Friday, March 29, 2013

Hemorrhoid Hell!

It wasn't easy deciding if, or even what, I should share about my history with hemorrhoids, but given that they aren't exactly rare, especially among athletes, and most especially among older athletes, I decided to tell my tale.

To minimize the grossness, I'll give links rather than write disturbingly detailed descriptions here.   So you should be able to read this even if you are a bit squeamish.  Follow the links at your own risk: Each is informative, but some are quite graphic.

First, some anatomy: Hemorrhoids occur in the anal canal, the lower part of the rectum.  Next, a basic definition, courtesy of Wikipedia, and a great overview of causes, courtesy of WebMD.  What is not hemorrhoids is the soreness due to too-frequent wiping, or using coarse toilet paper: That's just normal skin irritation.  However, prolonged irritation can and will make any hemorrhoids worse.

The most important take-away is that there are two basic forms of hemorrhoids: Internal and external.  Each presents different symptoms and responds to different treatments, though there is some overlap.  Some internal hemorrhoids can exist for many years without ever being an issue, so it is important to note that, while hemorrhoids are never desirable, not all hemorrhoids present problems or symptoms.

My hemorrhoids started to appear about six years ago, shortly after I turned 50.  One interesting fact is that as my reward for surviving to 50, I got "scoped" all the way to my cecum, and the doctor's report mentioned the presence of only "small and inconsequential" hemorrhoids.  Nothing to worry about.

The conditions that led to my hemorrhoids started well over a decade ago: I blame mine on cubicle farms and weight training.  (There can also be hereditary factors, but I have no family history of chronic hemorrhoids.)

Thanks to cube farms and their incessant noise, I started spending more time on the commode, as that became the only quiet place at work where I could think ("throne thinking").  Never had a problem in the gold old days, back when I had an office.  If only headphones and music worked for me, instead of adding to the distraction.  Things got worse when I added a smartphone into the mix.

The very first new word you learn in weight training is "valsalva".  Do it right, and you get a safe increase in lifting power.  Do it wrong and you still lift more, but you also radically increase pressure "down there".  The key difference is exhaling: Too often, I would hold my breath during my largest lifts, which is Not the Right Way.

Combine the two for years on end, and I was on a railroad to hemorrhoids.

My first hemorrhoids would "pop out" during heavy lifts, and were easily "put back" via subtle hand pressure.  (Look around in a gym for that "subtle hand pressure": After you see it once, you'll see it near every weight station.  Try not to laugh out loud.)  Once in a while one would refuse to go back in, after which it would dry out and get irritated: A few days of Preparation H worked wonders.  (Sniff in a gym and you'll smell it: Again, please try not to laugh.)

Then the fateful day came when I found blood in the toilet bowl with my stool, as well as on the toilet paper.  It is important to note that this was blood separate from the stool, not part of the stool itself (which is an indicator for an entirely different set of serious medical issues).  In this case, it indicated the "leaking" or rupture of an internal hemorrhoid.  Another indicator is the presence of small farts that have a metallic or smoky scent: That's the iron in the blood being oxidized in the rectum.  I also had those, but they only made me wonder about my diet.

Now, if you followed the links above, you'll know that hemorrhoids are really just rectal tissue that has become swollen with excess blood.  Most often the weakened tissue will heal on its own, and the excess blood will be reabsorbed by the body.  But this process has failed to happen in hemorrhoids that become problems, especially in those that leak.

At this point, there are two basic choices: Remove the blood, or remove the tissue (which also removes the blood).

The most direct way to remove the blood is to shut it off at its source, to tie-off the vessel supplying the blood, which is called a ligature (latin for "knot").  The process of applying a ligature is called a "ligation".  And for leaking internal hemorrhoids, the easiest way to apply a ligation is to put a rubber band around the hemorrhoid, a "rubber-band ligation".  Which also removes the tissue.

When I saw that blood in my toilet, I immediately got a referral to a lower-GI specialist, who then performed a series of rubber-band ligations.  It turned out there are around six blood vessels that feed the lower rectum, and I had a hemorrhoid over each of them.  So I needed a total of six rubber-bands, each of which was about the size of those used in kids braces.  We did 1-2 on each subsequent appointment.

