Thrombosed External Hemorrhoid – No Consensus After Decades Of Study

Thrombosed external hemorrhoid, known also as TEH among experts, has been the bane of mankind from ancient days. Medical research has experienced exponential gorwth over the last couple of centuries. In that event, one would not be unreasonable to expect that the diagnosis and treatment of TEH, frequently seen as non-life-threatening, would be routine and uncomplicated. Contrariwise, even today, the best of TEH experts are engaged in several unresolved controversies. Hundreds, if not thousands, of divergent hypotheses presented in research journals point to the need for more clarity.

Not unexpectedly, thrombosed external hemorrhoid patients encounter competing assessments when they consult a doctor and be confronted with a startling multitude of treatment procedures and medicines. Your doctor’s personal training and actual practice together with the preeminent view of the medical fraternity will determine the TEH therapy you receive. Experimental guinea pig may come to mind for the TEH sufferer who least expects it since TEH is normally regarded as a minor ailment. No disparagement of medical science and doctors is intended here, it is just one of those things, like the common cold.

Fundamental Controversy

The initial thrombosed external hemorrhoid issue to be analyzed is its etiology (US spelling) or aetiology (US spelling), the scientific moniker for the origin of a disease. Seen from any perspective, the controversy will not be any more pivotal! Convoluted interlinkages of the human anatomy continues to foil the search for a precise cause of TEH.

As a result, there is an expanding list of probable and possible contributory causal factors. Gebbensleben, Hilger and Rohde combed through 187 research papers on TEH spanning more than 40 years (Dec 1958 to Jan 2004), journal reference lists, standard textbooks and applied their own medical knowledge as practitioners before narrowing down 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 72 with TEH, 76 without TEH, both female and male, between the ages of 16 to 80. In line with its name, a prospective cohort study follows the evolving of certain factors in a group of individuals with similar characteristics (the cohort). Such a research method is superior to a retrospective cohort study where all the factors being studied had already taken place.

38 Etiological Factors

The thirty-eight etiological elements resulting in thrombosed external hemorrhoid identified by researchers from 1958 to 2004 can be separated into 2 categories -

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

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

Curious as it may be, thrombosed external hemorrhoid has no discernible statistical relation to Group 1. Further investigation of Group 2 factors was necessitated by apparent correlation to TEH as detected by the researchers. In the final analysis, it was found that only 6 of the 16 Group 2 factors were reliable indicators of TEH.

Of the 6 factors in Group 2, the 3 found to significantly increase the risk of TEH were use of excessive physical effort, age 46 or younger and use of dry toilet paper combined with wet cleaning methods after defecation. 3 factors associated with a significantly reduced risk of developing thrombosed external hemorrhoid include use of bathtub, weekly cleaning of genitals before sleep and use of shower.

Future research, the researchers submit, must cover all 6 factors when establishing best therapeutic practice (surgical or otherwise), causes (etiology) and prevention (prophylaxis). 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.

Alternatives

A limited study, point conceded by the researchers, but it nevertheless maps out the sometimes conflicting options for anyone suffering from thrombosed external hemorrhoid. Medical specialists may proffer to laypersons quite divergent advice given the considerable wide-ranging controversy (38 possible reasons, investigated in at least 187 research works over 40 years!). We must emphasize that we highly respect the work of medical professionals and do not play down any of their devoted efforts. Still, perhaps its time to allow alternative remedies to play a bigger role.

One such alternative treatment regime is H Miracle, easily the most favoured by TEH sufferers. Giving alternative remedies like H Miracle a chance has been the best thing for many a TEH sufferer. Natural and effective has been a key appeal factor for H Miracle. Especially captivating are the success stories of thrombosed external hemorrhoid sufferers validating that H Miracle is a enduring 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

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