Talk:Hemorrhoid/Archive 1

Sexually Transmitted
Shouldn't this category be removed, or else explained in the article, since it's already been discussed that it's not sex-related? —Preceding unsigned comment added by 81.154.124.48 (talk) 15:32, 31 December 2007 (UTC)

Prevalence
Can anyone provide some non-U.S based statistics please? I've added the globalize/USA tag to that section. Crimson Shadow 22:46, 24 July 2006 (UTC)
 * Yes I agree. --Faraz Parsa 02:37, 1 December 2006 (UTC)

Is the Hemorrhoid can be caused due to Anal Sex or Anal Intercourse.??? —Preceding unsigned comment added by 125.213.212.83 (talk) 10:48, 21 December 2009 (UTC)

Poor definition
Very remarkably, this article fails to explain what a hemorrhoid actually is. There is a very useful discussion, including pictures, at one web site. (I'll try to find it again.) &#37329; (Kim) 01:34, 9 Dec 2004 (UTC)
 * Hello, isn't hemorrhoid defined as varicosed (inflamed) rectal veins? Hfwd 06:35, 9 Dec 2004 (UTC)
 * I've just put on a title so it doesn't mess up the contents thingy. Hope you don't mind.Crimson Shadow 22:46, 24 July 2006 (UTC)

Order of treatment listing
I find it curious that medical treatments have been listed first. It seems more reasonable to go in the order a person would naturally proceed in his/her efforts, from least extraordinary (lowest risk and cost) to most, with surge7ry being the last extreme. I am changing the order in accordance with that thought until further discussion. I am also using the neutral point of view to clarify that different people use different treatments. Tom H. 17:10, Jan 24, 2005 (UTC)

Wouldn't it make more sense to order them in terms of treatment effectiveness or invasiveness? I don't think cost plays a legitimate role in evaluating the merits of a particular treatment regieme. That said, I agree that effective, low cost solutions be presented first.207.112.70.62 19:56, 19 October 2006 (UTC)

hi i jsut lloked up Hamorrhoids in the oxford medical ditionary and it defines them as 'enlarged spongy blood filled cushions of the anus' is this a case of differnt definitions in different aprts of the world. I htink i can se how varicous veins might be related to this definition phil, 18:47, 14 may 2007

I read that after surgical removal of hemorroids it may still reappear if one will not watch his\her lifestyle (posture, diet, etc). Can anyone confirm this information? 85.223.172.189 (talk) 10:38, 18 March 2008 (UTC)Alem


 * Definitely! You can remove hemorroids surgically and a week later, you'll expel hard feces and other hemorroids will show up. You must make sure to never ever have hard feces by watching your diet mainly. See Further advice below. -- Robert Abitbol

Reading on the toilet?
I'd like to know how reading on the toilet qualifies as a- "poor bathroom habits" and b- a cause for Hemorrhoids. Is this a joke? LeoDV 3 July 2005 19:29 (UTC)


 * Not at all. Not a joke.  Is there some way we need to improve the statement or clarify?  Tom Haws July 3, 2005 20:19 (UTC)

I agree with LeoDV, how does reading on the toilet cause haemorrhoids? Sounds like something my grandmother would tell me, not something that belongs in an encyclopaedia. --Rathilien 03:38, 3 November 2005 (UTC)


 * From eMedicine article "Prolonged sitting on a toilet (eg, while reading) is believed to cause a relative venous return problem in the perianal area (a tourniquet effect), resulting in enlarged hemorrhoids." Hfwd 16:20, 3 November 2005 (UTC)

Precisely our point. So it should read more like "Prolonged sitting on the toilet may increase the likelihood of haemorrhoids" not "Reading on the toilet causes haemorrhoids". That fact that you happen to be reading while you're sitting is beside the point, maybe I play my laptop while I sit on the toilet - I guess this won't cause haemorrhoids because I'm not reading. Sorry for being sarcastic, but you see my point. --Rathilien 04:13, 10 November 2005 (UTC)

I study medicine in Denmark (early stage though, but during anatomy-studies we read a lot about clinical cases and so on), and my teachers simply reduce it to "habits of long time sitting, e.g. truck drivers" and so on, which increases the riscs for H... Out of that you could always get that if you sit at the toilet for a long time... But on the other hand, if you increase the pressure in the rectal channel when sitting on a toilet, I guess you thereby increase the riscs...--Vevebe 08:06, 1 November 2006 (UTC)

NEVER COULD FIGURE OUT WHY PEOPLE AT THE OFFICE FEEL COMPELLED TO SPEND TIME READING IN THE MENS ROOM - A ROOM WITH A REVOLTING STENCH. WHUZ UP WIT DAT?


 * Rathilien: How the hell do you use your laptop without reading? Djupi 04:58, 19 February 2007 (UTC)

Prolonged sitting can, supposedly, be a contributing factor to hemorrhoids. See #1 in the list of references section - Mayo Clinic. NiteHacker 01:13, 20 May 2007 (UTC)

Djupi. Surfing internet porn with a wireless connection perhaps? But that's another subject for another W-pedia article. Greenbomb101 17:13, 4 November 2007 (UTC)

Also it causes the rectum to relax and can reduce blood flow and prolapse the rectum( which is much worse). Also the veins cn become knotted and require you to push the hemroid back up into the rectum to rmove the knot. —Preceding unsigned comment added by Euge123 (talk • contribs) 12:22, 9 June 2009 (UTC)

Suppositories
The article notes that suppositories "add very little since all of the symptoms come from the external tissues and not up in the rectum where the suppository goes." There are two problems with this: 1) the article notes that some hemorrhoids are external while some are internal so, according to the logic in the above statement, suppositories should address the internal ones, and 2) if suppositories "add very little" then why do doctors regularly prescribe them after an examination? -- Hux 06:58, 8 June 2006 (UTC)


 * Just to add, suppositories can be helpful to reduce straining and thus reducing venous pressure. Also, Hydrocortisone suppositories are standard therapy. Bdolcourt 14:10, 5 September 2006 (UTC)


 * I removed the statement that suppositories are of little use. They work just fine for thousands of people (including me), so such adverse statements need to be backed up. I also added a link to the Preparation H article, as this explains exactly how they work.--Shantavira 10:30, 4 January 2007 (UTC)

Citation styles
I have re-cast the references using cite.php, and have started re-formatting them using the citation templates. I hope to get a chance to finish the job sometime soon, but don't let that stop you if you want to beat me to the punch! --Slashme 11:56, 28 June 2006 (UTC)

Article disputed
I think the causes, prevention and treatments sections might not be factually accurate. Please discuss here. The evidence for squatting was grossly exagerated and of poor quality, and I'm wondering where the rest of the info comes from. If citation is not provided, this content may be deleted.--Steven Fruitsmaak (Reply) 09:47, 25 September 2006 (UTC)


 * Specifically, which statements are disputed? Labelling 3 sections as not accurate is fairly broad, please specify so we can take a look. Hfwd 06:31, 6 October 2006 (UTC)


 * These paragraphs simply don't state references, so although something is general as "The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves),..." sounds logical, I'd like to see a reputable source for it. But the Food-section is the one needing most cleanup I suspect.
 * "Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid." Like to see that one in a reputed source...
 * "Doucheing The Rectum" and "Doppler Guided Hemorrhoidal Artery Ligation : The only evidence based surgery..." could definitely use some backup too...
 * I know it's a pretty wide tag but I think those sections need a thorough investigation...
 * --Steven Fruitsmaak (Reply) 13:12, 7 October 2006 (UTC)
 * I'm dropping the tag. It isn't intended for statements that are simply unreferenced. ike9898 21:38, 9 November 2006 (UTC)

Cycling
Does anyone know if cycling causes Hemorrhoids? I've heard that it can cause impotence. —Preceding unsigned comment added by 62.231.61.249 (talk • contribs)


 * This page is for discussion of the article only. Try asking your question at the reference desk. Don't forget to sign your posts.--Shantavira 10:36, 4 January 2007 (UTC)

Are you kidding me?!
What are you people thinking with the second picture? Don't give me some garbage about how educational it is or how hemorrhoids are a fact of life and are disgusting in real life and should therefore be depicted in a disgusting manner on this website. The first image suffices...the only reason you would keep the second image in is to shock/gross people out. I think that some people on this site enjoy putting up pictures like this and claiming educational value instead of making the readers happy. There is absolutely no need for the second picture and I think it is extremely inappropriate. What possible value does that image have? The article is realistic and the first image conveys to the reader that hemorrhoids are gross....we get that from the description (I mean, they are blood clots of the sphincter)...what does the second image accomplish? I move for immediate deletion, I do not care that this has already been discussed...I still feel it should be deleted. 76.16.75.77 06:21, 29 January 2007 (UTC)
 * Wikipedia is not censored. Sorry.  Geoff B 06:11, 1 February 2007 (UTC)
 * I have to say it was quite educational. I had Hemorrhoid for the first time and thanks to this article I now know that it is not a gib issue.  Believe me, it was quite scary at first.  Kudos  24.89.245.62 04:11, 16 March 2007 (UTC)
 * same here. 71.116.132.217 (talk) 02:22, 14 March 2008 (UTC)
 * Not being funny but you can't really detract from the educational value of a picture, especially in the case of people who use WP as a first reference when they need to research something. Sure it grosses people out, but you can't censor WP, not least the internet... am  i wrongHeyimdan (Talk) 23:59, 5 May 2007 (UTC)

Uncited causes
Is it acceptable that anal sex is listed as a cause of piles in the matter-of-fact manner used in this article?? I'm putting the citation needed bit right there. BUPA and NHS (UK) do not list it on fact-sheets, so surely an encyclopaedic article shouldn't speculate?? Heyimdan (Talk) 01:29, 20 April 2007 (UTC)
 * After going through a few previews I've now noted that the wording of that has absolutely nothing to do with piles whatsoever. Should it even be included in the article? Particularly the brackets about vaginal sex. It just seems a bit underhanded.Heyimdan (Talk) 01:39, 20 April 2007 (UTC)

squatting position
"using the squatting position while making a bowel movement" what other position is there when taking a poo? —The preceding unsigned comment was added by 216.196.155.176 (talk) 04:44, 22 April 2007 (UTC).


