I don't give a damn if this upsets my colleagues. I'm going to say something that nobody with chronic hemorrhoids wants to hear. I performed my 2,847th hemorrhoidectomy on March 14th, 2024. Nine weeks later, on May 22nd at 4:12 AM, I was the one being wheeled into the OR with my own emergency thrombosis. My colleague and former student had to operate on me. I was 60 years old. I am a board-certified colorectal surgeon. Twenty-eight years of practice. Two external thromboses excised and one internal Grade III hemorrhoid banded during a 90-minute emergency procedure at the same hospital where I trained fellows for the last twelve years. I lost consciousness from pain twice before they got the anesthesia in. The hospital bill was $47,300. Post-op recovery, follow-up procedures, and physical therapy came to another $8,400. They let me operate again eight weeks later. My privileges are intact. My reputation held. But I will never band a hemorrhoid again without remembering that I was on that same table with someone I trained doing to me what I had done to nearly 3,000 patients before, because everything I had prescribed to my own body over the last eleven years had not saved my rectal cushion from collapsing. I am writing this because I know exactly what my colleagues will say when they see it. I do not care. If you are over 50 and you have had hemorrhoids for more than a year, or someone you love has, please read the entire thing. I know it is long. I know you are scrolling. I know you have things to do. Eighteen months ago I would have given anything for someone with my training to sit me down and tell me what I am about to tell you. Nobody did. I was diagnosed with mild internal hemorrhoids at 49. Grade I on anoscopy. My internist, a colleague at my own hospital, told me it was normal for a man my age who had been standing in the OR six hours a day for two decades. She recommended fiber, hydration, and a topical if flares became uncomfortable. The diagnosis did not surprise me. My father had suffered from chronic hemorrhoids for the last fifteen years of his life. He had used Preparation H twice a day, sitz baths on weekends, and switched to a donut cushion at 68. He never had surgery. He died at 79 of a cardiac event unrelated. But in the last decade of his life, he canceled every family trip that required more than three hours in a car. I watched my father slowly withdraw from the world because of a condition my own field kept telling him was "manageable." I did what any surgeon would do for himself. I added psyllium fiber to my breakfast. I stopped drinking coffee in the morning. I bought the same generic hemorrhoid cream I recommended to hundreds of patients after banding procedures. When flares got bad, I used topical hydrocortisone. Three interventions. All the same protocol I had personally recommended to thousands of patients after surgical consults. I walked three miles a day. I stopped sitting for more than 45 minutes at a stretch. I ate the high-fiber Mediterranean protocol we recommend to every post-op hemorrhoidectomy patient. Lean protein. Olive oil. Leafy greens. Minimal refined carbohydrates. Plenty of water. I checked every box on my own protocol. By age 55, my Grade I had progressed to Grade II. My internist added a stool softener and told me to schedule an annual anoscopy. She was not concerned. Grade II is common in men my age. I was, in her words, "managing well." Managing. That word again. I got my annual anoscopy at 58. The Grade II had become Grade III on the internal side, and I now had two small external tags that were prone to thrombosis. My internist recommended a consultation with one of my own partners for possible banding. I scheduled it. And then I did not go. I want to tell you why. Because sitting in my office at 7 PM staring at my own anoscopy report on my own screen, I recognized something. I was doing exactly what my father had done. He had been "managing" for fifteen years before he stopped traveling. He had used the same creams. He had sat on the same donut cushion. His hemorrhoids had never killed him, but they had slowly killed his ability to live. And now I was watching the same trajectory play out in my own body. I did not go to the banding consult because I already knew what my partner would say. I did not want to hear the same protocol I had recommended to thousands of patients. I told myself I had time. Nine months later I woke my wife at 3 AM. The pain started at 2:38 AM. I remember the exact time because I looked at the bedside clock and thought, this is not just another flare. It was not. It was the pain I had described to a thousand patients in follow-up appointments after they came in with acute external thrombosis. Sharp. Throbbing. Getting worse by the minute. My wife, a retired nurse, sat up before I could finish the sentence. She had heard me describe this exact presentation at our dinner table for twenty-five years. She drove me. We went to a competing hospital, not my own. Because I did not want the residents I had trained to see me in that position. They saw me anyway. The surgeon on call was a woman I had trained during her fellowship in 2019. She walked into the exam room, saw me on the gurney, and her face did the thing. She said my name. "I need excision and internal banding," I told her. "Two external, one internal Grade III. Get me in the OR." "Yes, sir," she said. They wheeled me