Thrombosed external hemorrhoid, frequently called TEH by medical practitioners, has long troubled mankind. Eureka moments have abounded in medical science over the last hundred years or so. For that reason, 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. So it is rather surprising to learn that, as we begin a new decade in 2010, the experts continue to debate several controversies about TEH. Medical papers recorded in professional journals detail many hypotheses, often with varying conclusions.

It is no surprise then that thrombosed external hemorrhoid sufferers have to cope with competing assessments when they seek the advice of a doctor and be faced with a perplexing range of treatment modes and remedies. 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. A consultation with the doctor may well leave a TEH patient feeling a little like the experimental guinea pig. Derision of the medical profession is the last thing intended here, more a case of accepting one of those things of humankind, much like the common cold.

Fundamental Controversy

The prime thrombosed external hemorrhoid controversy to be analyzed is its etiology (US spelling) or aetiology (US spelling), the clinical terminology for the cause of a disease. It cannot be more foundational than this! Absolute certainty of the cause of TEH continues to elude modern medicine due to the intricate makeup of human anatomy.

Inevitably,a constantly fluctuating list of possible causes makes its rounds. 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 the published etiological factors of thrombosed external hemorrhoid to 38.

The 3 gentlemen, in the months from Mar 2004 to Aug 2005, conducted an unusual prospective cohort study of 148 individuals, made up of females and males from the ages of 16 to 80, 76 without TEH and 72 with TEH. A prospective cohort study is one that follows, over a period of time, a group of similar individuals (the cohort) who di ffer 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 etc) have already occurred in the past.

Thirty-eight Causal Factors

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

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

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

Even though many oft-quoted factors are included in it, thrombosed external hemorrhoid has no representative statistical relation to Group 1. The researchers discovered adequate correlation in Group 2 factors with TEH to justify further investigation in the test cohort. Ultimately, the study distilled the dependable factors for predicting TEH from the 16 in Group 2 to only 6.

Age 46 or younger, use of excessive physical effort and use of dry toilet paper combined with wet cleaning methods after defecation are the three Group 2 factors discovered to correctly forecast the higher risk of TEH occurence. 3 factors associated with a significantly reduced risk of developing thrombosed external hemorrhoid include weekly cleaning of genitals before sleep, use of bathtub and use of shower.

On the basis of the results, it is advocated that these 6 factors have earned the right to be included in further research of TEH optimal therapy (non-surgical or surgical treatment), prophylaxis (prevention) and etiology (causation). In an uncommon zesty call to action, the researchers pronounced that fact and fiction must be clearly delineated in risk factors. However, they do concede that it is most likely a spectrum of various factors, as opposed to one main culprit, that contribute to TEH formation.

Alternatives

This study, though acknowledged by the researchers to be small in sample size, illustrates to some degree the difficulty faced by sufferers of 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 to mean that professional medical treatment be rejected. Nevertheless, the state of affairs indicates a need for alternative remedies to be given some weight.

The H Miracle is one such alternative treatment method that is very popular. The product of a former TEH sufferer, H Miracle has won over many. One of the biggest attractions has been the natural predisposition of H Miracle. Especially captivating are the success stories of thrombosed external hemorrhoid sufferers warranting that H Miracle is a 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

 

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