 * Sitting. On a toilet.  Geoff B 06:54, 22 April 2007 (UTC)

Is the text about the "Doppler Guided Hemorrhoidal Artery Ligation" valid to Wikipedia style?
The section on treatments has an entry called "Doppler Guided Hemorrhoidal Artery Ligation". In its text: I'm quite sure that it's not the correct way to write something in an article. It wouldn't be hard for anyone, given these excerpts, to think that the entry for that treatment was written as an advertisement. Mainly if you consider that the entry states great virtues and no drawbacks. Ok. Should the text in that entry be modified?
 * The person who added the text introduces himself.
 * It is described where the external link on the reference points to.

I was wondering that myself, but I'm not qualified to change it. It does sound a little like an advertisement, and while it was polite of the poster to add the clarification about the reference, it sounds unencyclopedic. Maybe this should be turned into a stub on another page instead? If there aren't enough references on the net for that, then it probably shouldn't be included at all. Prgrmr@wrk 18:50, 17 May 2007 (UTC)

Tags
Can someone cleanup this article already? There are way too many tags: globalize, trivia, a number of unreferenced tags. Please clean it up already! If I knew enough about the topic (I was merely here for research), I'd work on it. But this is in dire need of help! --myselfalso 19:20, 31 May 2007 (UTC)

Hmm
I just got a pretty painful case of hemorrhoids two nights ago. I don't really know where it originated from, but I've had minor cases in the past which go away on their own. now this is large and painful enough to warrant some research. I'm wondering about something. It looks like hemorrhoids are just big inflamations of blood. Can I aleviate the pain and pressure by trying to pop the hemorrhoid with a sewing needle or something? The only problem I would risk is an infection which is a big concern...


 * (March 30th) Are you out of your mind? Don't touch these hemorroids with anything unless you really want trouble! You'll end up bleeding profusely and you'll need to get stiches at the hospital. Go see a colo-rectal specialist and he/she'll apply the elastics on your hemorroids and you'll be OK. See Further advice below.


 * You simply probably had feces harder than at anytime before for a reason or another. Do you eat a lof of meat? No fruits, no salads, no white bread? -- Robert Abitbol

Try squatting for bowel movements. Use the full squatting position, not just elevating your feet. (This is according to Dr. Sikirov, who did the research presented in the article.) One way is to put a container on the floor and some "footpads" on either side of the container to raise yourself above it. Here's a picture of the setup. A little disagreeable, but much less so than surgery or ligation. Hemorrhoids result from the cumulative effect of straining on the unnatural "sitting" toilet. The epidemiological evidence is quite clear on this. Fiber has little or no value for prevention or treatment. --Jonathan108 01:08, 9 August 2007 (UTC)


 * This is what squatting looks like (for those who don't know.) And  this is the research on using it to treat hemorrhoids. Back in 1979, when President Jimmy Carter had hemorrhoid surgery, a reporter from Time Magazine asked a noted hemorrhoid expert what causes the disease.  His answer appeared in the next issue: "Man was not meant to sit on a toilet seat, but to squat in a field." --Jonathan108 01:41, 10 August 2007 (UTC)

Causes
Hemorrhoids have plagued human beings throughout history, perhaps beginning when we first assumed upright posture. Beginning in Medieval times, hemorrhoids were known as St. Fiacre's curse, and today hemorrhoid sufferers from around the world visit St. Fiacre's stone in order to obtain a miracle cure. St. Fiacre, also known as the patron saint of gardeners, was told he could farm all the land he could cultivate in a single day. He was given a particularly small shovel by a less then benevolent bishop. After a particularly long day of spading his garden, in order to obtain the maximum amount of land, he developed a terrible case of prolapsed hemorrhoids. Seeking a solution, he sat on a stone and prayed for resolution of his problems. This resulted in a miraculous cure and, according to legend, the imprint of St. Fiacre's hemorrhoids remains on the stone today. Hemorrhoid sufferers from all over the world continue to sit on this stone and pray for relief. . . --Light current 22:33, 25 November 2005 (UTC)

[edit] St Fiacre Clontubrid was once a parish, though the parish church has long since disappeared, its site being just south of the present chapel. The patron of this parish was St. Fiachra, whose feast was celebrated locally on February 8th. His holy well, which gives Clontubrid it’s name, is a few yards from the sacristy of the present chapel. Over the wall is a small, and very ancient, stone roofed house. The walls were once faced with smooth-surfaced stones but most of these were taken away about 1800 by Caulfied Best, of Clone House. The only opening is a doorway in the East Side. The floor was formed by three flagstones and underneath these was the well. Carrigan gives the name of the well as Tobar a “dhithreabhaigh” (pronounced Thubberararoo) – "The Well of the Hermit", confirming a local tradition that the well house had been the cell of a hermit. There are several saints named Fiachra but only one was known as Dhithreabhaigh (Hermit), the Fiachra of Meaux, France. The Fiachra of Clontubrid and the Fiachra of Meaux must, therefore be the same person. This St. Fiachra was a native of northwest Connaght and also spent some time as a hermit at Kilfera, near Kilkenny, where a pattern of St. Fiachra was held annually on the first Sunday of August. There was a life-size stone statue at Kilfera, called “St. Fiacre’s Statue” and, up to the middle of the nineteenth century, a small stone cell similar to, but larger than, that at Clontubrid. The remains of this cell were destroyed in 1869 to erect a Purcell monument in the graveyard. It is, however, through his work in France that the greatest cult of St. Fiachra has developed. He arrived at the Diocese of Meaux, (east of Paris), about 626 and was given a hermitage by the local bishop. Fiachra became famous throughout France for this work with the poor and the sick, for this holiness, and for his remarkable cures. Two later French saints, St. John of Matha and St. Vincent de Paul regarded Fiachra as their inspiration and patron while two famous French churchmen – Bossnet, Bishop of Meaux and Cardinal Richelieu – were also devoted to the cult of Fiacre. These latter two had great influence with the French Royal Family and pilgrimages were often made by the Kings of France to the shrine of St. Fiachra. Louis XI renovated the shrine, placing on it the Royal Coat of Arms of France. Louis XIII and his Queen, Anne prayed to Fiachra for an heir. When their son was born, they regarded him as the answer to their prayers. This son was to become King Louis XIV. Tradition says that Louis XIII died holding a St. Fiachra medallion in his hand. Louis XIV and Louis XV were both cured of fistulae, (a type of ulcer), after praying to St. Fiachra. So many people were thus cured of this ailment that it is known in France as “La maladie de St. Fiacre”, (St. Fiacre’s ailment). King Henry V of England, after the Battle of Agincourt (1415), allowed his soldiers to vandalise the shrine of St. Fiachra at Meaux and carry off the relics of the saint, *************beyond the boundary of the monastery and the relics were returned. By a strange coincidence, Henry died later of haemorrhoids, a condition which was traditionally cured by praying to St. Fiacre. By an even stranger coincidence, Henry died on August 30th, the feast day of St. Fiachra. Not surprisingly, these events added to the reputation of St. Fiachra. Such is the extent of his cult in France that three French towns bear his name and thirty churches are dedicated to him. In Paris gifts of flowers are brought annually to the Church of St. Ferdinand on his feast day. The first public transport in Paris, horse – drawn cabs, used the Hotel St. Fiacre as their terminus. They became known as “fiacres” and taxis in France have been so-called ever since. Just for good measure, Fiachra is also the patron saint of French gardeners. Certainly a man who made good, in the best tradition of the Irish emigrant! —Preceding unsigned comment added by Adyanthaya (talk • contribs) 09:34, 9 September 2007 (UTC)

St.Fiacre is also known as PATRON SAINT OF PROCTOLOGY

This reference i got when i was going through a text book COLON,RECTAL AND ANAL SURGERY- Curranttechnique and controversies by Ira J Kodner, Robert D Fry John P Roe.