down the corridor I had walked down thousands of times going the other direction. I looked at the ceiling tiles and counted them because I did not want to look at the surgeon who was about to operate on the anatomy I had studied and treated for twenty-eight years. I lost consciousness twice from the pain before they got the anesthesia in. My former fellow later told me they had never seen a patient present with three simultaneous acute pathologies of that severity. Two external excisions. One internal banding. All in the same 90-minute window I had performed for other patients nearly 3,000 times. I was in recovery for four hours. Home the same evening. But the real recovery took six weeks. Two of those weeks I could not sit down without a special cushion. Three weeks I could not drive. Six weeks of daily sitz baths and topical management before the wound closure was complete. I did not want the full workup my colleagues were suggesting after I healed. I ran it on myself anyway. Because I knew that if I did not, in three years I would be back on that same table with recurrence, watching my father's story play out in my own body. The proctology follow-up with my own partner showed the residual internal cushion was already showing signs of continued collagen degradation on high-resolution anoscopy. The tissue had not returned to baseline structure. He used the phrase, "early chronic remodeling of the anal cushion." Nobody had flagged this before because my anoscopies had only been graded on visible hemorrhoid presence, not on cushion structural integrity. The dermatology consult found signs of premature elastin loss in the perianal skin. I had been ignoring the increased skin fragility for two years. I had blamed it on aging. The pelvic floor physical therapist ran manometry testing. Measurable weakness in the internal sphincter and reduced elastic recoil of the surrounding tissue. I had been feeling the difference for months. I had blamed it on the surgery. The endoscopy showed early diverticular changes in the sigmoid colon. My colleague noted the association with long-term chronic straining patterns. I had never straining. But two decades of intermittent hemorrhoid flares had created the same pattern. Every tissue in my anorectal system was showing the pattern I had watched in hundreds of my own patients after their first surgical intervention. Same disease. Same collagen loss. Same tissue degradation. Weakness in the sphincter. Fragility in the perianal skin. Structural remodeling in the anal cushion. And finally, thrombosis and Grade III prolapse. I sat in my office on July 18th with all four reports in front of me and I understood something I had never let myself understand before. Every treatment in my protocol had been addressing a symptom. The topical creams were treating the flare. The stool softeners were treating the pressure. The fiber was treating the bowel movements. The banding and surgery were treating the visible hemorrhoids. Not one of them had touched what was doing this to my entire anorectal system. The underlying collagen loss. I am a colorectal surgeon. I am supposed to be the person who knows how to prevent this. I had performed the same three-intervention protocol on hundreds of patients who looked like my father. Every one of those interventions had passed peer review. Every one had followed the guidelines. Every one had been the standard of care. And it had failed me at 60. I sat at my desk that night at 11 PM after my wife had gone to bed and I did something I had not done since medical school. I opened PubMed and I searched for the actual mechanism. Not the surgical management guidelines. Not the post-op protocols. The mechanism. I read for five hours. I found what my training had covered lightly and never in the depth it deserved. Type I and Type III collagen degradation in the anal cushion. Fibroblast senescence in perianal tissue after 40. Progressive loss of elastic recoil in the vascular cushions of the anorectal junction. The mechanistic explanation for why the interventions I had been performing for twenty-eight years were treating downstream events without addressing the upstream tissue failure that was driving all of them. None of this was hidden. It sat in journals I had had access to for twenty-eight years. Diseases of the Colon and Rectum. Journal of Gastroenterology. The American Journal of Surgery. I had read those journals every month. I had read them for the surgical technique papers. I had never read them for the tissue biology papers because my training had told me the tissue was managed by lifestyle and the treatment was to address the visible pathology. My training was wrong. I closed my laptop at 4 AM. I sat at my kitchen table. I could not sleep. I understood at that moment that I had performed the same procedure that failed me on nearly 3,000 other people. And every one of them was walking around with the same collapsing rectal cushion, waiting for their May 22nd to arrive. Three weeks later I saw a patient in follow-up who should not have been in the state she was in. Her name was Rosa. She had come to me two years earlier for consultation on chronic Grade II hemorrhoids with recurrent bleeding. I had recommended banding. She had refused. She had come to me for annual follow-ups since then, and I had documented what I expected to see: slow progression to Grade III, eventual surgical requirement. I