The procedure itself is quite painless, with no anesthesia required.  As the rubber-band does its job during the following days, the tissue will start to complain, and some pinching or cramp-like sensations will likely occur.  Eventually the tissue will die and fall off, unnoticed, during a bowel movement.

After my last rubber-band ligation, I was hemorrhoid-free for almost 2 years.  During this time I also stopped doing heavy lifts, focusing more on building muscle density and strength rather than bulk.

Then I started getting "pop-outs" again, which soon were happening with each bowel movement.  Every. Single. One.  But they always went back in, and stayed in, and they weren't leaking, so I monitored them, but didn't worry about them.

During this time I had started triathlon, and was getting ready to step up from sprints to the Olympic distance.  Which meant I needed to run a 10K, something I hadn't done in at least two decades.  As I increased the distance of my training runs, the oddest thing started to happen: My "pop-outs" would occur after about 3 miles.  If I didn't stop and put them back immediately, I knew they would get irritated, so it made doing continuous longer runs a bit of a problem.

Rather than deal with the hemorrhoids, I instead decided that my anus wasn't doing its job, and was weakening under the pounding of the longer runs, so I started doing Kegels.  (Yes, they work for men too!)  But in my case, they didn't do much to prevent the pop-outs, mainly just postponed them for another mile or so.

I finally did my my first Olympic race, and to my surprise, I had no pop-outs during the run!  The difference, of course, was that I was wearing a tri-suit during the race, while I normally trained in running shorts.  Clearly, compression is also useful for preventing pop-outs!

So, I still had my pop-outs with every poop, though they always went back in nicely.  And I did my long runs in my tri-shorts, which kept them in.  The problem wasn't "solved", but it wasn't really a problem any more.

Then I decided I wanted to step up to the half-iron distance.  And a 13 mile run.  Since none of my prior runs were ever longer than 6.2 miles, I started planning to increase my run distance during last winter (2012-2013).  But before my plan started, I injured my foot during the Tri Classic, and didn't return to running until less than a month ago.  With tri-shorts on, I had a pop-out after the first mile.  I did Kegels for a couple days, but it happened again on my next run.

Finally, I accepted the simple truth that it was time for my hemorrhoids to get repaired.  Since it was already clear to me that this wasn't a case for more rubber-band ligations, I got a referral to a surgeon.  The scheduling worked out perfectly, and I had an appointment the next day.

If you ever want to make a lower-GI surgeon happy, just show up with hemorrhoids like mine!  She asked me to "push them out", and when I did, her eyes lit up like it was Christmas morning.  She asked me if I had seen them, and I said no, I generally went by feel back there.  So she ran off to find a medical book, and returned to show me some truly surprising photos, to which she added, "Yours are like these, only better!".

You know, you just have to love people who really love their jobs.

She next told me I was an ideal candidate for a new procedure called THD, or "Transanal Hemorrhoidal Dearterialization".  That "dearterialization"?  It's just a kind of ligation.  And "transanal" means they don't need to cut their way in.  The best part of all is that it is surgery that doesn't involve a scalpel: Only very careful stitching is required.

This looked like an obvious winner to me, since even if it went poorly, it left open all the more traditional (and more invasive) surgical procedures.  We immediately scheduled my pre-op appointment and the surgery, and I had my procedure last Friday, March 22nd.

I won't go into the details of the procedure (which is cool) or my recovery (which has had its ups and downs), other than to say:
  1. Coming out of general anesthesia was the best chemically-induced feeling I've had since the '70's.
  2. I was immediately up and about, the main limitation being an inability to sit for very long (which improves every day).
  3. The tissue swelling that occurs makes it feel like you always need to "go".   So you try, get a little leakage, and wipe.  Over 20 times a day.  Which produces extreme irritation if you  forget to PAT instead of wipe!

I'll add to this story as my recover completes and I return to work and running.

1 comment:

  1. Thank you for sharing your very valuable experience! You saved me a lot of research.
    Can I ask few questions?

    1. How do you feel/training now?
    2.Are there any limitations?
    3.What was approx cost of a surgery?

    Thanks again!

    Rina

    ReplyDelete