REF: Rachochot JE, Petourand CH, and Riovoire JOm: St. Fiacre. The healer of haemorrhoides and patron saint of proctology, Am. J. Procl. 22:175, 1971Adyanthaya 09:43, 9 September 2007 (UTC)

[edit] St. Fiacre Adyanthaya 09:47, 9 September 2007 (UTC)St. Fiacre Abbot, born in Ireland about the end of the sixth century; died 18 August, 670. Having been ordained priest, he retired to a hermitage on the banks of the Nore of which the townland Kilfiachra, or Kilfera, County Kilkenny, still preserves the memory. Disciples flocked to him, but, desirous of greater solitude, he left his native land and arrived, in 628, at Meaux, where St. Faro then held episcopal sway. He was generously received by Faro, whose kindly feelings were engaged to the Irish monk for blessings which he and his father's house had received from the Irish missionary Columbanus. Faro granted him out of his own patrimony a site at Brogillum (Breuil) surrounded by forests. Here Fiacre built an oratory in honour of the Blessed Virgin Mary, a hospice in which he received strangers, and a cell in which he himself lived apart. He lived a life of great mortification, in prayer, fast, vigil, and the manual labour of the garden. Disciples gathered around him and soon formed a monastery. There is a legend that St. Faro allowed him as much land as he might surround in one day with a furrow; that Fiacre turned up the earth with the point of his crosier, and that an officious woman hastened to tell Faro that he was being beguiled; that Faro coming to the wood recognized that the wonderworker was a man of God and sought his blessing, and that Fiacre henceforth excluded women, on pain of severe bodily infirmity, from the precincts of his monastery. In reality, the exclusion of women was a common rule in the Irish foundations. His fame for miracles was widespread. He cured all manner of diseases by laying on his hands; blindness, polypus, fevers are mentioned, and especially a tumour or fistula since called "le fic de S. Fiacre". His remains were interred in the church at Breuil, where his sanctity was soon attested by the numerous cures wrought at his tomb. Many churches and oratories have been dedicated to him throughout France. His shrine at Breuil is still a resort for pilgrims with bodily ailments. In 1234 his remains were placed in a shrine by Pierre, Bishop of Meaux, his arm being encased in a separate reliquary. In 1479 the relics of Sts. Fiacre and Kilian were placed in a silver shrine, which was removed in 1568 to the cathedral church at Meaux for safety from the destructive fanaticism of the Calvinists. In 1617 the Bishop of Meaux gave part of the saint's body to the Grand Duke of Tuscany, and in 1637 the shrine was again opened and part of the vertebrae given to Cardinal Richelieu. A mystery play of the fifteenth century celebrates St. Fiacre's life and miracles. St. John of Matha, Louis XIII, and Anne of Austria were among his most famous clients. He is the patron of gardeners. The French cab derives its name from him. The Hôtel de St-Fiacre, in the Rue St-Martin, Paris, in the middle of the seventeenth century first let these coaches on hire. The sign of the inn was an image of the saint, and the coaches in time came to be called by his name. His feast is kept on the 30th of August.

Retrieved from "http://en.wikipedia.org/wiki/Talk:Fiacre"

The article listed Anal Sex as a cause and refrenced the mayo clinic website, which does not make any refrence to anal sex. So that refrence has been removed. http://www.mayoclinic.com/health/hemorrhoids/DS00096/DSECTION=3 In addition it is specifically mentioned as a myth that anal sex causes hemerrhoids on this website: http://www.hemaron.com/hemorrhoids-treatment/hemorrhoids-myths.htm --David F 20:28, 14 August 2007 (EDT)

Use of squat toilets
Someone asked a question about Sikirov's 1987 study, but put the question into the article. The appropriate place for discussing evidence is this talk page.

The question was about a control group. The study is not available online, but Sikirov reported all the details in his patent documents, which can be seen at this link. The chart displayed is easier to read if you click on "Images". --Jonathan108 (talk) 21:56, 26 May 2008 (UTC)

Genetics and most common used surgery?
Where is the mention of genetics being a cause? Why is this being left out?

The treatment section doesn't mention which noninvasive surgery is the most popular. --Ericg33 (talk) 07:51, 2 August 2008 (UTC)


 * sofixit Darkspots (talk) 07:59, 2 August 2008 (UTC)

Any images of external hemroids?
I think I've been suffering from them for a month now but I would like a reference picture to see what it looks like. Thanks! mousy —Preceding unsigned comment added by 75.15.223.94 (talk) 23:18, 21 August 2008 (UTC)

Alternative Treatment Section
For the record, I believe in alternative treatments such as herbalism. I maintain a national certification as a pharmacy technician and I'm also used to reading scientific studies. Several herbal hemorrhoid treatments have scientific studies backing them up.

However, they don't seem to be cited here. Reference numbers 16 and 17 are not peer reviewed articles, nor are they scientific studies. Number 16 is a book published without peer review and 17 is a review performed by someone without mainstream credentials.

Anyone can get a book published on what they think herbal medicine is without doing a single scientific study. Look up the book School of Natural Healing by John R. Christopher for proof. He worked as an herbalist for years and his book is relatively well known, but he never conducted a single scientific study. In fact, his company was recently cited for promoting dangerous herbal knowledge.

I have some herbal magic manuals in my library as well. I enjoy them for personal reasons, but they aren't written by scientists and also have no place in a medical article. In my experience, the people who write herbal magic manuals and the people who write most herbal remedy books have about the same qualifications. The magic authors are just more honest about it.

Many of the "natural remedies" are unsubstantiated, and the comment about the Alexander Technique goes especially against the grain. NPOV gets seriously mauled there, IMO. "Reducing regional pressure in such ways as improving posture and muscle tone, or in severe cases, undergoing a profound psychophysical reeducation, by a method such as the Alexander Technique."

To me, this statement implies that the Alexander Technique is a proven method for treating serious hemorrhoid problems. I've been over to the Alexander article, read both the article and talk page and found no such proof. It's barely been proven in one study to help with back pain! If it's going to be there at all, it needs some concrete backup referencing.

I'm pretty new to Wikipedia and I don't know exactly how to change all this, but it's clear it needs doing. Please understand that I'm attacking content and logic, not people, as per fair debate tactics. Somebody help? IceandInk (talk) 18:12, 13 October 2008 (UTC)


 * Sorry no-one responded to you in so long. In cases like this, if you think the refs backing up statements do not meet RS standards, feel free to remove the refs. If you think the statements themselves are spurious, if they are unreferenced or backed up by things which are not RS, you are again encouraged to remove those statements. Be bold. If someone doesn't like what you do, they'll revert you, and then a discussion should start on the talk page. Carl.bunderson (talk) 00:43, 1 January 2009 (UTC)

Link that appears to be advertisement...?
From the alternative medicine section: , like Holly Hayden

Links to a website - which shouldn't be in the main body anyway, and as far as I can tell Holly Hayden doesn't belong here anyway. If I'm wrong, feel free to replace.

Verloren Hoop (talk) 01:54, 14 May 2009 (UTC)

I should have read the talk first. I too saw the Holly Hayden link and it leads to a page that is password protected, and the site appears to be commercial. It wasn't appropriate IMO so I deleted it. I also deleted a footnote that leads to a 404 Page Not Found. If somebody finds a valid link please fix it. (I'm a beginner. I'll get an account and I'll get better.) —Preceding unsigned comment added by 24.171.152.16 (talk) 20:52, 25 October 2009 (UTC)

I found the link and it went to a site giving information on a home treatment. I see Holly Hayden selling an ebook on the treatment but the link is going to a site by Emma Marston a long term suffer of hemorrhoids offering support and advice on the home treatment, looks non commercial and more like the start of a support network. I would vote we keep support networks a major part of medical related information on Wiki. Commercial content can go and compete with the rest of the giants. But the charity support workers should get as much help as we can give. Not sure about the 404 messages. The link [Healing Hemorrhoids - A support website devoted to the Home Combination Therapy] would be more appropriate.

