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Q: I'm a healthy, 43-year-old woman and my only complaint is hemorrhoids. They don't hurt or bleed, but they itch so badly they keep me up at night and drive me crazy during the day. Over-the-counter creams bring only temporary relief. What can I do and will this condition ever go away?

-- B.E., Milwaukee

A: As you may know, hemorrhoids are swollen and distended veins in the walls of the rectum and anus. They can be external (outside of the anal opening), internal or both.

Hemorrhoids are very common and are often caused or made worse by straining during bowel movements, constipation, prolonged sitting, pregnancy, obesity and low-fiber diets.

Treatment of hemorrhoids, therefore, begins by eliminating or limiting the things that makes them worse. Changing your diet so that your stools are softer and limiting straining during your bowel movements can be very helpful.

Beneficial changes in the diet include adding more roughage and bulk expanders. Equally important is drinking plenty of fluids (eight glasses of water per day). These dietary changes will probably also help you lose weight, if that is an issue contributing to your problems with hemorrhoids.

If, after dietary changes, constipation remains a problem, an initial evaluation by a doctor is warranted to determine if any underlying medical problems or drugs you're taking may be contributing to the problem. If not, stool softeners and other medications, used sparingly to treat constipation, may help.

In addition, you can treat the hemorrhoids by direct application of warm water in a sitz bath or by using anti-hemorrhoid medications. This direct approach works best for external hemorrhoids that can be more easily reached.

If these self-care approaches don't work, or even if they do but you're tired of keeping up the treatment, the other option is surgery. There are many good surgical alternatives.

For many years, the mainstays of surgical treatment have been injection sclerotherapy, in which the hemorrhoid is injected with a substance that produces scar tissue in the vein, and rubber band ligation.

Rubber band ligation is really as simple as it sounds. A special rubber band is stretched around a loop of hemorrhoidal vein. The contracted band cuts off the circulation in the affected section of the vein and, over a few days, it clots and dies off. Rubber band ligation can only be done on hemorrhoidal veins that are both greatly distended and reachable.

More recent treatment options include infrared photocoagulation and electrocoagulation. The more invasive surgery, called hemorrhoidectomy, may be a better approach in a small number of cases.

Laser surgery is also a newer approach that has a high success rate. But like all surgical procedures, especially newer ones, the benefits and risks depend a lot on the person doing the surgery.

Whether or not you select surgery, what surgery is best for you, and what you can expect with regard to pain and other possible side effects depends on the status of your hemorrhoids, the procedure recommended, and the experience of the surgeon doing the procedure.

I suggest that you talk with your doctor, discuss all these factors, and assess the risks and benefits of each surgical approach. If you are still hesitant about surgery, a more vigorous adoption of the self-help procedures I've indicated may be your best decision, at least for now.

Update on arthritis: Almost 50 million people in North America have arthritis. Although osteoarthritis and rheumatoid arthritis are the most common forms, arthritis is a collection of over 100 different diseases that cause inflammation of one or more joints.

There are many different treatments for arthritis. Some treatments are useful for a specific type of arthritis, but other approaches help almost all types.

Recent research (compiled by the Center for the Advancement of Health) has shown that a person's attitude and mental state affects the condition's impact. Those who took an active role in coping and those who had strong networks of personal support were better off.

An NIH panel of experts also concluded that relaxation training and behavioral training programs were highly effective in controlling pain in arthritis. A good example is research that has shown that people with rheumatoid arthritis who took a stress management course were not only more confident but had less pain.

So if you have painful and inflamed joints, you need to be sure you find out what type of arthritis you have to better tailor medical treatment.

But adding stress management training and making sure you have a group of people you can rely on for support may go a long way to ease the pain.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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