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Suggest treatment for recurring hemorrhoids

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Posted on Wed, 23 Jul 2014
Question: I developed anal fissure/hemorrhoid during my delivery....will Oxerute help? Its been 3 months since my delivery and i was getting healed. But again the internal and external hemorrhoid is troubling me. Please prescribe a mediaction that will cure the hemorrhoid.
doctor
Answered by Dr. T Chandrakant (24 minutes later)
Brief Answer:
First get proper diagnosis of the exact condition.

Detailed Answer:
Hi.
Thanks for your query.

One of the most important issues after delivery is development of anal fissure and / or hemorrhoids.

I would advise you first to consult a General Surgeon to get a proper diagnosis , whether you are suffering from fissure and / or hemorrhoids. There can be a combination of both the problems.
The treatment is bit different for both the conditions, hence the necessity of having a very proper and clear-cut diagnosis which can be done only on clinical actual examination, digital examination and minimum of a proctoscopy examination by an expert in the field

In Anal fissure, there is a lot of pain , burning after applying water to clean, blood can be just smeared on the hard stool or a few drops only. The pain remains for half an hour or more and gets soothing with the Sitz bath. There can be an associated skin tag at the front or back- these are called ''sentinel piles''- they are not true piles, can not be pushed inside anal canal, are a bit firm to hard to touch and mildly painful.

In contrast: the piles ( hemorrhoids) are always painless ( unless thrombosed and prolapsed), Felt as a soft mass only, bleeding sometimes can be alarming. They can be reduced if pushed inside.

So if you want a real good treatment consult a General Surgeon, who can diagnose and give you the Medical treatment as per the final diagnosis.
Please continue Sitz Bath as it helps in both the conditions
Continue Medicines as per prescription of a General Surgeon after a proper diagnosis- insist on proper examination and diagnosis if you want a cure.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant (22 hours later)
Hello Dr. Chandrakant,

Thanks for answering my query. I have already consulted a General Surgeon and he did a physical examination and concluded to be a combination of anal fissure and hemarrhoid as you have explained above. There is no blood but there is terrible burning pain when cleaned with water.

When it is a combination what kind of treatment would you suggest. Currently I'm taking a stool softener Fermat in liquid 15 ml in the night and using Oxerute before and after evacuation.

Will the above medicines just help or is there any additional treatment required to cure my condition.

Thanks
XXXX
doctor
Answered by Dr. T Chandrakant (29 minutes later)
Brief Answer:
Good medical management; Surgery only if required

Detailed Answer:
Hi Madam XXXXXXX
IT is good to know that you have already consulted a General Surgeon.
When there is a combination of both; the treatment remains almost same for internal hemorrhoids and fissure as the cause is same for both the conditions.
I hope the hemorrhoids are not much symptomatic as there is no bleeding and must be grade I or II (if not prolapsing - need no special treatment)

Severe burning pain indicate fissure, which is open. Sitz bath before and after motion is passed, cleaning the area with a cotton ball soaked in the warm water, applying liquid povidone iodine ( batadine) to the peri-anal area helps avoiding secondary infection and relieving discomfort to a large extent.

I hope your Surgeon has prescribed you a course of antibiotic, metronidazole and anti-inflammatory medicines. You can certainly request for pain-killer to be taken before going for motion. Add probiotics and multivitamins.
Have normal full diet ( as against the wrong notion of stopping some foods and spices) you need to gave a well formed soft stool - NOT the liquid one). Adjust the doses of Fermat according to your needs.

Usually The fissure heals well in most of the cases. Only those patients who do not respond to medical management may require a small procedure. It can a Lord's Dilatation under general anesthesia or a small incision of the internal sphincter called internal sphincterotomy. Please discuss this with your Surgeon.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant (27 minutes later)
Dear Dr. Chandrakant,

Thank you for the quick response. I will follow as above. The reason no antibiotics prescribed for me is because i'm still nursing the baby. my baby is 3 months old.

Best regards
XXXX
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
There are safe antibiotics

Detailed Answer:
Yes , I do understand that due to nursing the baby, Your Surgeon would have avoided Antibiotic.
There are antibiotics which can be given safely even in nursing mothers. Please request for a course as this helps in recovery.

Anyway, please follow this and take sitz bath 3 to 4 times. IT soothes the muscles, keeps the area clean.

