Thrombosed external hemorrhoid, [or TEH as the experts call it, has been with mankind from time immemorial|known also as TEH among experts, has been the bane of mankind from ancient days|often referred to as TEH by medical experts, has long plagued mankind|frequently called TEH by medical practitioners, has long troubled mankind|often shortened to TEH by medical professionals, has troubled many for a long time|shortened to TEH by busy medical experts, has long troubled both men and women|or TEH for short, has long troubled both medical experts and sufferers alike|known also by its acronym TEH, troubles both men and women, old and young|or TEH, has been the subject of decades if not centuries of intensive medical research|or TEH for short, has been intensively studied for centuries in both men and women|known also as TEH in medical circles, has been subjected to indepth and extensive research over decades|commonly abbreviated to TEH, has seen its fair share of controversy in the medical community]. Just retracing back a few decades will leave one in awe at the advances in medical research. For that reason, it is not unreasonable to expect that TEH, being typically non-life threatening, would be a medical condition with cut and dry therapeutic solutions. Contrary to expectations, right this moment, there are several unsettled controversies among TEH experts. Medical papers recorded in professional journals detail many hypotheses, often with varying conclusions.

[It is hardly surprising that|Not surprisingly,|Not unexpectedly,|It is no surprise then that|It comes as no surprise then that] thrombosed external hemorrhoid [sufferers|patients] [have to cope with|have to contend with|have to deal with|encounter|meet with|are faced with|have to grapple with] [opposing|differing|competing|clashing|conflicting] [views|opinions|beliefs|assessments|conclusions|viewpoints|recommendations|instructions|guidance] when they [seek the advice of|consult] a [specialist|doctor|medical professional] and be [presented|faced|confronted|greeted|met] with a [baffling|bewildering|confusing|perplexing|flustering|staggering|startling|stunning|overwhelming|mind-boggling|astonishing] [array|range|selection|multitude|lineup|collection] of treatment [procedures|methods|modes] and [medicines|medications|remedies|prescriptions]. The therapy recommended by your doctor will probably be influenced by the prevailing view of the day, his personal experience in terms of training and actual TEH consultation. Empathy for the guinea pig in experiments may be one of the emotions felt by TEH sufferers, not least because they had expectations that TEH is a pretty mundane medical condition. Like the common cold, one might be resigned to TEH without being at all disrespectful of the medical profession.

[Controversy At Its Very Basic|Fundamental Controversy|Basic Controversy]

The [foremost|first|leading|initial|principal|primary|prime] thrombosed external hemorrhoid [debate|controversy|issue|argument|discussion|contention|disagreement|discord|dispute] to be [analyzed|examined|considered|explored|investigated|scrutinized|surveyed|studied|cross-examined|evaluated|reviewed] is its etiology (US spelling) or aetiology (US spelling), the [medical|scientific|clinical] [description|term|expression|moniker|designation|nomenclature|terminology] for the [origin|cause|causation|source] of a disease. It cannot be more elemental than this! Intricate inter-relationships in the human anatomy may explain the lack of precision in identifying the root source of TEH.

A mercurial list of contributory causal possibilities naturally results. [After examining 187 research papers on TEH spanning more than 40 years (Dec 1958 to Jan 2004), journal reference lists, standard textbooks and their own medical knowledge as practitioners, Gebbensleben, Hilger and Rohde narrowed down the published etiological factors|Gebbensleben, Hilger and Rohde combed through 187 research papers on TEH spanning more than 40 years (Dec 1958 to Jan 2004), journal reference lists, standard textbooks and applied their own medical knowledge as practitioners before narrowing down the published etiological factors|Combining their own medical knowledge of TEH as practitioners with standard textbooks, journal reference lists and 187 research papers that spanned more than 40 years (Dec 1958 to Jan 2004), Gebbensleben, Hilger and Rohde eventually condensed the published etiological factors|187 TEH research papers spanning Dec 1958 to Jan 2004, tomes of standard textbooks and years of practical experience later, Gebbensleben, Hilger and Rohde finally distilled the published etiological factors|Gebbensleben, Hilger and Rohde studied 187 TEH research papers (published between Dec 1958 and Jan 2004), standard textbooks, journal reference lists and called on their own practical know-how before filtering the published etiological factors] of thrombosed external hemorrhoid to 38.

