I would like to know what can be done for hemorrhoids -- the cause and cure for them. I am using Preparation H suppositories now. Will these be an effective treatment?

- Carolyn, Alma , Kansas

Dear Annoyed over Hemorrhoids-

Hemorrhoids are common, affecting about 4% of adults in the United States. The hemorrhoidal plexus, a clump of veins composed of rectal veins and superior and inferior hemorrhoid veins, may become engorged due to increased pressure, and become inflamed or irritated if a blood clot forms within them.

Why these normal veins become symptomatic is not completely understood. We find hemorrhoids more commonly in those who strain to pass stools, or have chronic constipation, diarrhea, prolonged sitting, advanced age, pregnancy, and rarely, pelvic tumors.

There’s a spectrum of possible treatment for a hemorrhoid disease. We start with stool softeners and bulking agents to decrease any straining on the stool. Many physicians recommend warm sitz baths in which the bottom is immersed in a basin of warm water for fifteen minutes up to four times daily. Personally, I think our fast-paced society frowns on people who stop work to immerse their bottom.

A mainstay of treatment is immaculate anal hygiene. It is difficult to get the nooks and crannies around those suckers clear of fecal debris, and this residual poo leads to the equivalent of painful diaper rash. I recommend using no toilet tissue, just baby wipes, the hypoallergenic type with aloe, to clean the outlet area thoroughly. You should allow the affected region to dry, wearing breathable cotton clothing, and going around unclothed down below when socially acceptable.

After you’re clean down there, you’d like to shrink the enlarged hemorrhoids. Our best bet is desiccating witch hazel products such as the one our reader is using, with an intent to turn a fat juicy grape into a dehydrated raison. I prefer Tucks pads, which include the witch hazel but no moisturizing cream or ointment.

The pain can be improved by occasional dabs of 2% lidocaine jelly, available at the pharmacy with a prescription. Steroid suppositories or creams, containing hydrocortisone, should not be used for longer than one week, as they cause skin rash or thinning of the skin with prolonged use.

If the hemorrhoids are huge or just won’t resolve, more aggressive management might be advised by your doctor. The techniques include banding (a rubber band is placed around the hemorrhoid causing it to fall off), sclerotherapy ( a caustic agent is injected into the hemorrhoid to fibrose the tissue), and one of five surgical techniques.

If you do experience BRBPR (doctor speak for "bright red blood per rectum"), see your physician even if you’re sure that you have hemorrhoids. In a group practice of five gastros, about twice a year we diagnosed a rectal cancer in someone who also had hemorrhoids, so had been ignoring the smears of blood on their toilet tissue. BRBPR is a reason for a flexible sigmoidoscopy at any age, and a colonoscopy if approaching fifty.