DEAR DR. DONOHUE: I read your article on hemorrhoids. Do you have more information on nonsurgical treatments for them? – D.H.

Hemorrhoids are cushions of tissue that contain blood vessels, muscle fibers and filler material. You can think of them as varicose veins and won’t be too far off base.

The position of hemorrhoids and how far they have dropped determine what procedure is most appropriate for them.

External hemorrhoids are close to the anal opening. This is an area with many nerves, so external hemorrhoids can be most painful, especially when a clot forms in one of the hemorrhoidal veins. Evacuation of the clot can often be accomplished in the doctor’s office. Keeping stool soft by increasing dietary fiber or by using products such as Metamucil or Citrucel is both treatment and prevention. Soaking in a tub of warm water is another way of soothing and shrinking external hemorrhoids.

Internal hemorrhoids are located a bit farther up the anus. There are fewer nerves in this area, so internal hemorrhoids are less painful, unless they have a clot and have dropped far downward. They can drop so much that they protrude from the anal opening.

The extent of their drop is graded from 1 to 4, with 4 being a hemorrhoid that protrudes from the anus and cannot be pushed back in. Grades 1 and 2 internal hemorrhoids can often be treated with rubber bands placed around their base. In about a week, the hemorrhoid sloughs off. Surgical stapling is suitable for many hemorrhoids, and grades 1, 2 and 3 hemorrhoids respond well to it. It sounds barbaric, but it is actually not so painful. The doctor pushes the hemorrhoid back into its normal position and tacks it there with staples. Coagulation with infrared light can cure small grade 1 and 2 internal hemorrhoids. Sclerotherapy, the injection of a liquid that causes the hemorrhoidal vein to collapse, takes care of grades 1, 2 and 3 hemorrhoids. Grade 4 hemorrhoids usually require surgery.

Not all of these techniques are available everywhere, and not all are suitable for every hemorrhoid problem.

DEAR DR. DONOHUE: I read and hear much about hepatitis B and C, but little about A. Why? I had infectious hepatitis when I was a child. My doctor says that it was hepatitis A. Does this kind of hepatitis stay with you for life? – A.M.

Hepatitis A is very much with us. It doesn’t get as much publicity as hepatitis B and C, because hepatitis A does not stay with a person for life. It’s the kind of hepatitis that comes about from food contaminated with the virus and from shellfish that live in polluted waters. Person-to-person spread is another route of transmission.

The initial illness of all the hepatitis viruses is similar, with loss of appetite, vomiting, fatigue, joint and muscle pain, headache, skin and eye yellowing and a rise in temperature. People can be very sick with hepatitis A, but death is quite rare and chronic infection doesn’t happen. There is a vaccine for hepatitis A, and those who are at risk of infection are urged to obtain it — travelers going to countries where hepatitis A is prevalent, military personnel and people with chronic liver disease, to mention a few. The Centers for Disease Prevention and Control recommends that all infants older than 1 receive the vaccine.

Hepatitis is a common and misunderstood illness. The hepatitis booklet deals with hepatitis A, B and C. Readers can obtain a copy by writing: Dr. Donohue – No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am 33 and have a ruptured back disk. Would an operation stop me from participating in sports? – E.M.

If you follow hockey, you know that the number of professional players who have had back surgery for ruptured disks is quite high. They continue to play professional hockey after their operations. There’s no reason you cannot play sports after such surgery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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