In the period from Mar 2004 to Aug 2005, the 3 experts undertook an uncommon prospective cohort study involving 148 patients (72 with TEH, 76 without, of both genders and with ages from 16 to 80). As suggested by its name, a prospective cohort study is forward-looking and focused on a group of people with similar characteristics (the cohort) but differing in the factors being studied. By not relying on past events, like in a retrospective cohort study, the prospective model finds greater levels of acceptance.

[Thirty-eight Causal|38 Causal|Thirty-eight Etiological|38 Etiological] Factors

The [thirty-eight|38] [etiological|causal|etiological or causal|causal or etiological] [determinants|elements|factors] [resulting in|leading to|contributing to|giving rise to] thrombosed external hemorrhoid [fingered|identified|pinpointed] by researchers from 1958 to 2004 can be [separated|divided|broken down|segregated|subdivided] into 2 [categories|groups|batches] -

(1) [Nationality, gender, employee, worker, housewife, self-employed, prior anal surgery, assumption to have hemorrhoids, diarrhea, hard bowels, use of laxatives, sitting on cold surfaces, straining at defecation, lifting a heavy load, sneezing, coughing, spicy meals, use of shower or wet wipes after defecation, pregnancy and menses|Gender, nationality, housewife, worker, employee, self-employed, assumption to have hemorrhoids, prior anal surgery, hard bowels, diarrhea, use of laxatives, straining at defecation, sitting on cold surfaces, lifting a heavy load, coughing, sneezing, spicy meals, pregnancy, use of wet wipes or shower after defecation and menses|Employee, self-employed, housewife, worker, nationality, gender, prior anal surgery, diarrhea, use of laxatives, spicy meals, assumption to have hemorrhoids, hard bowels, coughing, sneezing, pregnancy, menses, straining during defecation, use of shower or wet wipes after defecation, sitting on cold surfaces and lifting a heavy load|Use of shower or wet wipes after defecation, assumption to have hemorrhoids, straining at defecation, sitting on cold surfaces, prior anal surgery, use of laxatives, hard bowels, diarrhea, spicy meals, pregnancy, menses, sneezing, coughing, nationality, gender, self-employed, employee, worker, housewife and lifting a heavy load|Assumption to have hemorrhoids, prior anal surgery, lifting a heavy load, sitting on cold surfaces, nationality, housewife, worker, employee, self-employed, gender, pregnancy, menses, use of wet wipes or shower after defecation, straining at defecation, use of laxatives, hard bowels, diarrhea, spicy meals, coughing and sneezing|Diarrhea, hard bowels, use of laxatives, straining at defecation, use of shower or wet wipes after defecation, assumption to have hemorrhoids, prior anal surgery, pregnancy, menses, spicy meals, coughing, sneezing, gender, nationality, self-employed, employee, worker, housewife, sitting on cold surfaces and lifting a heavy load];

(2) [Age, body mass index (BMI), retirement, career as trainee, civil servant, pregnancy, excessive physical effort, sports, recent alcohol intake, ano-receptive sex, frequency of  bathtub use, frequency of shower use, frequency of genital cleaning before sleep, use of dry toilet paper after defecation combined with wet cleaning, use of dry toilet paper only, use of soaps and gels after defecation|retirement, career as trainee, civil servant, age, body mass index (BMI), pregnancy, recent alcohol intake, sports, excessive physical effort, frequency of shower use, frequency of bathtub use, ano-receptive sex, use of dry toilet paper only, use of dry toilet paper after defecation combined with wet cleaning, use of soaps and gels after defecation and frequency of genital cleaning before sleep|use of dry toilet paper only, use of dry toilet paper after defecation combined with wet cleaning, use of soaps and gels after defecation, frequency of genital cleaning before sleep, frequency of shower use, frequency of bathtub use, ano-receptive sex, recent alcohol intake, sports, pregnancy, excessive physical effort, career as trainee, civil servant, retirement, body mass index (BMI) and age|frequency of shower use, frequency of bathtub use, frequency of genital cleaning before sleep, use of soaps and gels after defecation, use of dry toilet paper after defecation combined with wet cleaning, use of dry toilet paper only, sports, excessive physical effort, ano-receptive sex, recent alcohol intake, body mass index (BMI), age, pregnancy, career as trainee, civil servant and retirement|excessive physical effort, sports, pregnancy, recent alcohol intake, ano-receptive sex, frequency of bathtub use, frequency of shower use, frequency of genital cleaning before sleep, body mass index (BMI), age, career as trainee, civil servant, retirement, use of soaps and gels after defecation, use of dry toilet paper only and use of dry toilet paper after defecation combined with wet cleaning|use of soaps and gels after defecation, frequency of genital cleaning before sleep, use of dry toilet paper after defecation combined with wet cleaning, frequency of shower use, use of dry toilet paper only, frequency of bathtub use, ano-receptive sex, pregnancy, recent alcohol intake, excessive physical effort, sports, career as trainee, retirement, civil servant, body mass index (BMI) and age].