pulled her chart before she came in expecting to recommend the banding again. Her Grade II had regressed to Grade I. The bleeding episodes had stopped fifteen months earlier. The external tags I had noted the year before had spontaneously resolved. Her anoscopy showed the anal cushion had returned to baseline structural integrity. In twenty-eight years of practice, I had never documented spontaneous regression of Grade II hemorrhoids to Grade I with cushion restoration. It does not happen. The medical literature does not describe it happening. I looked at her across the exam room and asked her what she was doing. She was quiet for a moment. Then she said, "Doctor, my abuela Elena has been telling me since I was diagnosed. She grows medicinal plants in her yard in San Antonio. I did not bring it up because I did not think you would take it seriously." I asked her what her abuela had told her. She wrote a name and an address on the back of my prescription pad. Doña Elena Vargas. A neighborhood in San Antonio, Texas, I had never heard of. A house with a garden of plants her grandmother had brought from Oaxaca eighty years ago. I flew to San Antonio the following weekend. I did not tell my wife where I was going. I did not tell my partners. I did not tell anyone in my institution that a board-certified colorectal surgeon was flying to Texas to meet an 82-year-old Oaxacan grandmother because everything I had been taught in twenty-eight years of practice had not saved me. I pulled into the driveway of a small stucco house at 10:45 AM on a Saturday. The garden along the front walkway was unlike anything I had seen outside of a botanical ethnobotany exhibit. Cacao seedlings in ceramic pots. Yerba santa. Toloache. Copal trees on either side of the front door. Plants I recognized from the botanical section of surgical journals I had not opened since medical school. She was on the porch grinding cacao beans in a stone metate. Small woman. Thin. Early eighties. Silver hair pulled back. Wearing a dark red rebozo despite the Texas heat. No swollen joints. No brace on her hands. Just easy, steady grinding. I introduced myself. Not as a surgeon. As Michael. She looked up with sharp black eyes and asked me why I had come. I told her. I told her I was a colorectal surgeon. Twenty-eight years in practice. That I had my own emergency surgery seven weeks earlier. That my protocol had not saved me. That my entire anorectal system was showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her. She listened. She did not interrupt. When I finished she set the metate down and said, "Come inside, doctor." Her kitchen smelled like cacao and canela. She poured me hot cacao without asking. Not chocolate. Not cocoa powder from a can. Raw ceremonial cacao ground fresh from the metate outside, whisked into hot water with cinnamon and a touch of raw honey. She sat across from me and said, "Your medicine is treating the wrong tissue. You know this. That is why you are sitting at my kitchen table." I did know it. She said, "Every cream you prescribed. Every band you placed. Every surgery you performed. All of them work on what has already collapsed. That is all. The collagen underneath, the tissue that was supposed to hold everything up, none of them touch it." I said, "I understand the mechanism. I read the papers last week." She smiled. "Then you understand it in journal papers. You do not yet understand it in your own body." She picked up five cacao beans from a wooden bowl. She set them on the table in front of me in a small pattern. "This one is your sphincter. This one is your skin. This one is your cushion. This one is your veins. This one is your rectum." She tapped each bean. "Same collagen loss. Grinding through all five since you turned 40. Every one of your specialists has told you they are treating five different problems. It is one problem. You already know this. But you have been trained for twenty-eight years to treat each of them separately." I nodded. I could not speak. She said, "The creams calm the flare. The stool softeners ease the pressure. The banding removes what has already prolapsed. The surgery cuts out what has already thrombosed. Below all four, the collagen has been degrading since you were 40. Year after year. Every meal. Every bowel movement. Every long hour standing in your OR." She leaned forward. "The surgeon who operated on you did not repair the cushion. She removed what had already failed. If the collagen is not addressed, you will be back on that table within three years for another thrombosis, another band, another cushion collapse. This is not opinion. This is the mechanism you already understand." I said, "I know." She said, "Now here is what nobody taught you in medical school. For over three thousand years the women in my grandmother's village have been using one thing for this. My grandmother grew it. Her grandmother before her. I am 82. I have never had hemorrhoids. My mother lived to 96 without them. My daughters do not have them." She stood. She walked to a shelf. She pulled down a dark clay jar. Inside were dried cacao beans, deep brown, still in their fermented husks. "Real Criollo cacao," she said. "Theobroma cacao criollo. Not what your patients are buying in the supermarket. What is sold as chocolate at the store is forastero. A different variety. Cheaper. From West African plantations. It contains almost none of the