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Treatment for hemorrhoids, sigmoidoscopy, side effects of laxatives - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Digestion and Bowels
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2584 Questions
Doctor :   hi
Doctor :   how can i help you?
User :   I would like to follow up in regard to a case of piles that I had discussed here before and am trying to treat
Doctor :   ok
Doctor :   proceed
User :   Not sure if this is the same Dr I spoke to last time
User :   if not you may review my chat history
Doctor :   Do you know the name of the doctor with whom you hvae spoken last time?
User :   no because the chat window only says "Doctor"
Doctor :   Let me go through your chat history
User :   would be nice if the service showed a name or ID
Doctor :   Yes
User :   Please refer to the history from 13th of May
Doctor :   soon we will develop our software and modify it
User :   great
Doctor :   ok
Doctor :   So how is your condition right now
Doctor :   Have you had relief from symptoms
Doctor :   Are you there?
Doctor :   I have gone through your chat history.
User :   ok

User :   sorry
Doctor :   ok

User :   I have had very little relief from the symptoms
User :   Let me discuss what I have done for treatment first
Doctor :   proceed
User :   I have avoided red meat entirely, some poultry and fish, but always accompanied by plenty of fruits and vegetables, some whole grains as well
Doctor :   ok
Doctor :   good
User :   and warm to hot bath for 20 - 30 minutes most days
User :   Also apply witch AAAAAAA
User :   about once or twice a day
Doctor :   ok
User :   itching and soreness seems to be the only symptom that improves with this treatment
Doctor :   Apart from those whatelse do you have?
User :   still experiencing; bleeding sometimes, always feel like I have to have a bowel movement or that stool is stuck, an external lump about the size of a grape that appears on the outside of the spincter muscle and pain when I sit in office chairs
User :   those symptoms remain

User :   but I do have a bowel movement just about every day if not more
Doctor :   have you had physician checkup again?
User :   not since the sigmoidoscopy which was 2 weeks ago

User :   I think that was the cause of many of these symptoms
Doctor :   what was the treatment advised by doctor immediately after sigmoidoscopy?
User :   Well he said he found an enlarged papillae and hemmorhoids, I asked if they could be removed but he said only if they continued to bother me a lot. He only advised increased fibre in my diet
Doctor :   eventhough sigmoidoscopy is a tough procedure to undergo it would not cause any severe symptoms
Doctor :   probably it is the misinterpretation
User :   I think the procedure itself was okay, but the prep required harsh laxatives
User :   I am concerned the prep may have contributed not the procedure itself

Doctor :   laxatives at a single time wont harm colon
Doctor :   if you use them repeatedly then they cause inflammation of bowel which leads to mild bleeding
User :   ok

Doctor :   Are you using any laxatives right now?
User :   no

Doctor :   ok, thats good
Doctor :   so when is your follow up appointment?
User :   I don't have one scheduled and they did not recommend one at the time
Doctor :   ok
User :   I may need to make one, but am not sure if I should wait or what I should be asking about.
Doctor :   can you please list me the symptoms form which are you suffering right now , apart from soreness and itching
User :   yes
User :   1. Feeling that rectum has stool in it 24/7 even after a complete BM 2. Bleeding in stool, toilet or paper once or twice every week or so 3. Feeling of pressure like pain when sitting in an office chair or coughing. 4. Lump that presents when having a BM or after for a few minutes generally subsiding afterwards, this lump is on the external sphincter not a prolapsing pile from inside
User :   also sometimes itching or sornesss but not 24/7

Doctor :   ok
Doctor :   ok
Doctor :   What was the diagnosis by doctor
Doctor :   ?
Doctor :   external piles or Internal piles or rectal polyp??
User :   he said enlarged / hypertrophed papillae and hemmorhoids

User :   he did not specify internal or external
User :   he said both were nothing to worry about
User :   but I am not comfortable with these conditions
Doctor :   yes
User :   I think it would have helped if he gave some more detail as to internal vs external
User :   If I had to guess from my symptoms I think I have both
Doctor :   as per the symptoms you described it comes under first degree hemorrhoid
Doctor :   Do you have excruciating pain or mild pain?
User :   mild
User :   it can be a bit sharp when I first sit
User :   but I can tolerate it
Doctor :   because external hemorrhoids arise from skin which borders the anal canal which have lot of nerves so it leads to excruciating pain
User :   rest of the time it is mostly discomfort
Doctor :   but Internal hemorrhoids arise from anal mucosa so they are usually painless , but someitmes as in your case they might cause negligible pain
User :   well it was very sore when I had to use the laxitives

Doctor :   yes

Doctor :   laxatives leads to excessive bowel movement which naturally exacerbates your underlying mild pain
User :   I think if I weren't using baths, high fiber and witch XXXXXXXX this lump may be more painfull
User :   but the lump is very visable as external

User :   can even see it in the mirror
Doctor :   ok
Doctor :   I can understand your concern
User :   I am also fearful that this could get worse and at an inconvenient time
Doctor :   if at all it is very large and cumbersome , there is nothing wrong in going for a surgery
User :   I have to travel far sometimes
Doctor :   this isa minor surgery
User :   so you think surgery may be the best option at this point?
Doctor :   yes
Doctor :   you said its size is approximately around a grape , right!
User :   during BM and after yes, but completely dissapears after

User :   on it's own
Doctor :   No need to suffer from discomfort.
Doctor :   Schedule an appointment in near future .
User :   ok
Doctor :   And talk to your physician regarding this
Doctor :   let him know your point of concern
Doctor :   And ask him the possibility of surgery
Doctor :   He will naturally explain all the possible treatment options .
Doctor :   It seems someone frightened you regarding surgery through their bad experience.
User :   I have read that surgery can be very painfull and loose week or more of work if not longer
Doctor :   It is not a complicated surgery . It is a minor procedure .
User :   maybe the teqniques have since improved
User :   could you describe this in more detail?
Doctor :   yes a lot.
User :   I know there are both office procedures and traditional surgery
Doctor :   Apart from removing it with scalpel , now a days they are doing ligation and banding procedures which are Out patient basis procedures which can help you a lot .
User :   I have read a little about the banding and think this sounds like a good option for any internal piles I may have, but also read that this may not be appropriate for external lumps
Doctor :   among them advanced procedure is stapled hemorrhoidectomy
Doctor :   That why i am asking you to consult your doctor first .
User :   I will, but I may need to be a little more aggressive in my question asking because they like to say things are minor when I feel more treatment is needed.

Doctor :   no they never mention like that

Doctor :   You are the patient it is your responsibility to tell all the symptoms , and how they are affecting your daily routine life.
User :   ok
Doctor :   ok
User :   Can my Gastroenterologist perform such procedures or do I need another specialist for this?
Doctor :   It depends on Diagnosis of your condition.
Doctor :   Usually general surgeons will take care of hemorrhoids
User :   ok
Doctor :   evn rectal polyps can be treated by general surgeons
User :   hmm
Doctor :   So it is better to consult a general surgeon at this point of time .
User :   I may wish to go back to the GI that diagnosed it, and guess he could refer me to someone else if need be
User :   so that the full history is considered

User :   and less new exams needed
Doctor :   yes that is a good option
User :   ok
Doctor :   Is there anythingelse can i help with?
User :   no that was it for today, I thank you for your support, you have been knowledgable and patient

Doctor :   thank you
User :   It is rare that we get to spend this much time discussing with Doctors in the US

User :   they generally can only spend 5 minutes tops

Doctor :   yes i know that
User :   thank you
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
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