Most people return to their normal activities on the same day, but it may be wise to have someone drive you home after the procedure. Larger injected veins may get lumpy or hard for several months. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). Allergic reactions to the injected chemical may happen at the time of the injection and are rarely serious. AskMayoExpert. Usually, they dont need further treatment. Most people experience little or no pain with the shot. It's possible for the silver nitrate to burn some of the skin of the vulva when it's first used. Banding usually requires two or more procedures that take place about 2 months apart. Post-operative instructions anorectal surgery. Follow these guidelines: Antibiotics such as tetracycline or minocycline (Minocin or Dynacin) may make your skin stain if you take them seven to 10 days before or after sclerotherapy. The cause of venous disease varies but may be caused by one or more of the following factors: Follow prevention tips as recommended by your doctor. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Laser treatment, or endovenous thermal ablation, is another good alternative to ligation and stripping of varicose veins. The cyst can then be removed, destroyed using the laser, or left in place with a small hole to allow fluid to drain from it. One of the most common surgery related questions we get is what to expect after hemorrhoid surgery. Sclerotherapy means injecting a solution into the bleeding varices to control the bleeding. These include: Blood clot. Your healthcare provider will perform sclerotherapy in their office. While not a serious health risk, varicose veins can be eliminated for cosmetic reasons or if they cause discomfort. A hemorrhoidectomy usually results in more pain than sclerotherapy. Chicago Vein Institute is a practice solely dedicated to the diagnosis and treatment of vein diseases. Within the first year after diagnosis, 5% of small varices and 15% of large varices bleed. All rights reserved. Special elastic support stockings may be recommended by your doctor to prevent blood from pooling in the veins. Your doctor may recommend over-the-counter medication, such as Advil (ibuprofen). Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. You still need to allow your body to heal. Rarely, a blood clot may travel to a deeper vein in your leg (deep vein thrombosis). Chyle extravasation can result in delayed wound healing, Your doctor will examine you to identify the type of hemorrhoids you have and their grade or degree of severity, and determine the best course of treatment. A carbon dioxide laser can be used to create an opening in the skin of the vulva so the cyst can be drained. Also called rubber band ligation, this procedure involves using a tight band around the base of the hemorrhoid to cut off its blood supply. Once your hemorrhoids are removed, you will begin to feel better with each passing day. This site complies with the HONcode standard for trustworthy health information: verify here. Advertising on our site helps support our mission. A single copy of these materials may be reprinted for noncommercial personal use only. Sclerotherapy. You dont have to live in pain. Hemorrhoidopexy is sometimes referred to as stapling. The cyst is first opened withacutand the fluid is drained out. Getting up and walking around again as soon as possible following either of those events is also advised. https://www.radiologyinfo.org/en/info.cfm?pg=sclerotherapy. Itching is a normal sign of healing in a surgical incision or areas of scarring. Sclerotherapy is done at the doctors office. The severity of hemorrhoids is classified by grades as follows: These types of hemorrhoid surgery can be done in your doctors office without anesthesia. diet changes, such as eating foods high in fiber and staying hydrated, making lifestyle changes, working toward a healthier weight. Tiny blood vessels may develop in the treated area. This procedure is intended for treating internal hemorrhoids up to Grade 2. Hemorrhoids: Diagnosis and treatment options. In some instances, several sclerotherapy treatments may be needed. All rights reserved. You can use both medications and non-pharmaceutical treatments to help you in your recovery. Symptoms include itching and swelling. You can expect at least some pain and discomfort for one to four weeks after the procedure. Insurance companies dont provide coverage for sclerotherapy when its performed for cosmetic reasons. In some cases x-rays may be taken after a contrast medium is injected into the veins (venography) to highlight them. The redness where the needle went in should go away within a few days. These may include general signs such as a fever, or more specific signs such as the presence of pus. Foam tends to cover more surface area than liquid. Find more COVID-19 testing locations on Maryland.gov. By Jennifer Whitlock, RN, MSN, FN If youve had a blood clot in the past, you may be able to have sclerotherapy, depending on what caused the clot and how serious it was. Over a period of a few weeks, the blood vessel turns into scar tissue and then fades from the surface of the skin. You can learn more about how we ensure our content is accurate and current by reading our. Jennifer Schwartz, MD, is a board-certified surgeon and Assistant Professor of Surgery at the Yale School of Medicine. The terms "hemorrhoids" and "rectal varices" are often used interchangeably, but theyre separate conditions with different causes and treatments. Once the anesthesia takes effect, your surgeon will cut out the large hemorrhoids. Some patients have short-term fecal incontinence during recovery. Some procedures are more painful than others. Other office procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. 2023 Chicago Vein Institute. Last medically reviewed on October 27, 2021. Its not painful, but you may feel pressure or mild discomfort. How much water you should actually drink isnt as simple as youd think. Inject a liquid or foam solution directly into your blood vessel, using very fine needles. Sclerotherapy. The scope allows the doctor to see. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Mayo Clinic's Center for Aesthetic Medicine and Surgery is now open in Rochester. A small amount of blood is not unusual. Scarring occurs in the blood vessels, stopping blood from flowing through them. Most hemorrhoidal flare-ups stop hurting within 2 weeks without treatment. However, about 5% of the time, they can be permanent. Youll most likely see your healthcare provider for a follow-up visit a month or two after sclerotherapy treatment. Evaluating the safety, efficacy and complications of electrotherapy and its comparison with conventional method of hemorrhoidectomy. Radiofrequency is a treatment to solve skin laxity, with an effect similar to lifting without surgery. You may also have pain with urination. Coagulation therapy is also called infrared photocoagulation. Bright Red Blood in Stool: Should I Worry? 