active compounds. It contains up to eighty percent less procyanidins, which are the compounds that repair the collagen." She set the jar down. "Real Criollo cacao has two compounds your body needs. The first is called procyanidin B2. This is what signals the fibroblasts your training tells you cannot be reactivated. Once the fibroblasts wake up, they begin producing new collagen in the tissue where you need it. The degradation stops. The cushion begins to rebuild." She held up the jar. "The second is called epicatechin. The compound that gives cacao its bitterness. It repairs the vascular walls of the small vessels inside the cushion that have been weakened for years. The vessels that carry blood to your anal cushion. The ones that dilate and bulge every time you strain even slightly. The tissues your former fellow excised seven weeks ago." She looked at me. "Two compounds. From one plant. One reactivates the fibroblasts. The other heals the vessels that have been damaged while the fibroblasts were dormant. That is why the women in my grandmother's village do not have hemorrhoids like yours." I asked her if the form mattered. She nodded. "Real Criollo has to be at the right variety, at the right dose, protected by the right delivery. Forastero does nothing. Even Criollo at the supermarket is processed at high heat, which destroys most of the active compounds. In Oaxaca we grind it cold on the metate. My grandmother did not know the biochemistry. She knew that the cold-ground cacao was medicine. That is why our women live into their nineties without prolapse." She paused. "There is a company my niece in Austin told me about. They source the real variety. DNA-verified Criollo from small farms in Oaxaca and Chiapas. They cold-process it to preserve the procyanidins. They combine it with soft psyllium mucilage, which coats the tissue while the rebuild is happening. So the collagen you are producing actually holds instead of getting stripped again with every bowel movement. Two capsules a day. For 150 days. Then you stop." She wrote a name on the back of a napkin and slid it across the table. Venalys. I ordered three bottles from her kitchen table before I left San Antonio. I flew home the next morning. I did not tell my wife where I had been. The bottles arrived the following Tuesday. I took 2 capsules with my breakfast the next morning. Week two. The flare-adjacent tightness I had been living with since the surgery began to ease. I had been sleeping with a cushion between my legs since the operation because any pressure would wake me. That week I slept without the cushion for the first time. Week four. I ran a home anoscopy check with a mirror. The residual internal cushion looked less inflamed. The color had shifted from dark red to a lighter pink. I documented it in my personal notes. Week six. I noticed I had not used any topical cream in three weeks. Before the surgery, I had been using topical hydrocortisone twice a week during flare cycles. After the surgery, I had used it daily for the first month. Now I had not touched it for 21 days. Week eight. I ran a formal anoscopy at my own office with one of my partners. He documented that the residual internal cushion showed signs of tissue remodeling toward baseline structure. He asked me what I was doing. I told him I would tell him later. Week twelve. Full pelvic manometry testing. The internal sphincter tone had improved by 22 percent from my post-op baseline. The elastic recoil of the perianal tissue was measurably higher. The bleeding episodes I had experienced monthly for eight years had stopped. My chair anxiety score, which I had been informally tracking on a 1-10 scale, had dropped from a 7 to a 2. Week eighteen. Second formal anoscopy. The internal cushion had returned to baseline Grade I structural integrity. The perianal skin fragility had visibly reduced. The external tags that had been prone to thrombosis before the surgery had not reappeared. Week twenty-one. Day 150. Final follow-up manometry and full anorectal imaging. The sphincter tone was at 96 percent of expected baseline for a 60-year-old male with no history of hemorrhoids. The cushion structural integrity was documented as "restored to pre-pathology baseline" by the imaging specialist. I asked him if he was sure. He was sure. I stopped taking Venalys that day, as Doña Elena had instructed. That was seven months ago. I have not had a single flare since I stopped. No topical creams. No cushions. No modifications. I sit through cases in the OR for four hours at a stretch without needing to shift. My wife noticed before I did. I brought the imaging to my practice partner. Another colorectal surgeon. Nineteen years of practice. Someone I had trained. I put the pre-treatment imaging next to the post-treatment imaging on his desk and I did not say anything. He read them. He looked at me. "Michael. What did you do." I told him. The Oaxacan grandmother. The kitchen table. The two compounds. The collagen. The cushion. All of it. He listened for forty minutes without interrupting. When I finished he was quiet for a long time. Then he said, "I have not been trained on this. But I want to see this in my own patients. Tell me the name of the product." I gave it to him. He has been running it with sixteen of his post-op hemorrhoidectomy patients for the last four months. He called me last week. Eleven of them have documented tissue