The Emma Marston link is a thinly veiled commercial redirect for Holly Haden. I counted six links on the page and that was just at a quick glance. The links are scripted in .php and are tracked on clickbank (if you can catch the screen fast enough, the address bar will look something like this: http://d6c0e068vhay2v73fg3e2qcxf7.hop.c l i c k b a n k.net/?tid=HEALINGHEMORRHOIDSINFO). The Holly Haden site is commercial and proposes to "... Unravel what they don't want you to discover ... curable no matter how severe" for the low-low time-sensitive price of $37.00. By tracking redirects, the Emma Marston site has a vested interest in the Holly Hayden site, and appears to be part of a viral marketing campaign. I leave it to the lead writers of this article to take the appropriate action. 24.80.236.204 (talk) 07:39, 5 November 2009 (UTC)Will

Possible copyvio
Large parts of this article appear to be copied from this site, though since it's a gov site it may be in the public domain. It's worth looking into.--Orgullomoore (talk) 01:46, 2 November 2009 (UTC)

Vague Terminology
What is an "hostile hemorrhoid" and what is "hemorrhoid radiation" ? These terms are not standard medical terms and are used somewhat arbitrarily in the article. Very confusing. —Preceding unsigned comment added by 173.88.154.149 (talk) 14:02, 23 November 2009 (UTC)

Image
Funny. Just as this morning I was wondering about an image for this article, someone comes along and does exactly what I thought would be an outrageous example of why some images are a poor excuse for what an encyclopedia can be. I was going to say, "Should I photograph myself for the Hemorrhoid article?" And here along comes a fellow who does just that. I realize we don't have paid artists on staff, but until we can procure some high quality line sectional illustrations, we will just have to do without images. The information presented from surface photos is not clear, and the grossology factor outweighs any informative value it might have. This also applies, I think to photographing yourself for the penis or nipple article. A photo simply does not inform and educate like a good, full-color, sectional illustration. Need we gross out just for fun? Tom Haws July 8, 2005 04:27 (UTC)


 * Agreed. Photographs of the real thing don't belong. If it's not safe for family-type viewing, there's no educational value in it. --crumb 8 July 2005 05:25 (UTC)

Leonard suggested we might have a text link "See here for a photograph." I think Leonard and I see essentially eye to eye. I note again that the particular image in question is really not very enlightening about hemorrhoids. It pretty much is essentially a picture of a clean anus with a sore and hair near it. The sore is not quintessentially hemorrhoidal in appearance, from what I can see. I really like Leonard's suggestion of a text link because it resolves the main problem which is that a lot of people would probably rather not read the article than have that image taking their picture. Again, this isn't the right image, but if there are strong feelings in favor of it, a text link is a good compromise that invites improvement. Tom Haws July 8, 2005 14:41 (UTC)

I've deleted links to the pictures as it was taken from another website and may be copyrighted Hfwd 17:14, 10 July 2005 (UTC)


 * Sorry. When I added the image to this article, I haven't stopped and taken copyright issues with the photograph into consideration. I only added the photograph to end the stupid troll war with CunningLinguist14 who persistently inserted a photograph of an anal fissure into the article. (see history) --crumb 17:45, July 10, 2005 (UTC)


 * No worries - I understand. Troll war is the bane of wiki.Hfwd 17:26, 12 July 2005 (UTC)

Somebody copyrighted a picture of a haemorrhoid? Geez, what's the human race coming to... --Rathilien 03:34, 3 November 2005 (UTC)

Is it possible to remove the picture itself? I am rather disgusted by it and that was not the reason why I came to the page.

This is simple if you are offened by it don't look at it. its rather simpleYourname 23:41, 23 March 2006 (UTC)


 * The current picture is good and I think it certainly belongs in the article since it does show the truth. (Image:Hemorrhoids1.jpg) Although I also agree it is gross and shocking to see. But if the rest of you prefer shrinking the size of the image or changing it to a text link I won't disagree. By the way, I think that image might be good to have there to show to those that say we should "suck it up" and stop complaining about our "minor" problem. --David Göthberg 06:23, 2 April 2006 (UTC) (Who's actually in for surgery tomorrow...)

The current pictures are repulsive and unnecessary. They are not enlightening in any way and only have shock value. I am removing them.

I dont like the image. I would definitly support a text link to the picture for those interested. At its current position, its impossible to NOT see it.

I propose we delete the picture, not because it's gross, but because it's misleading. The picture seems to be a prolapsed grade III or IV hemorrhoid, which is a severe (and chronic) form of hemorrhoid afflicting only a small portion of patients. If we need to put a picture, then we should use an endoscopic image of a grade I or II hemorrhoid, the most common form. Hfwd 15:10, 24 May 2006 (UTC)

this one is simple if you don't like it don't look at it now quit compling and whining Yourname 19:27, 25 May 2006 (UTC)

stop removing the pic until a vote has been made on one said to remove itYourname 19:46, 25 May 2006 (UTC)


 * Wikipedia is not a democracy. Users who agree with the above may remove the picture, without having to wait for some arbitrary vote. --Hetar 04:58, 30 May 2006 (UTC)

unless you are in chage here i will restore the picture if it is removed untill someone who IS in chage says differentYourname 23:54, 4 June 2006 (UTC)

My $0.0.2: I don't think that "it's gross" should be a reason to remove the photo since, like it or not, it does inform the reader about what hemorrhoids look like. However, I also agree with Hfwd's opinion - if it's misleading in that it doesn't represent the most likely physical appearance of the condition then that particular photo shouldn't be there. As far as a sectional illustration goes, that would also be worthwhile, but in addition to, rather than instead of a photo. -- Hux 06:50, 8 June 2006 (UTC)

Well for me the picture has great value, because I decided to see a doctor soon after I see what my small (POSSIBLY, that's why I need to check a doctor) Hemorrhoid problem could become! In this way it's been very useful and I also think seeing an actual picture always helps. But I agree we should add a note about the "grade", that is depicted here.

From my POV as a med student, it should be there. This is an encyclopedia you know. I'm adding it again, with an explanation of the fact that those are indeed more serious forms. Grossness is not a valid arguement. And please, everyone sign your comments with for tildes like this ~ .--Steven Fruitsmaak | Talk 21:13, 10 August 2006 (UTC)

Images are Disgusting, Some Think
Especially the second one. This is the Wikipedia, not some shock website. I think an image like this would be much more suitable --void main 14:17, 22 July 2006 (UTC)


 * I agree. That photo has very little educational value.  24.175.10.61 03:40, 29 July 2006 (UTC)

See also the discussion above.--Steven Fruitsmaak | Talk 22:52, 10 August 2006 (UTC)


 * The endoscopic views are pretty good. An image of an external grade I or II hemorrhoid would likely be quite beneficial. The Grade III/IV ones currently there are probably excessive. A cartoon of the course of the hemorrhoidal veins would also be beneficial. Bdolcourt 14:12, 5 September 2006 (UTC)

That may not be accurate in saying that grade I and II are the most common... it also may depend on what region(s) you may be talking about... just US or the world on the whole! If you are going to use that argument... then what reference do you have on that? I haven't seen any data on that to back up such a statement. In any case, when people get grade I or II, they usually tend to put it off since it's not that serious... then it progresses to grade III or IV but still may put it off because of the pain and healing stages and from the fear of getting the problem taken care of! I wonder what the stats are on that? At what grade do most people tend to resolve this problem? Here's a prime example of it (talk about disgusting too!)...


 * I think any images would serve the people who are seeking knowledge on this subject! Maybe to resolve this issue, maybe there should be a level/rating set on such and/or ALL images on Wikipedia... such as G, PG, etc.  Anyways, in closing... I say...

Strong keep NiteHacker 01:53, 20 May 2007 (UTC)


 * I am not even sure that what I have is the same as what is pictured. Mine does not look anything like that. And, can it actually burst?!? 75.164.243.220 07:01, 10 November 2007 (UTC)PostPregnancyPain

Strong keep (March 30th 2008) It does not burst. This is an excellent picture. Very realistic. Mild case of hemorroids I would say. The colo-rectal doctor (which some call derisively the ass doctor) will apply two elastics on the hemorroids; the elastics will choke the hemorroids and in turn, they will eventually melt and be expelled during feces and the problem will be gone. Yhe hemorroids will reappear if the conditions that led to their appearance in the first place are repeated. Colo-rectal specialists see a lot of such hemorroids every day. It's not clear in the picture if the anus is obstructed by the hemorroids. RobertAbitbol

Yuck
Strong delete Please, someone, remove them.

Keep These images can be disgusting for some people, but that's the truth. How to illustrate the article without these? I know this is a hard problem, maybe I'm against removing them because of being a medical student. So I should say: don't remove them. But if too many editor want these to remove, then there's no choice. NCurse work 06:34, 7 September 2006 (UTC)

Strong keep

If I can add a comment from a patient's point of view: My wife recently had haemorrhoid surgery, and this kind of image is actually helpful to the more curious patient who really wants to know what a haemorrhoid looks like from inside, and what a severe haemorrhoid can look like. I think it is reasonable to apply some censorship to inflammatory (no pun intended!) and frankly pornographic images, but these images are directly explanatory to the material. If these images are considered disgusting by some, that's not so surprising, as varicose haemorrhoids are by nature rather disgusting things (in so far as a disease can be considered to be disgusting). So this is my strongly felt vote to keep these images. --Slashme 08:40, 7 September 2006 (UTC)

Keep Why delete them? Because some people find them disgusting? I hate the appearance of wasps, but I'm not complaining about images of wasps being in the wasp article. Crimson Shadow 22:22, 7 September 2006 (UTC)

Keep They are relevant to the article. Medical pictures are often not all that "sexy" to look at, but these are not speculative imo. and are relevant to the topic. galar71 23:02, 7 September 2006 (UTC)

We'll be keeping these - they're relevant and accurate. We will soon have a less-"disgusting" diagram to place at the top of the page, but although we may move the photos down in the article there's no need to remove them. &mdash; Catherine\talk 23:34, 7 September 2006 (UTC)

