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Thrombosed external hemorrhoid, frequently called TEH by medical practitioners, has long troubled mankind. Medical research has experienced exponential gorwth over the last couple of centuries. Consequently, as TEH is usually non-life-threatenting, a reasonable expectation would be that its treatment would be faily cut and dry, routine and ordinary. Interestingly, we learn that several TEH controversies continue to be actively debated by medical experts around the world. Opposing views and hypotheses, presented by researchers in medical journals over many years, indicate that much more research is called for.

It is no surprise then that thrombosed external hemorrhoid patients are faced with conflicting guidance when they consult a specialist and be met with a flustering range of treatment methods and medicines. Actual clinical practice of your doctor, his theoretical leanings and the foremost therapy dominating the medical circle of the day will determine the treatment you may receive. The strange feeling of being a guinea pig may well up after a TEH patient finishes a discussion of the wide array of TEH issues with the doctor. Pouring scorn on the medical circle is not the aim here, merely a resigned acknowledgment of one of those things, of which another instance would be the common cold.

Controversy At Its Very Basic

The primary thrombosed external hemorrhoid contention to be explored is its etiology (US spelling) or aetiology (US spelling), the scientific designation for the origin of a disease. It cannot be more foundational than this! Despite technological advances, the exact cause of TEH has not been pinpointed to date, confounded by the intricacies of the human anatomy.

As a result, there is an expanding list of probable and possible contributory causal factors. Gebbensleben, Hilger and Rohde studied 187 TEH research papers (published between Dec 1958 and Jan 2004), standard textbooks, journal reference lists and called on their own practical know-how before filtering the published etiological factors of thrombosed external hemorrhoid to 38.

The 3 gentlemen, in the months from Mar 2004 to Aug 2005, undertook an unusual prospective cohort study of 148 individuals, made up of males and females aged between 16 to 80, 72 with TEH and 76 without. Consistent with its name, a prospective cohort study of similar individuals (the cohort) examines the development of certain factors over a future period of time. With its reliance on future events to draw conclusions, the prospective cohort study is considered superior to the retrospective version.

Thirty-eight Etiological Factors

The 38 causal or etiological elements resulting in thrombosed external hemorrhoid fingered by researchers from 1958 to 2004 can be divided into 2 categories -

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

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

Contrary to common perceptions, thrombosed external hemorrhoid has little convincing statistical relation to Group 1. Group 2 contained statistically plausible factors which were studied further in the cohort of 148 persons. It may disturb some to know that only 6 out of 16 Group 2 factors can be depended on to predict whether TEH will ensue.

Three Group 2 factors associated with an elevated risk of contracting TEH were age of 46 or younger, use of dry toilet paper together with wet cleaning methods after defecation and use of excessive physical effort. The three factors significantly connected to the lower occurence of thrombosed external hemorrhoid include use of bathtub, weekly cleaning of genitals before sleep and use of shower.

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 unusually theatrical fashion, the researchers announced that there is a need to separate fact from fiction in studying risk factors. They also believe that it is likely that not one, but a spectrum of different factors may contribute to the formation of TEH.

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. Professional diagnosis may vary to the surprise of laypersons due to the far-reaching contentious research (187 research papers over 40 years yielded 38 causal factors but no clear culprit!). The above comments are not to be interpreted that proper medical advice be discounted. However, the situation suggests the need to be more open to alternative medicine.

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. A key draw for H Miracle has been the claim to being natural in concept and execution. Without fail, the key attraction is that of thrombosed external hemorrhoid sufferers confirming that H Miracle is a enduring 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