Bob VogelQ. I am a T8 complete para, 12 years post-injury. Lately I’ve been noticing some bleeding when I do my bowel program. Other wheelers I hang out with say it is probably hemorrhoids. This has me worried. A friend’s hemorrhoids got so bad he needed to have them surgically removed and it took over two weeks of bed rest to recover.

What are hemorrhoids? Are they more common in people with SCI? Can they be prevented or managed to avoid surgery?

— Steve

A. Steve, hemorrhoids are swelling of veins in the rectum and around the anus. When they swell too much, they lose their elasticity and bulge out in sac-like protrusions. Unfortunately hemorrhoids are extremely common in people with SCI, and the longer you have been injured, the more likely you are to get them. Clinicians I spoke with say that in people with SCI, the main cause seems to be chronic minor irritation or trauma that happens during a bowel program.

Although a major sign of hemorrhoids in people with SCI is bleeding during a bowel program, never assume that this is the cause. It is extremely important to notify your doctor of any new or unexplained rectal bleeding and get an exam to identify the cause. It could be a symptom of a more serious condition, including cancer.

Although SCI and neurogenic bowel management make it more likely to develop hemorrhoids, there are options that may reduce your chances of developin