The endo pic is a neat compromise for the top. The grade 3 and 4 hemorrhoid pics do go over the top a little (I quickly perused Yamada, Odze, Sleisenger and Fordtran and the hemorrhoid pics they use are less graphic), but certainly shouldn't be deleted. Agree with Catherine that they could go lower in the article. -- Samir धर्म 05:44, 8 September 2006 (UTC)


 * Then I think it has been solved. :) Cheers. NCurse [[Image:Edu science.png|16px]]work 06:13, 8 September 2006 (UTC)


 * Keep they're medical images in a medical article. I didn't find them gross (and I was looking at them while eating dinner). Sarah Ewart (Talk) 13:42, 8 September 2006 (UTC)

I say keep, but must at least pre-warn about the nature of the picture like this hemorhoids page where the owner refer it to another section but pre-alert before user click it —Preceding unsigned comment added by Chongfl (talk • contribs) 00:41, 23 March 2010 (UTC)

New diagrams

 * Here are some diagrams from NIH -- I believe these are public domain, per PD-USGov-HHS-NIH:


 * http://www.nlm.nih.gov/medlineplus/ency/imagepages/17069.htm
 * Surgery series:
 * http://www.nlm.nih.gov/medlineplus/ency/presentations/100026_1.htm
 * http://www.nlm.nih.gov/medlineplus/ency/presentations/100026_2.htm
 * http://www.nlm.nih.gov/medlineplus/ency/presentations/100026_3.htm
 * http://www.nlm.nih.gov/medlineplus/ency/presentations/100026_4.htm


 * And here area a few other public domain photos, from other language versions of Wikipedia:
 * de:Bild:H%C3%A4morrhoiden.jpg
 * pt:Imagem:Hemorrhoids.jpg


 * That might give us a few more choices. &mdash; Catherine\talk 02:59, 20 August 2006 (UTC)


 * Never use ADAM-pictures, those are NOT PD-USGov-HHS-NIH. I'm going for the German picture.--Steven Fruitsmaak | Talk 20:12, 20 August 2006 (UTC)


 * Darn, I thought they'd work so well here too, but I see you're right. Ick.  I'm adding a "diagram requested" tag at the top of the page here, and I'll try contacting a couple of the folks on Wikipedians/Graphic artists and see if they can take on this ugly job.  Sorry about the mislead....  &mdash; Catherine\talk 20:28, 20 August 2006 (UTC)


 * Many thanks to User:WikipedianProlific, who has agreed to make a diagram for the page sometime in the next week or so! &mdash; Catherine\talk 19:54, 6 September 2006 (UTC)


 * Again, great thanks to Prolific who has provided a brilliant diagram for us! &mdash; Catherine\talk 18:15, 12 September 2006 (UTC)
 * A wonderfully illustrated diagram! Well done; it's comprarable to diagrams in textbooks of gastroenterology -- Samir धर्म  05:47, 14 September 2006 (UTC)

Strong modify.
Hemorroids are a horrific reality. Yes, they are terrible to watch, yet their horrific nature does not warrants the deleating of images that explain what the hemorroid looks like, and in some bizarre way the shock they provide may be considered helpful to those who undervalue the severity of the diagnosis. What to do then? Perhaps profesional images would be assimilated better. I dont really see the value of images I cannot observe, just like I do not see the profit of a site whose images I cannot tolerate. I would sujest a link to more explicit images with a BIG disclaimer where these more explicit images can be stored. Eman.

Thanks, Now I Need Eye Bleach
I see the issue of the picture has been discussed ad nauseam (pun fully intended) above.

Just wanted to add my 2 cents about this -- although I suppose it's really a general policy issue for Wikipedia.

Seeing someone's swollen butthole first thing in the morning is not really the kind of Wikipedia experience I want. I'm squeamish and careful about what kind of searches I do in Google Image Search when I'm researching, say, skin diseases. Just because I might have the condition described doesn't mean that I want to see a picture of it.

On the other hand, I don't think it's inappropriate to have medical images in Wikipedia.

I don't share the objection that these are not appropriate for "family viewing" etc. (they are not pornographic, just explicit)-- it's just that many medical images are so gross I don't feel like reading the article at all. Yes, I know that other people may not share this feeling, but many people obviously DO.

So is it too much to have a link to the image on a separate page with a warning, e.g. "Warning: Link to Graphically Explicit Medical Photograph"? That way I don't have to see it if I don't want to, but it is there for everyone who does.

Does anyone know of a policy discussion where this issue is discussed? Some of you underestimate how much a graphic medical picture can upset and disturb people who are squeamish. You may not share that feeling, you may hold it in contempt, but you should still understand that it's a very visceral and real reaction that is quite common. There's a reason not everyone wants to go into medicine! StrangeAttractor (talk) 16:10, 10 July 2009 (UTC)

crikey - KEEP

It's a bum hole for crying out loud. We've all got one, and this just happens to be a (good) picture of one with a hemorrhoid. This IS the wikipage on hemorrhoids isn't it? I suggest people who find images of hemorrhoids 'gross' or unpalatable in the morning, stop searching for web pages on the topic!!!

Tcal (talk) 14:39, 16 November 2009 (UTC) —Preceding unsigned comment added by Tcal (talk • contribs) 14:35, 16 November 2009 (UTC)


 * Some people adore opera. That doesn't mean I want to hear it blaring when I load up a page on opera.  Some people, such as you, adore bum holes.  That doesn't mean I need to see one when I load up a page on hemorrhoids.  Frankly, its bad enough just corresponding with one. StrangeAttractor (talk) 07:55, 14 December 2009 (UTC)

Complications
Someone should list the complications of hemmorhoids like emboli formation and bleeding and whatnot.
 * Have rewrote the article.-- Doc James (talk · contribs · email) 10:14, 14 April 2010 (UTC)

Use of squat toilets
Have removed this text as it is based on primary and WP:OR. We would need a review to include it under the section on prevention. May be able to add it under a section on society and culture.

Based on their very low incidence in the underdeveloped world, where most people squat for defecation, hemorrhoids have been attributed to the use of the "sitting" toilet. Dr. Berko Sikirov published a study in 1987 testing this hypothesis by having hemorrhoid sufferers convert to squat toilets. Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. This chart summarizes the results. This study was undertaken in a very small number of people, when compared to the numbers involved in recognized high-quality trials. Therefore, the results, while highly suggestive, cannot be assumed to provide a firm conclusion.

No follow-up studies have ever been published. The American Society of Colon & Rectal Surgeons is silent regarding the therapeutic value of squatting.

Doc James (talk · contribs · email) 11:13, 14 April 2010 (UTC)


 * This source [] actually concludes that squat toilet increase the risk of hemorrhoids! Doc James (talk · contribs · email) 11:20, 14 April 2010 (UTC)

That source is not available without paying for a subscription. Could you quote the relevant section? They must cite some research as the basis of their "conclusion." Curious that there's no such research to be found in PubMed.

Secondly, the Sikirov study is not original research. It was published in a reputable journal, the Israel Journal of Medical Science. It is listed in PubMed. I don't understand why this is not considered a valid source.--Jonathan108 (talk) 16:27, 14 April 2010 (UTC)


 * It is primary research ( see WP:MEDRS ) rather than a review article. The passage from the ref above states "Even totally asymptomatic people can engorge their anal cushions massively by bearing down. Performing a Valsalva maneuver during proctoscopy will confirm this fact. Vascular engorgement of anal cushions is also made more obvious by straining in the squatting position. We believe that the propensity of the Asian population to have larger hemorrhoids (piles) is in part related to many Asian toilets being of the squatting type. Prolonged and repeated straining on a sitting toilet also results in engorgement of these cushions. As such, reading in the toilet and prolonged and repeated straining with chronic constipation or frequent diarrhea also predispose to symptomatic hemorrhoids. Pregnancy and delivery exert tremendous pressure or bearing down and are also common causes of large, congested, and prolapsed piles."  Doc James  (talk · contribs · email) 21:17, 14 April 2010 (UTC)

As I suspected, there was no research (epidemiological or clinical) involved in that "conclusion". The worldwide incidence of hemorrhoids clearly shows that it's a disease of the western world and is rare among squatting populations. Here are three sources that confirm this.  

