My Experience: Rubber Band Ligation plus Thrombosed External Hemorrhoids

I'm in the middle of a very long recovery and figured I'd take the time to lay out my experience in the hopes that a) it helps others and b) provides a jumping off point for people to share their own experiences. In short, I've had 3 rubber band ligations for internal hemorrhoids (2 bands each time) and have subsequently been dealing with 3 thrombosed external hemorrhoids after the fact. The relationship between those two things is a matter of some debate, but regardless, I had the banding treatments and have since been dealing with the VERY long process of waiting out several painful blood clots on the outside of my anus. It's been a hoot.

I'll start at the beginning.

In April of last year, after a particularly nasty bout of constipation that I should have treated with fiber and water but was too stupid to do so, I ended up with what felt like a prolapsed hemorrhoid (or hemorrhoids). Having had something like this when I was younger that resolved itself, I attempted to treat with Preparation H and--shudder--reinsertion in the hopes that it would eventually go away. After 3 months of this, I decided it was time to see a colorectal surgeon. Upon examination, he told me that he could do the rubber band ligation procedure and that this was relatively safe, with mild pain, but good results. I took a week to think about it then returned and said go for it.

In retrospect, the recovery from that banding and subsequent bandings wasn't all that bad. I had a sense of "fullness", some bleeding and pain for a few days, but with Metamucil and water, I was able to tolerate it fairly well. Don't get me wrong, I wouldn't recommend doing it as a weekend activity with your pals, but I survived.

3 weeks after the first treatment, I still had a sensation of prolapsing or general swelling and, since it went okay the first time, I figured it was safe to keep going. So we banded again. Arguably this treatment was more painful, plus there was a terrific moment when my doctor wasn't getting enough suction on the machine and had to solve that problem mid-procedure. Turns out he needed a new hose and chastised the nurse for not checking the suction before we started. "Take your time," I said, my butt in the air, trying not to eat the cushion my face was pressed into. As new bands got slapped onto a very sensitive part of my anatomy, I recall thinking "this is the last time." But honestly, I was willing to do this until I was fully healed.

Same 3 week period of recovery. As before, I spent the weekend relaxing. Took Advil. Slept in another room away from my girlfriend so I could toss and turn. On the back end (relax) of that experience, and approaching week 3 (again), I felt what seemed like another prolapse toward the back, or upper, part of my anus. I wonder in retrospect if this swelling was actually coming from the rim (an external) but regardless, safe procedure right? Let's do it one more time. So I did. Last time, no hose malfunctions, and that seemed to deal with these sensations of prolapse.

Then the fun really began.

We started in July, and now we're in late September and I start to feel bad sensations back there that I had never felt before: burning primarily. Scary, since I had never even had pain before. Was this rectal fluid? Was I leaking all the time? Did I make a terrible mistake? Was I broken? I visited my doctor again (he was getting to know me pretty well at this point) and he diagnosed "pruritus ani" (irritated bunghole to the layperson) and gave me Calmoseptine cream: a combination of zinc oxide as a skin protectant and menthol for its cooling effects. In my case, it might as well of been f---king napalm. Despite being concerned that I needed a "skin protectant" from "moisture" and why the hell THAT was the case, I went home and applied the cream, the thinking being that my skin just needed time to heal to achieve a state of normalcy.

This stuff burned like all hell. I wiped it off. Then I resolved to try again, since my treatment was all I was thinking about at this point. God it hurt. It was like I traded my old problems for new, worse ones. Burning, sticky ones. Well, after two days of trying this cream, I finally got a new result: I developed my first ever thrombosed external hemorrhoid. (That's a big painful purple blood clot on the rim of your ***.)

Now, I have to stop here and ask you are those two things related? The burning cream and the blood clot? My doctor said no. But menthol stimulates blood flow so it's not exactly a crazy theory. Or maybe having it on my skin made me clench my cheeks for two days straight and THAT caused it. Read on and decide for yourself. I know one thing: I'll never put that stuff on my butt ever again. Ever.

So at this point I'm dealing with a thrombosed external hemorrhoid (or TEH if you're busy). This is supposedly a rare condition that is arguably worse than the original prolapsing because at least that didn't hurt (even if having your insides or your outside wins the battle of which is worse psychologically). I'd say it was the size of a black bean (for some reason, we always compare this stuff to food) and it was quite clearly on the outside of my anus--one reason I'm inclined to believe in the accuracy of my original diagnose of internals. This one felt different. The doctor, as most do, advocated "conservative" treatment (i.e. wait it out).

