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What causes hemorrhoids and what is the treatment?

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General Surgeon
Practicing since : 2008
Answered : 3176 Questions
Hello, About five days ago, I noticed a small lump about the size and shape of a medium to large-sized olive pit (or kidney bean) in my perineum area closer to my anus. Three days ago, I noticed that the lump began to bleed. I went to the doctor mentioned that I had also been feeling some slight pain, when touched, in the area where my upper inner thigh and groin area meet. I thought this was due to some stretches I had been doing in physical therapy. I was later advised that these are inguinal lymph nodes. The doctor believes that the bump is hemorrhoids and finds some slight swelling of the lymph nodes, for which Bactrim, the antibiotic, was prescribed. I have also been experiencing lower back pain for the last six months, which is the reason I was doing physical therapy mentioned above. Do any of these symptoms seem inter-related? In either event, if a patient presented to you with similar symptoms, how would you diagnose? Thank you!
Posted Sat, 4 Jan 2014 in Digestion and Bowels
Answered by Dr. Grzegorz Stanko 24 minutes later
Brief Answer: Detailed below. Detailed Answer: Hello! Thank you for the query. Is it possible for you to attach a photo of it so I can give more accurate answer? Hemorrhoid is always connected with the anus (comes from inside or from the verge of it). Can bleed and give pain occasionally (usually when blood clot appears). Hemorrhoids are usually caused by constipation, bad diet or steady lifestyle. Hemorrhoids rather do not give enlarged lymph nodes in the groin. However if the lump is somewhere between the anus and the scrotum, its rather not a hemorrhoid. In this area, painful lump is usually caused by fistula between the rectum and the skin. Pain and bleeding is caused by infection and pus collection (what gives a lump). Enlarged lymph nodes in the groin can be present. Both conditions have nothing in common with stretching. Back pain does not appear with hemorrhoids or rectal fistula. If the back pain appears with one side leg pain, spine issue is most probable. If the back pain is associated with frequent urinating, pain while urinating, kidney infection seems most probable. Pain in the groin can be caused by stretching. It is called inflammation of the adductor of the thigh and should be ruled out with inguinal hernia (which can appear after stretching as well). Here is what you should do: 1.In case of hemorrhoids: - rectoscopy - sitz baths with Oak Bark twice a day - hemorrhoids suppositories - add fiber rich products and mineral water to your diet to make stools more loose - wash your rectum after every stool - if it wont help in a week or so, surgery should be considered 2. In case of rectal fistula: - rectosigmoidoscopy - pelvis MRI - surgeon consult 3. To rule out inguinal hernia/ diagnose adductor inflammation ultrasound of this area should be done. It will also tell if the lymph nodes are enlarged or not. 4. In case of spine problems, MRI of the spine is necessary 5. Urinary tract infection should be diagnosed with simple urine analysis. Hope this will help. Feel free to ask further questions. Regards.
Above answer was peer-reviewed by
Follow-up: What causes hemorrhoids and what is the treatment? 32 minutes later
Thank you so much for your quick response. It is very difficult for me to take a photo of it, due to the location. I will note, however, that is much closer, relatively speaking, to the anus than to the scrotum; but, it extends for a little under an inch along the perineum area toward the scrotum, but not near it. Also, I should note that I was given a prescription for pramoxine/1% hydrocortisone cream, which I first used last night. Prior to that, I used an over-the-counter hemorrhoidal cream for a day and a half. I have noticed a slight shrinking of the lump since taking both, but slightly moreso with the pramoxine, just between last night and this morning. For the lymph node issue, the ER took a CT scan of my pelvic region. The doctor said that they didn't notice any abscess, but did see some fluid. I'm guessing this is why the antibiotic may have been prescribed. I am very apprehensive about antibiotics for two reasons--1. I believe that they should NOT be taken unnecessarily (without confirmation of an infection that can't be managed by any other means) and 2. the side effects I've read that people have experienced were very scary. By the way, is there a homeopathic antibiotic? They did take a urine sample, but I don't believe I ever saw the cup leave the room and they never gave me any results from that. They only mentioned that my kidney function seemed fine, due to a quick test from a blood sample (they did this to determine if they could give me the XXXXXXX for the CT scan.). One other thing I will mention, if it might be helpful, is that my wife has Herpes. She hasn't experienced an outbreak in quite some time and, in our 12-year relationship, I was never diagnosed with it. We have had unprotected sex on many occasions (including within the last two weeks).
Answered by Dr. Grzegorz Stanko 1 hour later
Brief Answer: . Detailed Answer: You should not be afraid of antibiotics. Especially those commonly used like Amoxiciline or Ciprofloxacine. This medicines are very safe when used reasonably. Please note that first antibiotic is taken from a fungi (Penicilin fungi) so we can say its a natural substance. Penicilin were little bit modified what has given plenty of antibiotics (including Amoxiciline). You are right, it should not be taken without cause. But it is very hard to determine exact source of infection and sometimes it is necessary to use it as a precaution. There is nothing wrong in it. Side effects can happen, however most of them are very very rare (leaflet must contain all possible side effects - its a kind of drug manufacturer protection against possible responsibility and sues). If we talk about homeopathic antibiotics, well garlic is know to be some kind of antibacterial agent. Herpes lumps does not hurt at all, grow slowly and constantly. So this is not a herpes for sure. Prescribed medicine for hemorrhoids is fine. The most important is diet, soft stool and avoiding pushing hard on stool. Please note that there is no medicine which will cause complete hemorrhoids cure. All know medicines can make symptoms go away and hemorrhoid to decrease the size. But permanent cure is surgery. Please try also sitz baths with Oak Bark - sounds strange but can really help. Hope this answers all your concerns. If not, feel free to ask questions. Regards.
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