Dear Doctor: Like a lot of older people, I suffer from hemorrhoids that cause some pain as well as intermittent bleeding after bowel movements. My doctor recommended surgery, but I’ve also found relief using a hemorrhoid cream. What’s the best treatment?

Dear Reader: "Hemorrhoids" is the name given to a common condition in which veins in the tissues of the lower anus or the rectum become inflamed and swollen. They can be internal or external, and each type causes different symptoms.

Internal hemorrhoids occur within the rectum, which is the lowest portion of the colon, or large intestine. Although these can sometimes cause bleeding, they tend to be painless. External hemorrhoids present as visible bumps or swellings on and around the skin of the anus, which is the opening through which feces passes. External hemorrhoids often cause pain and intense itching around the anus, and they can bleed.

Both types of hemorrhoids can become thrombosed, which means that a blood clot has formed inside. Internal hemorrhoids can also prolapse, which means that they bulge beyond the anus. This is often quite painful, but it is usually not dangerous.

Although the exact reason someone develops hemorrhoids is often not known, causes include chronic straining during bowel movements due to constipation, sitting on the toilet for long periods of time, pressure due to pregnancy or weight gain and chronic diarrhea. Diagnosis is done via a visual or digital examination of the anus, or with an endoscopic device, which is a thin flexible tube that allows the physician to closely examine the anal canal.

When it comes to treatment, we believe that the first approach should be adjustments to behavior and lifestyle. It’s important to avoid sitting on the toilet for long periods of time, which puts pressure on the rectum and anus. Don’t spend more time on the toilet than it takes to urinate or complete a bowel movement. For some people, a change of diet may be needed in order to deal with chronic constipation. This includes drinking plenty of water for adequate hydration, and eating lots of fresh greens, fruits and vegetables to get the insoluble fiber that makes stools softer and easier to pass. Using a Squatty Potty, a raised platform that turns the seated position on a toilet into a squat, can result in less straining during a bowel movement.

As you’ve discovered, creams and ointments can help to ease symptoms like swelling and itching. However, they don’t cause hemorrhoids to heal. Hemorrhoids often go away on their own. But when lifestyle methods aren’t enough, or fail to adequately manage symptoms, then the conversation will turn to surgery, known as a hemorrhoidectomy, to address the affected tissues. Hemorrhoidectomies are usually done on an outpatient basis, which means you go home the same day.

One final note -- whenever you have anal bleeding, it is important to see your doctor for an exam. We recently had a patient who came to us with bleeding hemorrhoids. Thanks to additional testing, it was discovered to be a rectal cancer, and the patient was able to seek appropriate treatment.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm looking for new ways to deal with all the stress I feel these days, and a friend keeps talking about something called "mindfulness." What is that, exactly? Is there any proof that it actually works?

Dear Reader: We hear a hint of skepticism in your question, and we understand why it’s there. The word "mindfulness" sounds vague and a bit New Age-y, but the concepts behind the practice date back thousands of years. They have roots in Buddhism and other ancient spiritual traditions, which have been modified and Westernized over time.

As we know it today, mindfulness is an umbrella term for a range of contemplative practices that help the practitioner to become fully present in the here-and-now. Techniques to induce mindfulness can include deep breathing exercises, meditation, hatha yoga, a walk in the woods, losing oneself in a creative project or just sitting and quieting one’s thoughts. The goal is to silence the cacophony of the outside world in order to find the stillness of the inner one. Rather than letting one’s thoughts race from problem to problem, worrying about things that have not and may not happen, the practice of mindfulness seeks to bring the focus of one’s awareness to this very minute, without judgment, right now.

As anyone who has ever tried meditation probably knows, finding calm amid the turbulence of our thoughts and emotions can be a challenge. That’s why many people find it helpful when the practice is tied to some kind of movement, such as the slow and sustained flow of yoga or tai chi, or the soothing repetition of breathing exercises.

A growing body of recent research suggests that mindfulness techniques can be helpful in relieving stress, depression and anxiety, as well as lessening the physical toll that those emotional states can take on the body. There is also evidence that mindfulness is helpful for people living with chronic pain.

A study published in May 2018 found that participants who engaged in mind-body practices to induce relaxation for eight weeks had a change in gene expression that led to a measurable decrease in blood pressure. Research published in the Journal of the American Medical Association in 2016 reported that mindfulness meditation helped patients with lower back pain find drug-free relief. Scientists at Georgetown University Medical Center found that mindfulness meditation by individuals with a stress disorder lowered the biomarkers of stress response. And a review of a number of studies into the effects of mindfulness found that the practice can have beneficial psychological effects, including an increase in a sense of well-being and a decrease in anxiety.

It’s important to note that earlier studies often relied on self-reported results from participants, which caused skepticism about how effective mindfulness actually is. This has led to more scientifically rigorous studies that use control groups, which allow researchers to minimize any unintended variables. And as interest into the potential of mindfulness grows, new studies are using advanced imaging techniques, such as functional magnetic resonance imaging, to study the effects of the practice in real time.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Recently, my skin became irritated and started blistering. I was diagnosed with lichen planus, which I’m told is pretty common. What is it? How can people deal with the irritation and itchiness it causes?

Dear Reader: Lichen planus is a condition in which swelling, irritation and inflammation develop on various areas of the body. You’re correct that it’s common. And although lichen planus is most often seen on the skin, as in your case, it can also occur on the scalp, nails and mucous membranes.

The specific symptoms depend on the area of the body that is affected. On the skin, lichen planus appears as flat, itchy bumps with a reddish or purple color. These are usually firm and sometimes quite shiny. When it appears on mucous membranes, such as the inside of the cheek, the gums, the tongue or the genitals, it presents with clusters of tiny white dots that can look like lace. These may be accompanied by sores or inflammation that is often painful. On the scalp, the condition sometimes results in hair loss. Individuals with lichen planus on the nails often see thinning or splitting, develop marked ridges or grooves, and may experience nail loss that can be temporary or sometimes permanent.

Although the specific causes of the condition are not yet known, it is suspected to be a disease of the immune system.

Diagnosis of lichen planus is typically done with a physical and visual exam of the affected area, and by taking a sample of skin or a sore to examine under a microscope. Because the symptoms can be similar to several other skin conditions, including eczema and psoriasis, a blood test may be used to further narrow down the diagnosis.

There is no cure for lichen planus at this time, so the focus is on managing the symptoms. This includes using antihistamines to alleviate itchiness, and topical corticosteroid creams or ointments to help with swelling and redness. Retin A and certain types of light therapy have been found to be useful in helping to clear up the skin. For some patients, the prescription ointments prescribed for eczema are helpful. And in severe cases of lichen planus in which a patient has large areas of sores or bumps or experiences extreme itchiness or pain, corticosteroids such as prednisone, delivered as a pill or an injection, can provide relief.

When the condition develops in the mucous membranes, such as inside the mouth or on the genitals, the moist and enclosed environments make treatment more challenging. In the genitals, it can cause enough pain to interfere with sex. Sores in the mouth can make eating more difficult. Lichen planus also increases the risk of gum disease, which makes dental hygiene, including professional teeth cleaning, vital.

The good news is that the condition will often go away on its own over the course of a year or two. However, about 20% of people experience a recurrence. It’s not contagious, but there is evidence that some forms of lichen planus can run in families. Since people living with hepatitis C often also develop lichen planus, researchers are now exploring possible connections between the two.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)