DEAR DR. ROACH: I have a hemorrhoid. It’s not small, but it’s not huge. At times, it itches or gets inflamed and feels sore for several days. I’m thinking it could be tied off with dental floss so that the tissue can necrose and hopefully just fall away, and I can be done with it. Or could it end up being a catastrophe? Your thoughts, please. — J.O.
ANSWER: We all have hemorrhoidal tissue. It’s an important part of the lining of the rectum and consists of blood vessels and connective tissue. When we complain about hemorrhoids, we mean that the tissues have become symptomatic, sometimes because of inflammation or clotting, but other times, the hemorrhoidal tissue becomes irritated and enlarged for no discernable reason.
Initial treatment for symptomatic hemorrhoids includes adequate fiber and water intake (fiber supplements like psyllium or methylcellulose have been shown to improve symptoms, but high-fiber foods are effective too); regular exercise; and avoiding straining or lingering on the toilet. Medications that cause constipation should be avoided if possible — especially opioids. But many prescription medicines can cause constipation: iron supplements, the blood pressure medicine verapamil, antihistamines, antidepressants, and many others. (Your pharmacist can help identify any potential culprits.) Fatty foods and alcohol are often problematic, but spicy foods, contrary to common wisdom, seldom worsen symptoms.
Over-the-counter treatments can help. Ointments, some of which have anti-inflammatories, are useful short-term treatments, but steroid-containing hemorrhoidal treatments generally shouldn’t be used for more than a week or so. Sitz baths are also helpful for many.
When home treatments don’t work, it’s time to see your doctor or a gastroenterologist. The gastroenterologist can perform a rubber band ligation for some types of hemorrhoids, but you should not try to do that at home. “Necrosis” is the term for death of cells and tissues, and that is just not something you should attempt to do yourself. Let an expert with the proper tools and experience treat you. There are many other types of treatments, both in-office and surgical, and it takes judgment to figure out the right approach.
DEAR DR. ROACH: I’m writing in regarding your recent column on biotin affecting blood tests. I have yearly blood tests due to a thyroid condition. I take Synthroid daily. I also take 2000 mcg of biotin twice a day, because my nails were peeling and splitting. I seem to have had some improvement in my nails, so I would like to continue with the biotin.
My question is this: How long before my blood test should I stop taking biotin, to minimize the effects on the blood work and avoid any adverse blood-test effects? — L.S.
ANSWER: Biotin doesn’t cause problems with the thyroid and doesn’t affect the medication, but it can confuse the laboratory assay. You can avoid this by halting the biotin for two days prior to taking the thyroid test. Other hormonal tests, like progesterone and testosterone, can also be affected by biotin, but none of them are as prevalent as in thyroid testing.
DR. ROACH WRITES: A recent column on cystitis glandularis discussed the possibility of this condition progressing to bladder cancer. An alert nurse noted that the person with this condition was a smoker. I should have emphasized the importance of quitting smoking — nothing reduces risk of cancer as much as quitting smoking.
I’ve been in the elevator in the hospital and heard a patient I didn’t know say, “The doctor didn’t ask about smoking, so it must be OK.” Every patient, during every visit, needs to know how important smoking cessation is at making them feel better and live longer. I thank J.S., R.N., for this reminder.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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