Thrombosed External Hemorrhoid – No Expert Consensus

Thrombosed external hemorrhoid, known also as TEH among experts, has been the bane of mankind from ancient days. Medical science has made great advances, especially in the last century. Consequently, a reasonable man would expect the treatment of TEH, usually non-life threatening, to be fairly routine and straightforward. Paradoxically, the most talented in TEH therapy continue to be embroiled in controversies. Opposing views and hypotheses, presented by researchers in medical journals over many years, indicate that much more research is called for.

It is no surprise then that thrombosed external hemorrhoid patients meet with opposing guidance when they consult a medical professional and be faced with a overwhelming collection of treatment modes and medications. What your doctor prescribes will depend on the dominant wisdom in medical circles of the day, his personal view (as influenced by his specific training and how well read he is) and his own experience with treating TEH patients. A TEH patient can be forgiven for empathizing with the proverbial guinea pig, especially since TEH is generally seen as an ordinary ailment. Pouring scorn on the medical circle is not the aim here, merely a resigned acknowledgment of one of those things, of which another instance would be the common cold.

Basic Controversy

The initial thrombosed external hemorrhoid issue to be evaluated is its etiology (US spelling) or aetiology (US spelling), the medical term for the causation of a disease. No matter how its cut, controversies do not get any more pivotal! Total precision as to the reason for TEH eludes modern science to this day as a result of the intricate complexities of the human anatomy.

Unsurprisingly, a changeable list of contributory causes circulates in the medical fraternity. 187 TEH research papers spanning Dec 1958 to Jan 2004, tomes of standard textbooks and years of practical experience later, Gebbensleben, Hilger and Rohde finally distilled the published etiological factors of thrombosed external hemorrhoid to 38.

The 3 gentlemen, in the months from Mar 2004 to Aug 2005, devoted themselves to an unusual prospective cohort study of 148 individuals, made up of 76 without TEH, 72 with TEH, both male and female, with ages ranging from 16 to 80. Indicative of its name, a prospective cohort study follows the future development of certain factors in a group with similar characteristics (the cohort). Depending on future events rather than past events, as in a retrospective study, the prospective model has more adherents.

38 Causal Factors

The thirty-eight causal determinants contributing to thrombosed external hemorrhoid pinpointed by researchers from 1958 to 2004 can be separated into 2 categories -

(1) Gender, nationality, housewife, worker, employee, self-employed, assumption to have hemorrhoids, prior anal surgery, hard bowels, diarrhea, use of laxatives, straining at defecation, sitting on cold surfaces, lifting a heavy load, coughing, sneezing, spicy meals, pregnancy, use of wet wipes or shower after defecation and menses;

(2) use of dry toilet paper only, use of dry toilet paper after defecation combined with wet cleaning, use of soaps and gels after defecation, frequency of genital cleaning before sleep, frequency of shower use, frequency of bathtub use, ano-receptive sex, recent alcohol intake, sports, pregnancy, excessive physical effort, career as trainee, civil servant, retirement, body mass index (BMI) and age.

Contrary to common perceptions, thrombosed external hemorrhoid has no meaningful statistical relation to Group 1. Sufficient statistical correlation to TEH in Group 2 factors warranted further study in the 148-patients cohort. Somewhat disappointingly, the original 38 suspected factors, filtered down to 16 eventually became further distilled down to 6 that could predict TEH with some accuracy.

3 factors in Group 2 that resulted in considerably increased risk of TEH were age of 46 or younger, physical over-exertion and use of dry toilet paper in combination with wet cleaning methods after passing motion. The 3 significant factors correlated with a lower risk of thrombosed external hemorrhoid included use of bathtub, use of shower and genital cleaning before sleep at least once a week.

Future research, the researchers submit, must cover all 6 factors when establishing best therapeutic practice (surgical or otherwise), causes (etiology) and prevention (prophylaxis). Somewhat melodramatically, the researchers stated that the line between fact and fiction must be clearly drawn in investigating risk factors. Nonetheless, several instead of one main factor is believed to be behind TEH formation.

Alternative Treatment

Somewhat limited in scope, as acknowledged by the researchers, but the study explains in part the wide range of solutions to be grappled with by those afflicted by thrombosed external hemorrhoid. The extent of the controversy is so extensive (187 research papers spanning 40 years and 38 possible causes!) that it is no wonder that we may hear quite divergent views from medical professionals. Please do not read this section to mean that we disrespect the good work of medical professionals. However, the current state of affairs does suggest that alternative remedies may have a role too.

Among others, H Miracle is an alternative remedy with many adherents. Put together by a former hemorrhoid sufferer, it has found many supporters. Its natural foundation has been a source of attraction for H Miracle. Of special attention are the thrombosed external hemorrhoid sufferers validating that H Miracle is a permanent and lasting answer.

Reference:

O. Gebbensleben, Y. Hilger & H. Rohde: Etiology of thrombosed external hemorrhoids: results from a prospective cohort study. The Internet Journal of Gastroenterology. 2009 Volume 8 Number 1