Some of the sources mention diet as the main preventative factor and other sources (including the renowned Denis Burkitt) also mention squat toilets. Clearly, research is needed to determine which is the most relevant factor. Sikirov has made a good start. --Jonathan108 (talk) 02:48, 15 April 2010 (UTC)


 * Anything published after 1972? The ref I mentioned is more recent.  I do not think there is sufficient evidence either way and agree more research is needed.  Until that research is done however it does not belong in the main sections of a WP article. Doc James  (talk · contribs · email) 14:41, 15 April 2010 (UTC)

Here's an excellent study Sikirov completed in 2009. Since it hasn't been published in a peer-reviewed journal, it doesn't meet wiki-standards. But maybe it will inspire hemorrhoid specialists (and their patients) to give the concept a try. --Jonathan108 (talk) 22:18, 15 April 2010 (UTC)


 * There is some evidence but we should wait until it is published in a review on the topic. Doc James (talk · contribs · email) 22:57, 15 April 2010 (UTC)

Epidemiology
Pg 157 American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. 

pg 191 Nonprescription product therapeutics by W. Steven Pray 

pg 275 Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

MICROED8 (talk) 19:46, 1 May 2010 (UTC)

Citation Verification
(Part of the WikiProject Medicine effort)

Background section:
Current citation " a b c d e f g h i j k l m n o p q r s t u v w x y z aa Lorenzo-Rivero S (August 2009). "Hemorrhoids: diagnosis and current management". Am Surg 75 (8): 635–42. ." Is a hemorrhoids and needs to be replaced with a citation that is open access. Also, the citation is used too frequently throughout the article. Please update to include multiple easily accessible sources suggested below. Most resources suggested would be relevant for most sections in the article.
 * Possible replacement references for addition to both introductory paragraphs where citations need to be added:

Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

Final sentence of first paragraph failed full verification: reference (Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994) on pg 274 says that pain associated with external and internal hemorrhoids depends on if they have thrombosed, otherwise they may both be asymptomatic.

American Gastroenterological Association technical review on hemorrhoids, great overview of hemorrhoids and their treatment/prevention: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 


 * It is preferred to stick with a recent review rather than using older papers or textbooks. There is no requirement that the article be freely accesible.  Anyone can get access at a large university library or ask.  It is not a hemorrhoids link so I am not sure were this comes from. Doc James  (talk · contribs · email) 21:46, 1 May 2010 (UTC)
 * I agree with Doc James: a sixteen-year-old book is not preferable to a very recent peer-reviewed review article.  For common conditions like this one, Wikipedia usually recommends that editors rely primarily on sources published within the last five years.   Additionally, WP:PAYWALL applies. WhatamIdoing (talk) 21:46, 7 May 2010 (UTC)

Classification section:
citation needed for hemorrhoids please see above comments about first citation:

American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 

Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

External
Professional Guide to Diesease by Lippincott Williams & Wilkins: great resource with pictures pg 289-90 

American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 

Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

Internal
Current diagnosis and treatment surgery, by Gerard Doherty 2009 pg 708

American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 

Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

Above sources
Would recommend that we use stuff published in the last 5 or 10 years. Doc James (talk · contribs · email) 21:47, 1 May 2010 (UTC)


 * I agree. --WS (talk) 08:24, 5 May 2010 (UTC)

5% of Americans!?
I can find numerous pages on the Internet, many of them prestigious medical sites, that quote the number of Americans that suffer from hemorrhoids at some time in their life as being much higher than 5%! Some pages quote a figure of 75-80%. Most quote 'more than 50%'. Therefore the figure stated in the article appears, unfortunately, way too low!! CrackDragon (talk) 03:53, 16 July 2010 (UTC)
 * Please find a recent review article as per WP:MEDRS we can than add both figures. BTW the 5% should have been at any given time rather than at some point in a persons life. I have corrected it.  The ref does not give the lifetime prevalence.  If you could find a review article please feel free to add it.  Doc James  (talk · contribs · email) 18:48, 17 July 2010 (UTC)


 * Nice to see we've found a compromise! Shame you had to move the goal posts for us to do so!! CrackDragon (talk) 21:57, 18 July 2010 (UTC)

Intro sentences need to be modified to reflect the common use of the term
Currently the first 2 or 3 sentences represent a medically accurate description but do not not reflect the fact that what most people (and over the counter medications) refer to as piles are the pathological state. I tried to fix this but was reverted. I suggest starting out with a sentence along the lines as "Hemorrhoids are commonly known as an inflammation........" and then follow that sentence up with others that give the correct medical description Cshay (talk) 17:52, 10 August 2010 (UTC)
 * Also, I would expect the intro sentence to answer this question: "What are Hemorrhoids?". I think the answer to this question is "veins in the anal canal". Anything else should come later in the paragraph. Cshay (talk) 17:03, 3 September 2010 (UTC)

Signs and symptoms
include citations for Mayo, March of Dimes and NIH that are listed as citations for this article

Mayo Clinic staff (18 March 2010). "Hemorrhoids". MayoClinic. . Retrieved 18 March 2010.

National Digestive Diseases Information Clearinghouse (November 2004). "Hemorrhoids". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH. http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/.

"Hemorrhoids". March of Dimes. August 2009. http://www.marchofdimes.com/pnhec/159_15290.asp.

Maybe include below for more detailed information:

American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 

Causes
include citations for Mayo, March of Dimes and NIH that are listed as citations for this article

Mayo Clinic staff (18 March 2010). "Hemorrhoids". MayoClinic. http://www.mayoclinic.com/print/hemorrhoids/DS00096/DSECTION=all&METHOD=print. Retrieved 18 March 2010.

National Digestive Diseases Information Clearinghouse (November 2004). "Hemorrhoids". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH. http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/.

"Hemorrhoids". March of Dimes. August 2009. http://www.marchofdimes.com/pnhec/159_15290.asp.

Maybe include below for more detailed phrases

American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. Pg 156-177 

Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

Pathophysiology:
pg 275 Digestive Diseases in the United States: Epidemiology and Impact. James E. Everhart 1994 

Prevention:
citation 7 is the same as 5 please update.

include citations for Mayo, March of Dimes and NIH that are listed as citations for this article

Mayo Clinic staff (18 March 2010). "Hemorrhoids". MayoClinic. http://www.mayoclinic.com/print/hemorrhoids/DS00096/DSECTION=all&METHOD=print. Retrieved 18 March 2010.

National Digestive Diseases Information Clearinghouse (November 2004). "Hemorrhoids". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH. http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/.

"Hemorrhoids". March of Dimes. August 2009. http://www.marchofdimes.com/pnhec/159_15290.asp.


 * Neither the mayo clinic nor march of the dimes are preferred by WP:MEDRS thus they should not be typically used. Will look at the other ref however it is a bit old. Doc James  (talk · contribs · email) 02:14, 6 September 2010 (UTC)

Diagnosis
Pg179 diseases of the intestines Max Einhorn 2008 

pg 158 American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. 

Differential
American Gastroenterological Association technical review on hemorrhoids: The ASCRS textbook of colon and rectal surgery by Bruce G. Wolff, James W. Fleshman, David E. Beck. 

Definition/Usage
This article in its current state is schizophrenic regarding whether the term refers to "normal vascular structures" which are generally present in all healthy or unhealthy individuals, and which may in some cases "become pathological", but otherwise are unremarkable; or whether it refers to something that "occurs", having "symptoms" and "causes" when it does, and otherwise is not present and can be "prevented". If the cultural and/or professional usage is inconsistent, then the article should address and clarify that up front, and then adopt a consistent usage throughout. 134.134.137.71 (talk) 21:29, 24 November 2010 (UTC)
 * Technically hemorrhoids are normals parts of human anatomy which become pathological hemorrhoids when thrombosed. How do you wish the wording was improved? Doc James (talk · contribs · email) 22:17, 24 November 2010 (UTC)

Edit request on 7 March 2012
Hi, I have noticed that among the procedures there is also mentioned the "Doppler-guided, transanal, hemorrhoidal dearterialization". Doing a little research I found this page here http://en.wikipedia.org/wiki/Transanal_hemorrhoidal_dearterialization where the procedure is described in more detail. I reckon it would help to link the 2 pages, the acronym (THD) of the procedure should be mentioned as well. Hence the text should be changed to: Doppler-guided transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment using an ultrasound doppler to accurately locate the arterial blood inflow. — Preceding unsigned comment added by Bookworm63 (talk • contribs) 11:06, 7 March 2012 (UTC)

Sources (scientific journals): http://www.springerlink.com/content/mn363n1378j64343/

http://onlinelibrary.wiley.com/doi/10.1111/j.1463-1318.2009.01915.x/abstract;jsessionid=7D66B5F93C8D9532FA135F8041E0BB04.d04t02

http://www.americanjournalofsurgery.com/article/S0002-9610%2801%2900759-0/abstract

Thanks!

