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Dear Doc: I’m a 59-year-old insulin-dependent diabetic. About six weeks ago I developed hemorrhoids. Let me tell you, they are a pain in the butt for sure.

I saw my primary doctor, who gave me hydrocortisone suppositories to reduce the inflammation and a combination cream to control the itch — hydrocortisone and something else. I’m better now, but he thinks I should have surgery.

I don’t want surgery, especially because I know diabetics are at a higher risk with anti-itch stuff. I’ve been using both of them, with good results. Can you help me? — Joe from Jacksonville

Dear Joe: Let’s think about the anus for a minute. It’s an incredible thing. Day in and day out, it differentiates between solid, liquid and gas — rarely making a mistake. It controls our waste products so we go where we want and when we want. It’s a joy, except when those pesky “piles” protrude. That’s when joy can turn into misery.

The worst hemorrhoids, the ones that always need surgery, are the ones that prolapse, or actually fall out of the rectum. You have to put them in after you poop, and with some folks it's also after they laugh, sneeze or even take a deep breath. I always recommend surgery for them.

But short of that, a little TLC, with a dab of something else, can shrink those pesky things down to nothing. Conservative treatment is the method of choice. Now, take note: If they’re bleeding, you need to be checked by a doctor because that could be from something else, such as colon cancer.

Let’s begin with bulk, or fiber. It unequivocally helps. Try bran or other high-fiber cereal in the morning or my favorite, psyllium, the most common brand being Metamucil. If you knew how many times I have recommended that, you’d think I have stock in the company. I myself take the stuff, on and off, when those little buggers act up.

Psyllium is dietary fiber not absorbed in the small intestine. The excess soaks up the moisture, making a nice bulky and soothing stool. It gets the job done.

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By the way, the U.S. is the world’s largest consumer of psyllium, perhaps because we consume so many refined carbohydrates. Whole grains, fruits and vegetables are propulsive while chips, soda, white bread and candy are bad news. Oh, and one more advantage of psyllium: It can reduce cholesterol.

Next, let’s talk sitz baths. Try these two to three times daily — drop your drawers and sit in a nice warm, comfortable bath. But would you find that schedule difficult? If you’re like me, yes. The alternative is to spend about $10 on a plastic sitz bath that sits on the toilet. I’ve found them online in a number of colors — a rainbow of plastic.

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Sitting in warm water promotes healing, increases circulation and stimulates elimination. It really works.

Now, what about those suppositories? Most research has shown they don’t do much. And what about the combination cream, usually hydrocortisone cream with a xylocaine-like product? I’d stop that. Some people develop a hypersensitivity to the stuff.

That’s just what you don’t need — one more thing for your remarkable anus to worry about. Using an astringent, such as witch hazel (found in Tucks pads) or just plain old Vaseline is usually all you need.

And finally, wipe yourself with super-gentle toilet tissue (not the cheaper, rough stuff) or, better yet, use flushable adult toilet wipes. They’re even gentler.

If all of this fails and you’re still suffering, there are other minimally invasive techniques such as hemorrhoid banding that can be done as an outpatient procedure requiring hardly any recovery time.

My spin: Conservative treatment is the way to go for hemorrhoids, making your anus a happy camper. Stay well.

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This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including, but not limited to, any form of professional relationship) is implied or offered by Dr. Paster to people submitting questions.

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