rarely seen nor felt however we know they are there due to fresh blood either on digital rectal examination, on a bowel movement and finally sometimes spotting on the undergarments. There is also the issue of intense pain at times. Please just bear with me, I am hoping that by explaining a bunch of things you will understand the recommendation at the end.
Grouped into 4 stages
-Stage I – Internal hemorrhoids that bleed.
-Stage II – Internal hemorrhoids that cause bleeding and prolapse with straining but return to their resting point by themselves (no need to push them back in with your fingers).
-Stage III – Internal hemorrhoids that bleed and prolapse with straining and require manual effort for replacement into the anal canal
-Stage IV – Internal hemorrhoids that do not return into the anal canal and are therefore constantly outside.
Quick treatment reference:
Stage I initially treated with no surgery, simple changes in diet with fiber, water, toilet training etc and the liberal use of anti-hemorrhoid creams which do not cure but help with the symptoms including removal of itch, pain and discomfort.
Stage II or III hemorrhoids are initially treated with nonsurgical procedures (Rubber Band Ligation).
Very symptomatic grade III and grade IV hemorrhoids are best treated with surgical hemorrhoidectomy (removal of hemorrhoids).
A more elaborated treatment follows.
Treatment for Stage I and II
Because it is believed that straining and a low-fiber diet cause the disease we typically try more conservative treatment options which include: increasing fiber and liquid intake and retraining in toilet habit. This should shrink internal hemorrhoids and decreases their symptoms; therefore, first-line treatment of all 1st and 2nd degree (in some cases 3rd and 4th although many surgeons disagree on this and from what I have seen as do I) internal hemorrhoids should include measures to decrease straining and constipation. However, regardless of this fact, a high fiber diet which includes more than 25g of fiber per day are a good preventative tool for certain colonic/anal diseases. Toilet retraining involves reminding patients that the lavatory is not the library and this should be practiced at all times Bathing in tubs with warm water usually eases painful perianal conditions probably due to relaxation of the sphincter and spasm. Aggressive therapy (AKA surgery) is reserved for patients who have persistent symptoms after 1 month of conservative therapy. Just to note, the idea here is to treat the symptoms not the aesthetics.
3rd and 4th stage hemorrhoids:
These are usually resolved (especially when resistant to proper clinical treatment and in my opinion most 3rd/4th stage individuals end up in surgery) require some kind of intervention. However there is good news Rubber band ligation is most common. Keep in mind though that surgical removal is reserved for patients with 3rd/4th stage hemorrhoids or patients who fail non-surgical treatment or patients who also have significant symptoms from external hemorrhoids or skin tags.
By the way the Rubber Band Ligation is basically putting a rubber band around the hemorrhoids responsible and thus depriving that area of blood. Just think of it as putting a rubber band around a finger.
From what you are saying it does seem you might require at least ligation however clearly a physician needs to review this. Regardless you should increase fiber as indicated (minimum 25g per day) with increased water intake and proper toilet hygiene (do not sit there for an eternity) as a method of avoiding increase pain and number of hemorrhoids. Also note that the available creams simply help with the symptoms but do not really “treat” the problem. A common mistake of patients is the incorrect use of these creams in which they simply apply it externally and superficially on the anal sphincter area. The proper use requires proper placement WITHIN the rectal canal (remember that hemorrhoids are external AS WELL AS internal). Most of these creams have an astringent (zinc paste or aluminum which helps keep area dry and sooth burning sensation, witch hazel is another one) or anesthetic (lidocaine, xylocaine or anything that ends with “aine”, basically “sleeps” the area) or steroid anti-inflammatory (ex: hydrocortisone most common, or anything that ends with “sone” which decreases inflamation), phenylephrine (preparation H which basically decreases vein size aka constricts) or all 3. The most effective creams contain hydrocortisone however a high dose steroid cream (>1% hydrocortisone) requires prescription, local anesthetic and astringent. Therefore use them as needed to pass the day but do not believe they will actually remove the problem but they will help shrink the hemorrhoid and even alleviate what you feel. Most people believe they do cure but it is false, it feels that way because you feel better and with time they go away but this was not due to the cream, in most cases they would have gone away with time anyway. They do help them resolve a little sooner due to the fact that they help reduce inflammation. Also stay away from the so called NSAIDS (Aspirin, Ibuprofen-Advil/Motrin, Naproxene-Aleve) which although stop clotting increases bleeding and can lead to more pain in some cases.
I really hope this helps you out Rebecca and that you can quickly get evaluated by a physician to finally resolve the issue.
Sincerely,
Dan MD
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