Case 1: Beverly before labor

Beverly was eight months pregnant. Her hemorrhoids had begun to flareup up at the beginning of her third trimester, two months before this visit. "I feel like it's a tone problem. My anal tissue just doesn't seem like it can support the weight of the baby. " She complained of pressure in the rectum (2). She felt like the skin would pop (2). She experienced a sense of fullness (3) and tightness (2). These sensations were much worse after a stool (3) and after drinking coffee (2). One night she could not sleep because of a twisting feeling (3) in the rectum. She was worried that the hemorrhoids would become worse during the duration of her pregnancy and, especially, during labor. On physical examination, two hemorrhoids about 1 cm in diameter were visualized protruding from the rectum.

Case 2: Beverly after childbirth

Beverly returned to see us seven weeks later. Her labor had lasted 29 hours, during which time she suffered from severe low back pain. She now felt a twisting (2) feeling in the rectum most of the time. The dis-comfort was temporarily relieved by cold applications (2). It was worse after a stool (3), at which time it throbbed (3). Beverly experienced some relief from elevating her legs. The pain was also worse from sitting down too long (2), at which time the pain became griping (2) or clenching (2). This was a problem because she needed to sit down much of the time to nurse her newborn son. There was only slight bleeding (1) with the hemorrhoids. Examination reveal one pink, swollen external hemorrhoid approximately 1.5 cm in diameter.

Case 3: Lois

Lois was a 45 year-old patient of ours of three years standing at the time of her hemorrhoid flareup. She had moved out of state, so we treated her hemorrhoids by phone consultation. Her hemorrhoids were terrible (3). "It's like when I had the kids. They are big (3) and painful (3). They burn (3). The pain can be needlelike (3). One is the size of a grape (3). I feel them all the time (3). It's worse lately since my mother in law is visiting and we're doing a lot of sitting. I can feel the pain travel up my back (2)." She had started to take rutin and Vitamin C and had also tried witch hazel and sitz baths, but nothing was helping. The tone of desperation in her voice was clear.

Case 4: Bill

Bill was in bad shape after painting the deck outside his house. He had squatted and stooped for two days in a row and ended up with a raging case of hemorrhoids. He had experienced hemorrhoids periodically in the past, but these were the worst. He felt a raw (3), sore (3), burning (3) pain in the rectum all the time. It was even worse after a stool (4). Bill experienced severe left sacroiliac pain (3) along with the hemorrhoids. The SI pain was sharp (2) and worse when he rose from sitting (3). He felt the hemorrhoids protruding (2). There was no bleeding. He could not come into the office, so there was no physical examination.