Bookworm63 (talk) 10:58, 7 March 2012 (UTC)
 * Yes check.svg Done. I added the link, but the acronym is unnecessary I think. If they go to the main article they will see it. — Bility (talk) 19:13, 9 March 2012 (UTC)

Suggestion for the improvement to the "etymology" section
The section on etymology is interesting, but could be improved if it explained how this condition came to receive the popular nickname of "piles" (I do not how it did, so I shall it to some with this knowledge to add that to the section). ACEOREVIVED (talk) 14:56, 31 July 2012 (UTC)

Typo
In the Classification section; missing space between the and dentate line:

"respect to thedentate line.[3]"

Aethalides (talk) 07:09, 3 September 2012 (UTC)
 * Thanks Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:10, 3 September 2012 (UTC)

Book I will come back to

 * http://books.google.it/books?id=DhQ1A35E8jwC&pg=PA182

Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:08, 17 September 2012 (UTC)

Merge "Procedures" with "surgery"
They are more minor procedures than the operations listed under surgery, but anything that is not pharmacological is surgery in my mind... tepi (talk) 19:28, 24 September 2012 (UTC)
 * A number of references do brake it up like this. Stuff that non surgeons will do would be counted as procedures IMO. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:42, 24 September 2012 (UTC)

I don't have experience about which of these procedures are "office" and which would require an operating theater. I wouldn't think that non surgeons did any of these procedures... I read now that ASCRS organizes treatment into: ...so perhaps it should be left be. tepi (talk) 20:12, 24 September 2012 (UTC)
 * dietary and lifestyle modification
 * nonoperative/office procedures
 * operative hemorrhoidectomy.
 * FPs do banding in my country in the office. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:17, 24 September 2012 (UTC)
 * Interesting, I didn't know this. They need specific training and certification? For the immediate period when they carry out these procedures, I would consider them surgeons too :D tepi (talk) 20:35, 24 September 2012 (UTC)
 * Sclerosing injections are done in offices in some countries too. I agree that one section, "Procedures" should cover all (surgial or otherwise). --Gibson Flying V (talk) 03:45, 2 October 2012 (UTC)

Sp "hemmorhoid"
In the history section, when discussing etymology, "hemmorhoid" is used. Firstly, i think the double m is a typo, and secondly, would the first UK english use of the word be "haemorrhoid" rather than "hemorrhoid" ? tepi (talk) 20:35, 24 September 2012 (UTC)
 * Thanks let me fix that. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:10, 2 October 2012 (UTC)

Photos
I wish there was a version of this article without the photos 82.46.109.233 (talk) 20:11, 6 April 2013 (UTC)
 * There is a way to view Wikipedia content without images. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:37, 6 April 2013 (UTC)

Maybe this article dont need the pics shown like that. I went here to read the article, anus pictures everywhere, cant read that article. Maybe a thumbnail collection at the bottom? — Preceding unsigned comment added by 90.184.30.102 (talk) 02:03, 23 June 2013 (UTC)

ICD-10: Update 2013
Since 2013 the ICD-10 code is no more I84, but K64. — Preceding unsigned comment added by 178.1.214.37 (talk) 07:36, 31 August 2013 (UTC)

New spelling
Apparently some authorities have started using a much simpler spelling for this word, ie, "hemroid". http://www.medicalnewstoday.com/articles/73938.php, http://www.thefreedictionary.com/Hemroid, and others. Can we include a discussion on the page? Tina Kimmel (talk) 01:03, 30 September 2013 (UTC)
 * Any reliable sources? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:00, 30 September 2013 (UTC)

Removed
Have removed this as undue weight "Balsam of Peru is often an ingredient in hemorrhoidal suppositories and ointments, such as Anusol. Balsam of Peru is in the "top five" allergens most commonly causing patch test reactions in people referred to dermatology clinics. People who are allergic to Balsam of Peru may experience pruritis and contact dermatitis.  "

The specific side effects of the sub ingredients of products that have little evidence can be discussed on those pages. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:45, 3 April 2014 (UTC)


 * Thanks for coming to the talk page. I was confused earlier when you deleted RS-supported material without doing so.


 * I don't think that exclusion of what you deleted is appropriate. If you want to shorten the text, fine.  Do so.  But I think your deletion of it is inappropriately  heavy-handed.


 * And does not accord with wp:undue.


 * And is illogical--as the article section it was added to already raises in the article the effect of such treatments ("many topical agents and suppositories are available for the treatment of hemorrhoids... Steroid-containing agents should not be used for more than 14 days, as they may cause thinning of the skin....")


 * And the article --Epeefleche (talk) 04:11, 3 April 2014 (UTC)already discusses the ingredients in such treatments ("Most agents include a combination of active ingredients.[4] These may include: a barrier cream such as petroleum jelly or zinc oxide, an analgesic agent such as lidocaine, and a vasoconstrictor such as epinephrine.[4]).


 * This is a natural balancing (a goal of wp:undue) -- it mentions with RS support that many such creams of ingredients X which is a top 5 allergen causing itching (one of the symptoms the patient seeks to avoid). It's a fine thing for you to allow the reader to know.  And given that the subject of the article is already the effects of the creams, and the ingredients of the creams, the mention that many creams have this ingredient with this effect is not undue in the least.


 * This is completely RS-supported.

And as you know, there are multiple RSs that bear on this subject. See, e.g., here and here.


 * Finally, your characterization above of the side effects of this ingredient of these products as having "little evidence" is flatly wrong. This is, as discussed above, at top-5 patch test allergen.  The number 2 allergen in the most recent indicated study.--Epeefleche (talk) 04:11, 3 April 2014 (UTC)
 * When I say the evidence is not good for topical agents. I mean that the evidence is not good for the effectiveness of topical agents in helping hemorrhoids. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:18, 4 April 2014 (UTC)
 * Allergies may occur to any one of a number of components of these topic creams. Do we have a ref that states that the topical creams that contain Balsum of Peru have a higher rate than those that do not? Most of the refs do not mention hemorrhoid creams. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:13, 4 April 2014 (UTC)

Contradiction?
From the entry:

Rubber band ligation -- "Cure rate has been found to be about 87%[3] with a complication rate of up to 3%.[11]"

Sclerotherapy -- "The success rate four years after treatment is about 70%[3] which is higher than that with rubber band ligation.[11]"

So, RBL has a success rate of 87%. Sclerotherapy has a success rate of 70% which the author thinks is higher than the RBL success rate of 87%

Maybe one of these is a typo?

Thanks. Rissa, copy editor (talk) 21:32, 29 September 2014 (UTC)
 * Fixed Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:15, 30 September 2014 (UTC)

Edit
I have removed some of the text that refers to haemorrhoids as being normal. Haemorrhoids are a pathological condition of the peri-anal veins. Even when they progress to harmless and painless 'skin tags' they are still not normal. Richard Avery (talk) 11:07, 29 December 2014 (UTC)
 * The term is used in two ways. Hemorrhoids are a normal part of human anatomy. And when they become inflamed are also called hemorrhoids. Here is a big textbook  Doc James  (talk · contribs · email) 12:15, 30 December 2014 (UTC)


 * Well you learn as you go, after too many years in nursing I had never been taught, even in the surgical lectures, that the fibrous-venous pads around the anus were called haemorrhoids, they were only referred to when they were in a pathological condition. And I've witnessed a few bandings and still didn't get it. Thanks for that good Doc James. That is an excellent book you've put up there. Richard Avery (talk) 16:18, 30 December 2014 (UTC)

What hemorrhoids actually are, and the order of the article
As I understand it from a colorectal specialist, the Pathophysiology section is where the article tells us what hemorrhoids are: a normal part of the anatomy that all humans have (three external and three internal, according to the specialist). The entire remainder of the article is about hemorrhoid problems. But the article presents the base definition very late, and then uses the unqualified word "hemorrhoid" as though the word applies specifically to the inflammation of them. Shouldn't it be changed around to reflect accurately the anatomy and the terminology? —Largo Plazo (talk) 12:30, 2 April 2016 (UTC)
 * The article presents the base definition in the very first sentence. Doc James  (talk · contribs · email) 13:49, 2 April 2016 (UTC)
 * OK, you're right. And I'm seeing how I got confused, which still calls for edits to the article. The first two sentences present them correctly. The article then veers away from accuracy beginning with the third and fourth sentences: "The signs and symptoms of hemorrhoids depend on the type present. Internal hemorrhoids usually present with painless, bright red rectal bleeding when defecating." When people speak of the signs and symptoms of something, they are the signs and symptoms of some disorder. The word "hemorrhoids" is being used here to denote the disorder, not the body part affected by the disorder. Internal hemorrhoids "present" no more than do teeth, taste buds, and tendons. Hemorroid inflammations and prolapses present. And so on through most of the article, so that after a few more paragraphs I'd, evidently, forgotten that the first two sentences had had it right. —Largo Plazo (talk) 15:55, 2 April 2016 (UTC)
 * Adjusted. Doc James  (talk · contribs · email) 02:06, 3 April 2016 (UTC)
 * Fair enough, though I did some copyediting. Thanks. —Largo Plazo (talk) 10:59, 3 April 2016 (UTC)
 * Have adjusted a bit further. The key is that the term hemorrhoid can be used for the normal or diseased state. Doc James  (talk · contribs · email) 14:39, 3 April 2016 (UTC)

Semi-protected edit request on 29 April 2016
Well, I did include the secondary (review) source below. Again, it's Palit S, Lunniss PJ, Scott SM. The physiology of human defecation. Dig Dis Sci. 2012 Jun;57(6):1445-64. doi: 10.1007/s10620-012-2071-1. Epub 2012 Feb 26. .

Very well. This peer-reviewed original research paper and the related description has been deleted and replaced by a review. So will my edit or part of it be added to the Prevention Paragraph?

