HEMORRHOIDS: Hemorrhoids are swollen blood vessels, or varicose veins, that form in the lower rectum or anus. They are not usually painful, but they can bleed, itch, or protrude. Most adults get hemorrhoids at some time in their lives. They are aggravated by pregnancy, childbirth, and straining at stool. The typical American diet of refined foods, which lacks the fiber and bulk necessary for forming soft stools, contributes by causing constipation.
DRUG TREATMENT: Preparation H is the hemorrhoid market cornered, but it is questioned whether it actually shrinks hemorrhoids, reduces inflammation, or heals injured tissue. Unfortunately, no other drugs seem to accomplish these feats any better. Not only do they not cure the condition; ointments and suppositories can make it worse by aggravating the trouble and sensitizing the skin.
The vasoconstrictors touted as shrinking hemorrhoids do constrict blood vessels. The problem is that the effect is only temporary. After a few days the drugs may produce a rebound effect, causing the blood vessels to become more dilated than before. Since these stimulant drugs are rapidly absorbed from the lining of the rectum, they can also cause significant side effects, including heart palpitations, sleeplessness, and paranoia. Hemorrhoidal preparations often include agents for wound healing, but these too lack evidence of effectiveness and so do the hydrocortisone products widely marketed for rectal itch. The latter have the further drawback that if used for long, they can cause skin disorders.
The best pharmaceutical solutions are old-fashioned petroleum jelly and zinc oxide. They don't treat the underlying problem, but they can ease anorectal pain and itch without significant side effects, and they can serve as a protective coating over the skin to prevent further irritation. Fortunately, uncomplicated external hemorrhoids usually go away by themselves in a couple of weeks without treatment.
If the problem persists -- and particularly if you are bleeding from the rectum -- see a doctor. Bleeding that is dark rather than bright red may be a symptom of colon cancer. Bleeding may also be related to ulcers.
OTHER HELPFUL AIDS: Consider wearing porous underwear that won't trap moisture, sitz baths, moist heat, rest, and cleanliness (though not with harsh soap or antiseptic, which can be irritating). Most important is to correct the underlying problem, usually constipation.
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