[Contrary to common perceptions|Though many familiar factors appear on it|Even though many oft-quoted factors are included in it|Despite including many common factors|In spite of the inclusion of many common factors|Surprising though it may be|Strange as it may seem|Quite unexpectedly|Curious as it may be], thrombosed external hemorrhoid has [little or no|no|little|insignificant|minor|no major|no discernible|little discernible|no significant|no meaningful|no compelling|little convincing|no consequential|no representative|little valid|no convincing|little compelling|minimal compelling|minimal] statistical relation to Group 1. Statistical relationships were evident in Group 2 factors to justify further studies in the cohort of 148 subjects. .

The 3 Group 2 factors of use of dry toilet paper combined with wet cleaning methods after defecation, use of excessive physical effort and age 46 or younger were found to significantly elevate the risk of TEH. [The three factors associated with significantly lower risk of developing|3 factors associated with a significantly reduced risk of developing|The 3 significant factors correlated with a lower risk of|The three factors significantly connected to the lower occurence of|The 3 factors closely correlated to the decreased risk of developing|The three factors most closely associated with the lower risk of manifesting|The 3 factors most significantly correlated with the reduced risk of|The three factors most closely related to diminished risk of|Of the 6 Group 2 factors, the 3 most closely linked to receding risk of|The 3 Group 2 factors out of the 6 that closely forecasted waning risk of] thrombosed external hemorrhoid [included use of bathtub, use of shower and genital cleaning before sleep at least once a week|include use of shower, use of bathtub and genital cleaning before sleep at least once weekly|include genital cleaning before sleep at least once weekly, use of shower and use of bathtub|include weekly cleaning of genitals before sleep, use of bathtub and use of shower|include use of bathtub, weekly cleaning of genitals before sleep and use of shower].

Future research, the researchers submit, must cover all 6 factors when establishing best therapeutic practice (surgical or otherwise), causes (etiology) and prevention (prophylaxis). With some unusual melodrama, the researchers pronounced that it is essential to ascertain the risk factors that are real and those that are fiction. Nevertheless, it is likely that the formation of TEH is due to several rather than one specific factor.

[Alternatives|Alternative Therapy|Alternative Treatment]

Despite the acknowledged small sample size, this study throws up great insights into why it can be confusing for the patient with thrombosed external hemorrhoid. The extent of the controversy is so extensive (187 research papers spanning 40 years and 38 possible causes!) that it is no wonder that we may hear quite divergent views from medical professionals. In now way is it being suggested that professional medical advice and diagnosis be ignored. However, the current state of affairs does suggest that alternative remedies may have a role too.

H Miracle comes highly recommended by those who kept an open mind about alternative medicine. Put together by a former hemorrhoid sufferer, it has found many supporters. Natural and effective has been a key appeal factor for H Miracle. Especially captivating are the success stories of thrombosed external hemorrhoid sufferers [attesting|confirming|validating|endorsing|substantiating|sanctioning|vouching|warranting] that H Miracle is a [permanent|permanent and lasting|lasting|perpetual|enduring] [answer|solution].

Reference:

O. Gebbensleben, Y. Hilger & H. Rohde: Etiology of thrombosed external hemorrhoids: results from a prospective cohort study. The Internet Journal of Gastroenterology. 2009 Volume 8 Number 1