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant (11 days later)
Hello Dr. Chandrakant,

Sorry couldn't reply to you earlier. I went for a follow up check up to my General Surgeon as I had burning pain and trouble evacuating even though I wasn't constipated. He did a physical examination and said that the anal sphincter has contracted and shrunk in the size of the passage which is the reason I'm having trouble with the evacuation of bowel. He said this is mainly because of lactating. These should subside in time and should completely stop once I stop breast feeding. If this condition doesn't improve he said I may have to undergo dilatation which he feels is not necessary. He has asked me to continue sitz bath. Also prescribed cream diet as stool softener and asked me to use smuth cream before and after evacuation. And to apply cream gel in the night. It's been 2 weeks the burning sensation has reduced but I still have a hard time evacuating. Please advise a solution doctor as I'm really suffering with this and I evacuate twice a day so I go through this trauma twice a day.

Thanks
XXXX
doctor
Answered by Dr. T Chandrakant (18 minutes later)
Brief Answer:
Better to try dilatation

Detailed Answer:
It is OK Madam XXXXXXX
Thanks for your feedback.

I can understand the pain you are going through plus the Motherhood- no proper timetable of anything.

Not to contradict your Surgeon, but I think it is his experience about lactation and the contraction of the sphincter.

One of the indication for dilation under General Anesthesia is failed Medical management. The Surgeon has already said about the contraction and shrinking of the internal sphincter.

I think dilatation should be given a try. It may help a lot.
Please discuss this with your Surgeon. Please note there are chances of recurrence or not getting sufficient relief, but remember there is more chances that you may be cured at the earliest. 65 % of the patients get a complete cure.
And you will be one of them as you understand and follow the medical management rigorously.

Please go ahead with dilatation after discussion with your Surgeon and family too.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. T Chandrakant (44 hours later)
Hello Dr. Chandrakant,

Thanks for your suggestion. I went to the another doc today and discussed about surgery as my condition has not improved as referred by my Gynaecologist. My current doc is not in town.

He has given me the following medications and asked to see him next Tuesday. If the spasm doesn't reduce he said it is better to do sphinterotomy.

Smuth cream to continue
Stool softener- Livoluk fibre instead of cream diet which I was taking
Lactihep
Ketanov

He feels that I should be fine after these medications. Otherwise he feels no point prolonging the pain and better to go for surgery. My only worry is that I'm breast feeding my baby and how will the surgery affect his feed and does it require to get admitted in a hospital. Please advise your thoughts.

Thanks
XXXX
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Take the medicines and surgery if it fails.

Detailed Answer:
Good that you took another opinion, just follow the advice and continue medicines.

Your only Worry:
Your Surgery is just a day-care one.
You can feed the baby before you go to the Operation Theater ( OT - my personal opinion), and feed the baby after few hours after the Surgery , when the Anesthetist allows. Please tell the Anesthetist about the breast feeding.

Yes, admission is required as the procedure is done in OT.
This is a Day-care Procedure.

Just go ahead if the medicines do not help.
All the best.

Above answer was peer-reviewed by : Dr. Prasad
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Dr. T Chandrakant

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Suggest treatment for recurring hemorrhoids

Brief Answer: First get proper diagnosis of the exact condition. Detailed Answer: Hi. Thanks for your query. One of the most important issues after delivery is development of anal fissure and / or hemorrhoids. I would advise you first to consult a General Surgeon to get a proper diagnosis , whether you are suffering from fissure and / or hemorrhoids. There can be a combination of both the problems. The treatment is bit different for both the conditions, hence the necessity of having a very proper and clear-cut diagnosis which can be done only on clinical actual examination, digital examination and minimum of a proctoscopy examination by an expert in the field In Anal fissure, there is a lot of pain , burning after applying water to clean, blood can be just smeared on the hard stool or a few drops only. The pain remains for half an hour or more and gets soothing with the Sitz bath. There can be an associated skin tag at the front or back- these are called ''sentinel piles''- they are not true piles, can not be pushed inside anal canal, are a bit firm to hard to touch and mildly painful. In contrast: the piles ( hemorrhoids) are always painless ( unless thrombosed and prolapsed), Felt as a soft mass only, bleeding sometimes can be alarming. They can be reduced if pushed inside. So if you want a real good treatment consult a General Surgeon, who can diagnose and give you the Medical treatment as per the final diagnosis. Please continue Sitz Bath as it helps in both the conditions Continue Medicines as per prescription of a General Surgeon after a proper diagnosis- insist on proper examination and diagnosis if you want a cure.