Hemorrhoid Treatments: Creams, Suppositories, and Lifestyle Tips

Hemorrhoid ointments and gastrointestinal-related issues?

Hello, doctor.
Recently, I experienced a flare-up of hemorrhoids, so I registered at the clinic.
After the examination, it was found that I have two slightly swollen internal hemorrhoids.
The doctor prescribed a week's worth of oral medication along with Yizhi Kang ointment and suppositories.
However, I have some questions:
1.
How deep should the ointment and suppositories be inserted? I found online that the tube should be filled and held for 2-5 seconds, but the ointment prescribed by the clinic did not come with a long applicator, and the suppository instructions stated to insert it into the rectum.
The depth varies for each person, and the doctor only instructed to use my finger to insert it, without further details on the suppository.
2.
I found in the Ministry of Health and Welfare's drug introduction that Yizhi Kang ointment and suppositories can eradicate hemorrhoids in 6-8 weeks.
Is this true? However, most doctors say that hemorrhoids will persist unless surgery is performed, and we can only prevent flare-ups.
3.
It seems that prolonged time spent on the toilet is extremely harmful to hemorrhoids.
Does "time spent on the toilet" refer to the time spent straining until the stool is expelled, or does it include the time simply sitting on the toilet? Can using a footstool help reduce the harm of prolonged toilet time on hemorrhoids?
4.
Currently, reviewing my lifestyle habits, the only high-risk factors for hemorrhoids I have are obesity, staying up late, and prolonged sitting.
However, due to work, I often need to work overtime until 1 or 2 AM, making it difficult to improve my late-night habits.
I can only get up and move for 1-2 minutes every hour, otherwise, I might get scolded.
Does this mean there’s really no solution?
5.
My diet has been normal for the past few months, but a few weeks ago, I experienced sudden diarrhea for two days, followed by constipation for two days, and then it gradually returned to normal (averaging one normal bowel movement per day).
Yesterday and today, I also had sudden diarrhea for two days, and in the evening, I felt slight bloating, but each time it was only gas.
Could this be related to my hemorrhoids?

Niming, 20~29 year old female. Ask Date: 2022/03/03

Dr. Zhang Shuhao reply Surgery

1.
It is correct that clinic physicians do not provide long tubes for hemorrhoid ointments; applying the ointment with a finger is less likely to cause injury to the anal area.
Therefore, even if the ointment comes with a hard tube, its use is not recommended.
The ointment can generally be applied up to one knuckle deep, spreading it evenly from side to side.
Suppositories should also be inserted with a finger, allowing them to slide in naturally after passing through the external anal sphincter.
When inserting, a bit of ointment can be used for lubrication.
2.
Hemorrhoids are part of the body's tissue, and ointments or suppositories can alleviate the swelling symptoms of hemorrhoid flare-ups, but prolapsed hemorrhoids will not resolve on their own.
Maintaining good lifestyle habits after treatment can help prevent recurrences; as long as flare-ups do not frequently affect daily life, surgical removal may not be necessary.
3.
Prolonged straining during bowel movements or excessive frequency can exacerbate hemorrhoid symptoms, with the most significant impact coming from the act of pushing stool out of the rectum.
Therefore, preventing constipation by increasing fluid intake and dietary fiber to make stools softer can help prevent hemorrhoid flare-ups.
Elevating the feet on a stool can facilitate straining, but it is essential to minimize the time spent sitting on the toilet to reduce irritation to the hemorrhoids.
4.
Adjusting lifestyle habits is not an overnight process; one can start with diet and exercise.
Increasing the intake of low-fat, high-fiber foods and ensuring hydration of at least 2000-2500 cc per day is beneficial.
Planning physical activities on weekends can promote circulation, and regular warm sitz baths can also help.
You are still young and have great potential; there is definitely a way forward.
5.
Both diarrhea and constipation can lead to hemorrhoid flare-ups, but hemorrhoids do not cause abdominal symptoms.
If there are signs of intestinal dryness, starting with a low-fat, high-fiber diet can help improve gut flora.
If there are concerns about colon issues, a consultation for examination can be arranged.

Reply Date: 2022/03/03

More Info

Understanding hemorrhoid treatments can be quite complex, especially when considering the various medications and lifestyle changes that can help manage symptoms. Let's break down your questions regarding the treatment you've received, including the use of creams, suppositories, and lifestyle tips.

1. Depth of Application for Creams and Suppositories: When using topical treatments like creams and suppositories for hemorrhoids, the depth of insertion can vary based on the product and individual comfort. For creams, it is generally recommended to apply a small amount to the affected area, and if a nozzle is provided, it should be inserted gently into the anal canal. The advice you found about inserting the nozzle for 2-5 seconds is a common guideline, but if your cream does not come with a long applicator, simply applying it externally and using your finger to spread it gently is acceptable. For suppositories, they should be inserted into the rectum, ideally past the anal sphincter. A good rule of thumb is to insert it about an inch or so, or until you feel resistance. If your doctor advised you to insert it until your finger is inside, that is a reasonable approach.

2. Efficacy of the Treatment: The claim that the combination of creams and suppositories can "cure" hemorrhoids in 6-8 weeks is somewhat misleading. While these treatments can significantly alleviate symptoms and reduce inflammation, hemorrhoids can be a chronic condition. Many healthcare providers agree that without surgical intervention, hemorrhoids can persist or recur. The goal of using these treatments is to manage symptoms and prevent flare-ups rather than to eliminate the condition entirely.

3. Duration of Bowel Movements: Prolonged sitting on the toilet can indeed exacerbate hemorrhoid symptoms. The concern is not just about the time spent pushing but also the overall time spent sitting. Ideally, you should aim to limit your time on the toilet to about 5-10 minutes. Using a footstool to elevate your feet can help align your body in a more natural position for bowel movements, potentially reducing strain and making it easier to pass stool.

4. Lifestyle Factors: Your acknowledgment of being in a high-risk group for hemorrhoids due to obesity, prolonged sitting, and lack of sleep is important. While it may be challenging to change your work habits, incorporating small changes can help. For instance, try to take short breaks every hour to stand up and stretch, which can improve circulation and reduce pressure on the rectal area. Additionally, consider discussing your work schedule with your employer to find ways to accommodate healthier habits.

5. Dietary Changes and Gastrointestinal Symptoms: The fluctuations between diarrhea and constipation can indeed be related to hemorrhoids. Straining during bowel movements can aggravate hemorrhoids, and diarrhea can lead to irritation of the anal area. It’s essential to maintain a balanced diet rich in fiber to promote regular bowel movements and prevent constipation. If you are experiencing significant gastrointestinal symptoms, it may be worth consulting with a healthcare provider to rule out other underlying conditions.

In summary, managing hemorrhoids often requires a combination of topical treatments, lifestyle modifications, and dietary adjustments. While creams and suppositories can provide relief, understanding the chronic nature of hemorrhoids is crucial. If symptoms persist or worsen, it is advisable to follow up with your healthcare provider for further evaluation and potential alternative treatments. Remember, maintaining a healthy lifestyle and being mindful of bowel habits can significantly impact your overall well-being and help manage hemorrhoid symptoms effectively.

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