Using squat toilets and maintaining anal hygiene by washing with water after defecation are recommended. The choice of squatting position is substantiated by a more complete evacuation of the feces in squatting position resulting in less retention, which causes continuous pressure on sigmoid colon. Washing contributes to better anal hygiene than use of toilet paper only - an important factor in hemorrhoid prevention. Palit S, Lunniss PJ, Scott SM. The physiology of human defecation. Dig Dis Sci. 2012 Jun;57(6):1445-64. doi: 10.1007/s10620-012-2071-1. Epub 2012 Feb 26. .

Kbojanowski (talk) 01:04, 29 April 2016 (UTC)
 * Per WP:MEDRS we use review articles rather than primary sources for medical content. Doc James  (talk · contribs · email) 13:17, 29 April 2016 (UTC)

So will my edit be taken in consideration? — Preceding unsigned comment added by 2605:E000:141B:8009:9593:B0DF:FF6B:334B (talk) 17:24, 29 April 2016 (UTC)
 * No they will not be included without a secondary source. Doc James  (talk · contribs · email) 18:32, 29 April 2016 (UTC)
 * Red information icon with gradient background.svg Not done for now: Per Doc James. Sam Sailor Talk! 22:00, 29 April 2016 (UTC)

Decline in quality over time
Thanks to poor editing, the current lead of this article is demonstrably inferior to what was there before. The lead of the article back in 2009 went as follows:


 * Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are swelling and inflammation of veins in the rectum and anus. The anatomical term "hemorrhoids" technically refers to "'Cushions of tissue filled with blood vessels at the junction of the rectum and the anus."[1] However, the term is popularly used to refer to varicosities of the hemorrhoid tissue.

This is a very clear statement of what haemorrhoids or piles are.

The lead of the current article goes:


 * Hemorrhoids, also called piles, are vascular structures in the anal canal.[3][4] In their normal state, they are cushions that help with stool control.[2] They become a disease when swollen or inflamed; the unqualified term "hemorrhoid" is often used to refer to the disease.[4]

This lead is inferior to what was there in 2009 on the following grounds.

1. The alternative spelling has been inexplicably removed to the infobox, leaving only one "correct" spelling for this term at the article.

2. The current article states that piles are vascular structures in the anal canal. While haemorrhoids may refer to such blood vessels in their normal state, it is doubtful that this holds for piles, which always refers to the diseased state.

This flight from clarity and completeness as a result of successive edits is disturbing. I suggest that the lead should be rewritten to restore some of its earlier clarity.

103.229.122.22 (talk) 11:52, 26 March 2017 (UTC)
 * The alternative spelling is in the infobox.
 * This ref does not state that piles only refer to the diseased state. Do you have a ref that does? Doc James  (talk · contribs · email) 12:04, 26 March 2017 (UTC)

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Etymology
I'm just itching to know the answer to this delicate question: Why are hemorrhoids called "piles" in British English? Sca (talk) 17:00, 12 November 2017 (UTC)

Non-US spelling should be included.
The English spelling used outside North America should be mentioned. — Preceding unsigned comment added by 31.81.179.41 (talk) 11:45, 16 October 2018 (UTC)

Update according to guidelines required
I have added a few guidelines from professional societies for the United States, France, India, Portugal and Italy (search for ref type=Professional society guidelines). The whole article should be updated accordingly. In particular, I have quickly glanced that most societies agree that surgical procedures should be a last resort, and other treatments should be pursed first. --Signimu (talk) 04:34, 7 November 2019 (UTC)

Semi-protected edit request on 29 April 2020
please change x to y because a number of factors that increase pressure in the abdomen are believed to be involved. Devajith Jijush (talk) 05:58, 29 April 2020 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Victor Schmidt (talk) 13:42, 29 April 2020 (UTC)

Treatments
Nonprescription product therapeutics by W. Steven Pray pg 197-201 

Mayo Clinic staff (18 March 2010). "Hemorrhoids". MayoClinic. http://www.mayoclinic.com/print/hemorrhoids/DS00096/DSECTION=all&METHOD=print. Retrieved 18 March 2010.

Conservative
I don't think the following sentence in the article is supported by the cited references. "While many topical agents and suppositories are available for the treatment of hemorrhoids, little evidence supports their use." Compare to reference 22 The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids (note: significance figures e.g. p value omitted for readability): "In a Cochrane review of 24 randomized controlled trials (RCTS) enrolling a total of 2334 participants, which compared an intervention using phlebotonics with a control, phleb demonstrated a statistically significant beneficial effect for the outcomes of pruritus, bleeding, discharge and leakage, and overall symptom improvement. Although beneficial, they did not show a statistically significant effect when compared with a control intervention for pain." — Preceding unsigned comment added by 2605:EF80:38:2F30:0:0:A60:55CB (talk) 20:31, 22 February 2021 (UTC)

Surgical
Surgical treatment of hemorrhoids by Indru Khubchandani, Nina Paonessa, Khawaja Azimuddin discusses a variety of surgical techniques 

citation marked does not have accessible PDF: MacLeod JH (1982). "In defense of cryotherapy for hemorrhoids. A modified method". Dis. Colon Rectum 25 (4): 332–5. .

pg 115 of Surgical treatment of hemorrhoids by Indru Khubchandani, Nina Paonessa, Khawaja Azimuddin discusses cryotherapy 

Semi-protected Edit Request on 16, June 2021
Change: Other conditions that produce an anal mass include skin tags, anal warts, rectal prolapse, polyps, and enlarged anal papillae.[5] Anorectal varices due to increased portal hypertension (blood pressure in the portal venous system) may present similar to hemorrhoids but are a different condition.[5] Portal hypertension does not increase the risk of hemorrhoids.[4]

To: Other conditions that produce an anal mass include skin tags, anal warts, rectal prolapse, polyps, and enlarged anal papillae.[5] Anorectal varices due to portal hypertension (blood pressure in the portal venous system) may present similar to hemorrhoids but are a different condition.[5] Portal hypertension does not increase the risk of hemorrhoids.[4]

Reason: Incorrect use of medical vocabulary grammar: The phrase "increased portal hypertension" imparts an incorrect state- Portal hypertension is an abnormal state if it exists at all- therefore the modifier "increased" is redundant, as well as incorrect, in terms of basic medical vocabulary and grammar.

98.178.191.34 (talk) 02:45, 17 June 2021 (UTC)
 * ✅, and thank you very much!  P.I. Ellsworth   ed.  put'r there 04:49, 17 June 2021 (UTC)

Requested edit
In the third paragraph, the sentence 'Medicated creams may be applied to the area, but their effectiveness is poorly supported by evidence.' cites a source that itself lacks any citation for this claim. In addition, the source differentiates between creams' unlikely ability to fix hemorrhoids and their potential, if questionable, ability to reduce symptoms. Other reliable sources seem to feel that creams do have the ability to reduce symptoms. It may be best to make this sentence question the ability of creams to heal hemorrhoids but not their ability to help with symptoms. Most readers will have come to this page in search of exactly this sort of sentence, so use your best judgment. I would make this edit myself, but do not yet have permission. Ubadubba (talk) 01:53, 29 September 2022 (UTC)
 * Red information icon with gradient background.svg Not done: please provide reliable sources that support the change you want to be made.
 * The cited source is the citation for this claim and its abstract clearly states, "[t]opical remedies provide no more than symptomatic relief—and even evidence for this is poor." If your contention is that the cited source is not reliable, you can bring that up at the reliable sources noticeboard. For your suggestion to alter the sentence, please provide the reliable sources you believe indicate an ability of topical medications to relieve symptoms, for evaluation. --Pinchme123 (talk) 18:17, 5 October 2022 (UTC)

I do not know about citations. I am confused whether the superscript number at the end of sentence is a citation to that sentence or many sentences before the superscript sentence. Ajay Sahay (talk) 13:17, 6 January 2023 (UTC)

Sitting
The paper (Schubert, MC; Sridhar, S; Schade, RR; Wexner, SD July 2009) cited in support of the statement "Other factors believed to increase risk include ... prolonged sitting" does not include the word "sitting" anywhere within. I have marked it as "dubious", please can a medical expert look at this. Martin of Sheffield (talk) 11:41, 20 February 2023 (UTC)

Semi-protected edit request on 6 July 2023
Add being "receptive partner in anal intercourse" as cause. Serenehunter (talk) 23:16, 6 July 2023 (UTC)
 * Red information icon with gradient background.svg Not done for now: Better reliable source needed.  — Paper9oll ≠≠ (🔔 • 📝)  23:21, 6 July 2023 (UTC)
 * , see these

103.67.156.38 (talk) 23:35, 6 July 2023 (UTC)
 * ✅ Xan747 (talk) 00:23, 7 July 2023 (UTC)

Semi-protected edit request on 7 July 2023
Add "being receptive partner in anal intercourse" as cause. 103.67.156.38 (talk) 00:21, 7 July 2023 (UTC)
 * Pictogram voting wait.svg Already done Please don't spam multiple requests for the same edit. Thanks. Xan747 (talk) 00:24, 7 July 2023 (UTC)