The Internet will tell you these things take 2-3 weeks to resolve. This has NOT been my experience. I'd budget 2 months of your life at least for letting these little b******s subside. Possibly more.

Anyway, I wait and burn, and just feel like hot garbage. The acute pain is gone in about 2 weeks, but that raw sensation, and the feeling of "something" being there remains. It gets physically bigger. Then smaller. Then bigger again. But over time appears to be very slowly shrinking. Or rather, after 4 weeks or so, it appears to be shrinking. I iced it plenty. I binge watched TV and generally felt worthless. I'm not normally a depressed person, but it was an emotion I have since gotten pretty acquainted with. Good moments were few and far between and I held them tight whenever possible. I went for walks. I lived my life whenever I absolutely had to. If I'd sweat back there, the combination of moisture and rawness felt like I was pouring diarrhea out my *** and would never be right again. I worried that I stank. (I didn't.) I imagined that I'd have to go live in a cave wearing adult diapers. Fortunately, I've never been able to substantiate this "leakage" fear (very clean undies and such) so I think it's probably just a misreading of a foreign, icky sensation. Thank. God. Not a great position to be in, but given the choice, I'll keep my continence if you don't mind.

This takes us just past Thanksgiving. The external seems to be gone at this point. It's here that I'd like to say that even when you think these things are "gone" be ready to still feel them for quite some time. I return to my doctor and ask what gives. He goes back to this "pruritus ani" diagnosis and advocates really committing to the hydrochloric acid, I mean Calmoseptine. Not being entirely sure it was the source of my TEH (since no one else seemed to think so) I said sure and committed to a week of using it.

I got maybe 3 or 4 days into it before I had to stop. Then waited a bit and tried again. And then stopped. A few days later, the world fell out from under me: TWO more thrombosed external hemorrhoids. This time in a different spot.

I can't tell you how devastating that felt. It was like in prison movies when a guy gets thrown in "the hole" and just when he thinks he's coming out, they tack on another month. I had just clawed and scraped my way through the last two months, thinking that once this thrombosis was resolved, I'd be free. And just as I began to accept that maybe that might happen, I got sentenced to a new double helping of the same damn thing. Only worse because I had to wonder if more were on the way. What was I doing wrong? Why was this happening to me? Why the hell did I order MORE Calmoseptine online? I guess I'll just keep that tube in case I ever hate anyone enough to recommend it to them.

So now I've got perhaps a 75% healed TEH on one side and two brand new ones on the other side. I'm afraid to move. I'm afraid to NOT move. It's November 25th and I figure maybe I'll feel better by Christmas.

And now present day. We are almost to New Years and how am I doing?

It's hard. Sitting for long stretches sucks so it's difficult to focus on work. I'm less social. I used to sit for very long stretches in front of my computer (hey, you think these things are related??) and now I'm scared to. Plus it just feels plain wrong all the time. Painful after a while. I feel like everything I do could touch off another TEH. If that happened, I honestly don't know what I'd do. I can still feel the new ones, or at least one of them. The original one I feel occasionally, but less so. I want to believe I'm getting better but it's hard to tell. I've taken about a hundred pictures of my butt (available on request, just kidding) and find myself struggling with the ongoing mental battle. I just want to be right again. In my darkest moments, I worry that I made a terrible mistake in getting the RBL in the first place, though I'm not sure what else I could have done. In my best moments, I think this is just part of a very long recovery process and these things take an ungodly amount of time to go away. I don't know. It's very hard to see the light, but I try to remain hopeful. Maybe in a month or two this will all be a memory. Maybe.

At this point, I'd like to say that I found a great thread on Healthboards which seems to have numerous parallels with my own story. I read it like some people read The Bible and it's given me more hope than anything else I've read online: https://www.healthboards.com/boards/bowel-disorders/1040189-external-hemmie.html

I HAVE to believe this will subside. But it's difficult. And it's very unlike me not to be proactive and try to "fix" a problem. It's just that anything I could do right now risks making things worse and so I just have to drink water, eat fiber, walk everyday, and rely on my angel of a girlfriend to help me get through. I miss being able to just sit like a normal person, but with any luck, that day will come.

Wish all of you a healthy and happy New Year. If I feel significantly better, I'll come back and post again.

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