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Symptoms and treatment of hemorrhoids

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Hi, i am 29 years old, 165lbs. For the past three weeks i have had irregular bowel movement. In the past i have had, what i think are hemorrhoids, wich usually last 2-4 days and are gone with the proper fiber, less straining and lots of water. This time i has not been that way. For the first week, i tried the before mentioned steps, but i did not get any better. This past week it has gotten way more painfull, here are my symptoms:

1. Intense pain while passing a soft stool (specially in one region of the anus)
2. Blood on stool, usually one part of the stool about 1 inch, sometimes more (50% of the times i bleed, almost always if i strain with a tad of pressure. The color is not dark brown red, i think its regular red, kind of like the blood color in shaving cuts.
3. Itching/burning
4. swelling of the anal region, always after passing stool
5. Pain and uncomfort sitting down on most days
6. 1-2 small stools per day is my passing in the past week and a half, usually once in the morning, once in the evening. I have the urge and would like more, but it has gotten very painful and agonizing knowing acute pain of coming my way, specially if i strain.
7. Spasm in my anus

* I have tried the following: 1-2oz olive oil daily, The Original Colon Cleanse (100% Psyllium husk), around 20-30g fiber daily. 2-3L of water. Meal portions, i have cut down on, so i pass less stools. No red meats and avoid fried foods. More veggies and fruits. Ointments, i have tried vaseline, preparation H cream and suppository, baby wipes and tuck wipes for cleaning, also to avoid straining i use the squatty potty. Sith baths when possible. My stools appear to be really soft but firm with regular shape.

*The only Rx i take is Synthroid 25mcg regularly, and Adderall 10mg on occations (5-6 times a week, until the 17th of June) ( i was studying for an exam)
*HBP is good, i dont suffer from any other diseases as far as i know
*Recent lab works, from 6/10 came all fine except bilirubin

I have been very aware and maybe shy on going to a pcp or specialist, i am doing everything in my will to get better. Should i change diet, creams or try something different like a laxative. Should i make an appointment asap on monday with the pcp or specialist, or should i head to the ER to get me checked out? Please help, the pain and uncomfort has been frustrating me almost all month long and has even been mentally aggravating.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 30 Doctors Online

Thank you for your query at
I understand what you are going through and will do my best to help you.
The intense pain, discomfort and spasm of the anus all indicate that you may have developed an anal fissure(a small tear in the anus) along with hemorrhoids. The bleeding on passage of stools could be from the hemorrhoids. This can be controlled by additional measures like a local anesthetic jelly applied before bowel movements to relieve spasm and decrease pain. I really appreciate all the healthy measures you have taken such as a high fiber healthy diet and increased fluid intake.
I have the following suggestions.
- An OTC containing Lidocaine like L-M-X® 5 rectal cream should be applied to the affected area up to 6 times/day for anorectal pain relief. There is no need for laxatives or any other cream.
- An OTC like Ibufprofen 400 mg, twice daily with food for 5 days will also give you good pain relief.
- Please do continue your healthy diet and plenty of fluids.
- Continue the 100% Psyllium husk, 10 g in a glass of water or juice, three times daily.
- Also continue the taking sitz baths for 15-20 minutes, after every bowel movement.
- Follow the above measures for 5 days. If symptoms persist, then you will have to see your PCP or a General surgeon for a per rectal examination which will give us an exact picture of your condition.
- I have seen your reports. You need to correlate your thyroid results with your treating doctor.
- I would strongly advise you not to take the Adderall as research shows no good evidence of performance enhancement and the harms definitely outweigh any benefit.
I hope this was helpful.
Feel free to ask queries.
Thank you.

Patient replied :

Thanks for the advice, i could not find find the lidocaine 5, but i got lidocaine hydrochloride jelly 2%, will it work? Also, today pain has been bad, yet i had the opportunity to pass stools 3 times which is an advance, twice with blood. Also, to pass stool more easily i tend to squat with the toilet stool "squatty potty", yet to pass it easier i push with my finger near my anus region, so my anus wont strain or expand so much and my stool goes down way faster, is that a safe practice?


Yes, the 2% Lidocaine hydrochloride jelly will work. If you have a applicator cone in the package, you can use it to apply rectally about 10-15 mins prior to a bowel movement. Not more than 3 applications daily. Follow the instructions on the package insert carefully. This along with the Ibuprofen should provide relief.

You can continue using the "squatty potty", it is a good practice, and you can provide support to the anal region with your finger. 

You would have to get a physical evaluation done if symptoms persist after 5 days.

Let me know if I can assist you any further.

Thank you.

Patient replied :

If symptoms persist on the next 4 days, what type of doctor do you recommend i visit for evaluation? Gastro, Colo-rectal, internist...?
Also, i have norflex and celebrex from a previous treatment, will any of these actually help my pain a bit more? Im bitting a towel for the pain and horrible itch and uncomfort.


If symptoms persist after 4 days, you can see a colo-rectal surgeon. 

For the pain, if Ibuprofen is not helping, you can take Celebrex 400 mg instead, once during the acute pain and 200 mg after 8-12 hours, on the same day. You can continue taking 200 mg, twice daily subsequently for the next 3 -4 days.

Norflex will not be of much help. So you do not have to take it.

If in case, your symptoms do not improve with this and measures mentioned earlier such as the Lidocaine jelly and sitz bath, you do not have to wait and can see the surgeon at the earliest.

Thank you.

Patient replied :

Thanks for the help, i went to the colo spec. He gave me a week on water enema and analpram, next week he's running more test if symptoms persist. So far, pain relief with enema has been of great help, yet there is still pain, and lots of it, if stool is slightly wider or not watery, but i have had the opportunity to clean out my colon which was hell before.

thanks for the help

Hello. Good to hear that your symptoms have improved. The pain might take a little more time to resolve. Please do continue the Analpram. Also, the tablet Celebrex, twice daily and the other treatment measures. You will get relief soon. Take care.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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