Thrombosed External Hemorrhoid

Thrombosed external hemorrhoid, or TEH as the experts call it, has been with mankind from time immemorial. Medical science has made great advances, especially in the last century. One would expect that TEH, being generally classified as non-life threatening, would be a very straightforward medical condition with long established diagnostic and treatment methods. So it is rather surprising to learn that, as we approach the end of 2009, the experts continue to debate several controversies about TEH. There are literally hundreds, if not thousands, of research papers offering divergent hypotheses, findings, and open-ended conclusions that only serve as a cue for further study.

 

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Not surprisingly, thrombosed external hemorrhoid patients have to contend with differing views when they consult a doctor and be faced with a bewildering range of treatment methods and medications. The doctor’s decisions for you may well depend on the expert view that dominate current medical circles, the expert view he personally subscribes to (which may depend on how well-read he is or what specific training he has undergone for TEH) and his actual experience with the TEH patients he treats. In a sense, a TEH patient may begin to empathize with the proverbial guinea pig in an experiment even though it is a ‘run-of-the-mill’ type of disease. No disparagement of medical science and doctors is intended here, it is just one of those things, like the common cold.

The first thrombosed external hemorrhoid controversy to be examined is its etiology (US spelling) or aetiology (US spelling), the scientific term for the cause of a disease. How much more basic can a controversy get! The human anatomy is so complex that there has been no way to conclusively pin down one specific reason that results in TEH.

The consequence of this is a long list of factors that have been noted as contributing to its occurrence. After examining 187 research papers on TEH spanning more than 40 years (Dec 1958 to Jan 2004), journal reference lists, standard textbooks and their own medical knowledge as practitioners, Gebbensleben, Hilger and Rohde narrowed down published etiological factors of thrombosed external hemorrhoid to 38.

Between 18 March 2004 to18 Aug 2005, the 3 gentlemen conducted a rarely-done prospective cohort study of 148 individuals (72 with TEH and 76 without TEH, aged between 16 and 80 and of both genders). A prospective cohort study is one that follows, over a period of time, a group of similar individuals (the cohort) who differ with respect to certain factors under study in order to determine how these factors affect rates of a certain outcome, contracting TEH in this case. Such a study is preferred over a retrospective cohort study where all the events (exposure, disease occurrence) have already occurred in the past.

The 38 causal factors leading to thrombosed external hemorrhoid identified by researchers from 1958 to 2004 can be divided into 2 groups -

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

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

Contrary to common perceptions, thrombosed external hemorrhoid has no statistical relation to the Group 1 even though it included many factors believed to be causes. Group 2 contained statistically plausible factors which were studied further in the cohort of 148 persons. Interestingly, the study concluded that of the 16 factors in Group 2, only 6 were found to predict TEH correctly.

3 factors found to be associated with a significantly higher risk of developing TEH included age of 46 or younger, use of excessive physical effort and use of dry toilet paper combined with wet cleaning methods after defecation. 3 factors associated with a significantly lower risk of developing of thrombosed external hemorrhoid included use of bathtub, use of shower and genital cleaning before sleep at least once a week.

The researchers concluded that these 6 factors should be considered in future research on the etiology (causes), prophylaxis (prevention) and optimal therapy (conservative or surgical treatment) of TEH. In dramatic fashion, the researchers declared that it is necessary to determine which risk factors are real and which are fiction. They also believe that it is likely that not one, but a spectrum of different factors may contribute to the formation of TEH.

Despite the acknowledged small sample size, this study throws up great insights into why it can be so confusing for the patient with 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. This is not to say we should not follow their advice and recommended treatment methods. But it does suggest that perhaps, we should be more open-minded when it comes to considering alternative remedies.

An alternative remedy known as H Miracle ranks highly on the internet. Put together by a former hemorrhoid sufferer, it has found many adherents. Its popularity is attributable to the recommended remedies being natural as opposed to pharmaceutical. Equally attractive are the testimonials of recovered thrombosed external hemorrhoid sufferers that it is a permanent solution.

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