remodeling on follow-up anoscopy. Four have come off all topical therapies. Two have canceled scheduled follow-up bandings because their internal grades have regressed. I am now on nothing for hemorrhoids. Zero medications. Zero creams. Zero cushions. I ate a full dinner sitting on a wooden chair last Sunday for the first time in eight years. My wife did not need to bring the cushion. I came within a few inches of standing in a similar position as my father before he stopped traveling. If I had continued the same protocol, in five years I would have been the man who canceled the family trip to Italy. Instead, I am the man who booked it for next spring. I am writing this because I still have my practice. I still have my wife. And I have watched every single sign of tissue degradation in my anorectal system reverse. I have watched a colleague I trained look at my imaging and say the word I had waited eleven months to hear. Rebuilding. Not managing. Rebuilding. I am also writing this because I know the truth about what my profession is doing. I did not sit at that grandmother's kitchen table because I wanted to. I sat there because everything my medical school and my board certification and my twenty-eight years of practice had taught me about how to treat this condition had failed me. I performed 2,847 hemorrhoidectomies before I had one performed on myself. Every one of those patients was walking the same trajectory I was walking. Every one of them left my OR with the same recovery protocol I was on. Every one of them was told they were "managing well." I do not know how many of them are already back on the table. I do not know how many of them are already living my father's last decade. I know that the standard of care my hospital taught me was built on the assumption that treating four downstream symptoms with four separate interventions was equivalent to addressing the collagen loss driving all four. It is not. I have four organs' worth of scan reports in my own body that prove it is not. And my father's fifteen years of decline prove it was not for him either. If your husband, your father, your brother, your mother, or you have been living with hemorrhoids for more than a year and you have been told you are "managing well" while your rectal cushion is quietly collapsing, please listen to what I am telling you. The collagen loss is what is doing this to you. Not the flare on any given day. Preparation H and every other topical cream calms the flare. It does not stop the collagen degradation. It does not reactivate the fibroblasts. It does not repair the damage the collagen loss has already done to your sphincter, your skin, your veins, your cushion, and your rectum. Hem Hero and every vein-support supplement work on the vessels while the collagen is still failing. You stop taking them, the hemorrhoids come back. Every time. Because vein support is not tissue rebuilding. The vessels can be strengthened all you want. If the collagen holding the cushion together continues to degrade, the vessels will bulge again the next month. Fiber does not save you. Stool softeners do not save you. Sitz baths do not save you. All of them address downstream pressure. None of them touch the collagen. There is one thing I know of that reactivates the fibroblasts and repairs the vascular walls. The two compounds in real Criollo cacao. Procyanidin B2 reactivates the fibroblasts. Epicatechin repairs the vessels. Together, at the right dose, in the right delivery form, protected by soft psyllium mucilage while the tissue rebuilds, they address what my three-intervention protocol did not touch. Venalys. DNA-verified true Criollo cacao from Oaxaca and Chiapas. Cold-processed to preserve the procyanidins. Combined with soft psyllium mucilage to protect the tissue during the 150-day rebuild. Third-party tested. Made in the USA. 2 capsules every morning with breakfast. For 150 days. Then you stop. 12 month Freedom Guarantee. If your hemorrhoids come back within 12 months of finishing the protocol, you get every dollar back. The system that trained me did not give this to me when I needed it. It is reaching you now. P.S. My father lived with chronic hemorrhoids for the last fifteen years of his life. He canceled every family trip that required more than three hours in a car. He never had surgery. He never had the emergency I had. But he lost the last decade of his life to the same slow tissue collapse that would have taken mine if I had continued the same protocol. Please do not let your family's decade be as small as his was. P.P.S. I do not work for Venalys. I do not receive a penny from this. I am writing this at 10:45 PM on a Sunday, alone in my office, because a patient came in Thursday whose Grade III had regressed to Grade I in four months and I recognized my own imaging on her chart. She had found Venalys on her own after reading a post from a woman named Sandra about her husband Robert. She told me the post had been circulating among the retired teachers in her book club. I read it that night. It was the third time in six months I had recognized my own patient in a story written by a stranger. Please share this with anyone you love who has been living with hemorrhoids. Even mild. Even Grade I. Even if they think they are managing well. I promise you they are not. ~ Dr. Michael Harrington, MD, FACS, age 62, colorectal surgery
Not enough history yet to show a trend.