struggling with hemorrhoids as well, my gut doc did you recommend surgery. Like you I am going to have to do something different than the prescription cream I am using now.

Edit … my gut doc did not recommend surgery.

I have some hemorrhoids that flare up now and then and it is bad. I asked my GI doc about it and she did not recommend surgery, either, because she said it could cause restriction of the anus.  But I wonder if the hemorrhoids are happening partly because our anuses have gotten so shrunk already from no large mass moving through that it now creates a lot of pressure to push stool out---even when it is loose stool. It seems to me if we had the hemorrhoids removed, we could do some kind of expander to keep the anus from restricting---kind of like what women can do with their vaginas (only a smaller tool). Also, my GI doctor said that the hemorrhoids would return, even if they were removed.  Also, there are various methods for hemorrhoid removal. It seems to me that some of them may cause less anal restriction than others. I have not researched this much, but like you, I am tempted to try to have them removed. Right now, for treatment, I do good ole witch hazel, which I squirt onto toilet paper, and if it is really uncomfortable I follow it with Dr. Butler's hemorrhoid ointment, which has a numbing medicine combined with a vasoconstrictor. Hemorrhoids literally ARE a pain in the ass!!!!

Hemorrhoids can be caused (and worsened) by straining on the toilet when emptying the pouch. Emptying without straining excessively is a skill we can all work on and improve, and I recommend practicing it.

@Scott F: do you have any tips for us?

@RHolt posted:

@Scott F: do you have any tips for us?

If you mean how to empty without straining, a lot of it is experimenting with your body to find out what works for you - what muscles to get better at relaxing, mostly, so less effort is required to empty. If your stool is formed then you’d be better off making it softer. Sitz baths can help manage the hemorrhoids as they resolve, and in extreme cases there are alternative treatments to surgery - sclerotherapy, for example - but ideally they will clear up on their own.

I don't really strain inordinately, but I do think the hemorrhoids are activated by the frequency of stools, for example, they are better in the morning and then they get more irritated by night.  Every butt cream I have tried with lidocaine (like Dr. Butler's, which should be BUTTler, BTW) makes my butt way more sore the next day.  Maybe I have an allergy to it!  Witch hazel is something I use a lot, too. 

I feel like the hemorrhoids are just one way my butt gets itchy or sore.  It's always something.  Yeast, hemorrhoid soreness, soreness further up, butt burn.  I'm always having to figure out which kind of sore it is.  And then there are times when my butthole is happy and undisturbed for some reason.  I want to know why it's so resilient sometimes and so prone to disturbance other times and how to make it so it doesn't get disturbed so easily!  Pain in the ass indeed!!

I was always told from Dr Shen that they dont recommend removing them as they can cause alot of issues. But on the FB JPouch group there are a few people that have had surgery successfully..

@Pouchomarx posted:

I was always told from Dr Shen that they dont recommend removing them as they can cause alot of issues. But on the FB JPouch group there are a few people that have had surgery successfully..

I didn't know there was a FB Jpouch group!  Which one are you talking about? I found 3:

I miss Dr Shen, I was already driving 8 hrs to see him. I couldn't follow him to NY

@TimD62 posted:

I miss Dr Shen, I was already driving 8 hrs to see him. I couldn't follow him to NY

You're lucky you got him for a while, at least!  I have never even seen him.  Too far to drive from Texas.  Too expensive to fly. 

I was his patient at CC for 12yrs, He is literally one of the best in the world !

@TimD62 posted:

I was his patient at CC for 12yrs, He is literally one of the best in the world !

That's what I have heard!

@TimD62 posted:

I miss Dr Shen, I was already driving 8 hrs to see him. I couldn't follow him to NY

IM IN CLEVELAND and Shen and Remzi were my docs, I still talk to both but i miss them.

@Sara Marie posted:

I didn't know there was a FB Jpouch group!  Which one are you talking about? I found 3:

The J-Pouch Group

Private · 11K members · 10 posts a day

This group is a serious support group which accommodates clinical questions and issues. Its is NOT a social group or a page to post personal pictures, jokes, memes,etc. PLEASE do not join the group if you are not willing to follow the rules.....

Ileostomy and Jpouch Support Network

Private · 7.4K members · 2 posts a day

Hey Guy's & Gal's~ This group is designed to take away the stresses and strains of having an Ileostomy or J-Pouch.. It can be a scary time especially if your awaiting surgery, But we're all here to support one another through good times and bad! if there is anything your unsure of or have any questions feel free to ask away. Anyone who wishes to join will only be added once ALL 3 QUESTIONS HAVE BEEN ANSWERED APPROPRIATELY. ....

J-pouch and Pouchitis

Private · 1.4K members

This group is for people who have a pouch or suffer with Pouchitis. To talk about tips on diet and keeping well or just share stories and give support.

first one, The J-Pouch Group

So y’all, I was looking at the thing that was worrying me squatting above a mirror and then comparing to internet pics and I think the large thing is a skin tag not a hemorrhoid. I think those are all internal but this external thing isn’t that. It seems to start right at the line between inside and not inside the anus. It may have a fissure at its source. I will get the doc to look, but I have read that skin tags can be more easily removed. It seems to grow and shrink, too, like a hemorrhoid, which is why I thought it might be a hemorrhoid just by feel. It is completely flesh colored and just looks like some misplaced skin. It does get really itchy when it is sticking out more and when it is really swollen it hurts.

Sara Marie, sounds like I have the same thing as you. It's external, flesh color, gets itchy too. Comes for a few days and disappears. Returns when pouch is really active and can also ache then.  I am waiting to see G.I. for inspection.  It has me worried as well.