Dear Doctors: Intense pain during a bowel movement sent our son to the ER. He got diagnosed with a blood clot in a hemorrhoid and needed surgery to fix it. I thought hemorrhoids happen when you sit a lot. Our son is a football player, so it's a big surprise that he even had them.

Dear Reader: Your son had a condition known as a thrombosed hemorrhoid. That's the medical term for a blood clot that develops inside of a hemorrhoid. This can range from a mild problem that can be managed with home remedies to the very painful emergency your son had. To understand what happened, we should begin with the site of the problem: the hemorrhoid.

The tissues of the lower bowel are served by a rich supply of blood vessels. These include veins, arteries and capillaries. These support the complex functions needed for elimination. Pressure on the veins in the rectum or the anus can cause them to swell. At the same time, the connective tissue that supports these blood vessels can get weak. The result is a bulging vein, known as a hemorrhoid. In some cases, blood can pool in the swollen vessel, raising the risk of a clot. This is a thrombosed hemorrhoid. It’s most often seen with external hemorrhoids. However, it can occur internally as well.

Prolonged sitting can lead to hemorrhoids. Repeated straining during a bowel movement can also be a cause. Other causes are pregnancy, obesity and not getting enough fiber. The natural weakening of tissues that comes with advancing age can also be a factor. Heavy lifting, including the weight training athletes do to increase strength and bulk, may also contribute. It can increase the intra-abdominal pressure that causes hemorrhoids to develop.

The surgery that your son underwent is a hemorrhoid excision. The sudden, intense and unrelenting pain caused by the clot is likely why surgery was needed. This surgery is typically done under local anesthesia. The doctor removes the clot through a cut in the surface of the hemorrhoid. They usually identify the site of the clot visually, or by gently palpating the swollen tissues. Removing the clot instantly relieves internal pressure and eases the pain. Patients often return home the same day. They are usually given instructions to take a daily sitz bath to keep the surgical site clean and moist. The incision should mostly heal within a week.

In most cases, swelling and discomfort improve after a few days. Some people find that a mild pain medication helps them while they heal. It is important to keep bowel movements soft as the area heals. That means drinking plenty of fluids and including plenty of fiber in the diet. It’s also vital to avoid too much sitting, abdominal straining and any heavy lifting during recovery. When the factors that caused the thrombosed hemorrhoid are adequately addressed, recurrence is rare.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: It is my understanding that one should sleep in a dark, cool room. At what age does it become a problem for children who have slept with night-lights and have been bundled up since birth? Do night-lights tell children that the dark is something to be afraid of?

Dear Reader: You are correct about new understanding regarding optimal conditions for a good night's sleep. They include a comfortable and yet supportive surface for your body, a quiet environment, a moderate room temperature in the mid-60s to low-70s, and no ambient light. This may sound like a finicky to-do list, but our nightly recharge is important. High-quality sleep not only sets you up for the tasks and challenges of the coming day, but it plays a key role in physical, mental and emotional health.

When it comes to the effects of ambient light on the sleep of children, you have actually posed two different and very interesting questions. One focuses on the physiology of light exposure on sleep systems that are still in the developmental stage. The other asks what effect the protection of a night-light might have on a child's response to darkness. Here in the United States, night-lights have long been a fixture of childhood bedrooms. But as we understand more about sleep physiology, it’s reasonable to wonder how they help or hurt. This is particularly true because of what we’re learning from research on circadian development.

It is important to understand that in children, the circadian systems that wire the human body to the Earth's cycle of light and dark are still developing. The daily shifts from light to dark and back again trigger complex hormonal shifts. These shifts are calibrating young brains and bodies. That means light at nighttime -- even the soft glow of a stuffed animal friend -- can nudge that timing. It can shift the biological sense of when sleep should begin. Research has shown that even a small amount of nighttime light can delay the internal sleep signal. This doesn't mean night-lights have to be banished, but it's a useful piece of information for managing children's sleep. You can always plan for a transition to a darker room in the future.

That brings us to your second question. Fear of the dark is natural and nearly universal in human development. It can begin as early as age 2 or 3, as memory forms and imagination grows. It usually peaks between ages 3 and 6. Brain development, parent reassurance and normal life experience work together to gradually resolve it. While a night-light can ease a fear of the dark, it’s not likely to cause it. What does matter is whether the light becomes a permanent fixture. If they never have darkness, a child can't make the important discovery that their room is just as safe without a light on.

The bottom line is that night-lights are not harmful for children. What matters is that they are used as a temporary bridge, and not a permanent crutch.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I started taking voice lessons from an instructor in her 30s who works with younger singers. I’m 72 and have COPD and asthma, and I am recovering from bronchitis. I can’t always reach the notes she thinks I should, and she says I give up too easily. Can I ask her to focus on the vocal range I already have, or is that copping out?

Dear Reader: First, we want to congratulate you on such an interesting enterprise. You are choosing to expand your world at a time of life when circumstances often dictate a contraction. For anyone at any age, taking the time to learn a new skill is both brave and admirable.

When it comes to the mixed results of your singing, it’s not that you aren’t trying hard enough. At age 72, you are undergoing physical changes that begin to affect the voice. Add in the underlying health conditions you described, which affect breathing and breath control, and the challenges you face as a singer are even greater.

Based on your instructor’s response, she may not be fully aware of how aging can affect the voice. As we grow older, the mechanisms that produce vocal sound are aging right along with us. The tissues of the larynx and vocal folds, including the muscles, mucous membranes and connective tissues, often stiffen, grow thin or lose bulk. This can lead to higher voices in men; lower voices in women; a hoarse, weak or shaky quality; reduced breath control; and decreased volume and endurance. One treatment for age-related changes in the voice is exactly what you’re already doing: exercising them. However, because of these physical changes, vocal work in older adults can require special expertise.

When you reach for and miss a note, whether high or low in the register, it’s not due to a lack of effort. It is a misfire within the complex apparatus that creates vocal sound. Concentrating on those missed notes can actually lead to vocal strain in an aging voice. Instead, vocal coaches who work with older adults take a more global approach. They concentrate on strengthening breath support, improving resonance and developing the parts of the voice that remain reliable and expressive. That is, they do exactly what you are asking, which is focus on the vocal range you already have.

This doesn’t mean you have to give up on growing as a singer. But doing it safely can require working with someone who understands the older voice. That means appropriate warm-ups, targeted exercises and realistic goals. The instructor should also be able to recognize each student’s specific limits. For adults like you, living with COPD or asthma, breath management can fluctuate from day to day. It’s important that vocal goals are both individualized and flexible.

Sharing this information with your teacher would be helpful. And to be sure you are on the right track, you might also consider working with a vocal therapist who specializes in older adults. If you are interested, your health care provider can help you with references.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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