1-2 weeks should be spent at home relaxing as much as possible. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Kang S, et al., eds. This closes off your vein, making it look and feel better. Chronic obstruction of the veins can also cause varicose veins, but in most cases no underlying abnormality can be identified. Should you require surgery with anesthesia, there are medications and non-pharmaceutical things you can do help speed up your recovery. A diet high in fiber will soften your stool. Its targeted to avoid damaging the surrounding tissues, skin surface, and adjacent organs. This in-office treatment works well for many people, especially on smaller varicose veins. When the operation is over, youll be taken to a recovery room for a brief period of observation. After your treatment, your provider may ask you to keep lying down for 15 minutes or so to make sure you dont have a bad reaction to the injected material. It may be wise to limit the use of opioids to avoid the risk of addiction. Possible complications of balloon catheter insertion include: If a cyst orabscess keeps coming back, a surgical procedure known as marsupialisation may be used. Thank you, {{form.email}}, for signing up. If the cyst is painful, a GP may recommend: Always read the manufacturer's instructions when using medicine you buy from a pharmacy or supermarket. We are #1 Voted in Vein and Pain Treatment Center New York, New Jersey, San Diego, and Houston, TX. Are pregnant. Doctors at Johns Hopkins recommend the following for treating varicose veins: Surgical options for treating varicose veins include the following: Non-surgical care for thrombophlebitis may include: At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Vascular Surgery and Endovascular Therapy. Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. Doctors can usually diagnose superficial thrombophlebitis based on your medical history and a physical examination. Depending on which veins are involved, your doctor may request ultrasound imaging on the veins in your legs. Once the needle is withdrawn, your doctor applies compression and massages the area to keep blood out of the injected vessel and disperse the solution. Before starting, your provider may try a test injection and wait a bit to make sure you dont have a reaction to it. This will usually be removed before you go home. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid. These procedures involve puncturing the cyst and draining the contents, or injecting the cyst with an agent that causes it to heal. It also looks at some potential complications and the steps you can take to speed your recovery and lessen pain. Soaking the rectal area in a sitz bath can provide significant pain relief. Chapter 249. Avoid activities that cause pain. A sitz bath involves soaking the anal area in a few inches of warm salt water several times a day for about 1015 minutes each time. Talk to your doctor if you have incontinence that does not improve in the weeks following surgery. Sclerotherapy involves injecting a solution directly into the vein. This procedure is referred to as a. This may include eating a high-fiber diet and drinking lots of water. Healthline Media does not provide medical advice, diagnosis, or treatment. Sclerotherapy is a minimally invasive treatment for varicose veins and spider veins. Your doctor will want to know your medical history, including asking about any: If you take aspirin, ibuprofen, naproxen sodium or blood thinners, your doctor may instruct you on how to stop taking the medication for a certain amount of time before the procedure, to reduce the chances of bleeding. This usually resolves during the recovery time. Varicose veins are twisted, swollen veins near the surface of the skin and occur when weak or defective valves allow blood to flow backward or stagnate within the vein. MedlinePlus. This may be full anasthesia, sedation, or a spinal block, which is similar to an epidural injection during birth and can allow you to stay awake. Although complications after marsupialisation are rare, they can include: After marsupialisation,you'll be advised to take things easy for a few days. We also offer Pain Management for It depends on the procedure you opt for, but you can generally expect to be recovering for 2-3 weeks. Infection is a risk after hemorrhoid treatment. Fecal incontinence is when stool leaks from the rectum. Undergo sclerotherapy. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Dallas NA, eds. Cleveland Clinic is a non-profit academic medical center. It is also important to drink plenty of water while you are recovering. Content is reviewed before publication and upon substantial updates. If you have a lump in the opening of your vagina, get itchecked by a GP. Usually appearing in the legs, varicose veins may also occur in the anus, where they are known as hemorrhoids. is the final procedure that can be used to alleviate hemorrhoids. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. The sclerotherapy solution causes the vein to scar, forcing blood to reroute through healthier veins. Dont put any lotion on your legs before or after sclerotherapy. It may produce less-pronounced symptoms at first (half of all cases are asymptomatic) but carries the risks of pulmonary embolism (when the clot detaches from its place of origin and travels to the lung) and chronic venous insufficiency (impaired outflow of blood through the veins), resulting in dermatitis, increased skin pigmentation and swelling. Damaged vein walls hinder the circulatory system, allowing blood to collect and flow in a retrograde (backward) fashion when the muscles relax. Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy. Your Chicago Hemorrhoid Treatment follow up visit, You dont have to live in pain. No matter which treatment you have, it is normal to have pain with a bowel movement in the week after surgery. You'll also want to avoid sun exposure to the treated areas during that time. Sclerotherapy takes longer than surgery for varicose veins or spider veins. A small, solid stick of silver nitrate is used in silver nitrate gland ablation. If you were treated for small varicose veins or spider veins, you can usually expect to see definitive results in three to six weeks. Weiss RA, Weiss MA. Whats the Difference Between Hemorrhoids and Rectal Varices? Treatment of hemorrhoids. Report these to your doctor so you can get the right treatment. Accessed Feb. 2, 2021. Over-the-counter pain medication and a sitz bath can help relieve pain. Portal hypertension is a complication of cirrhosis. A laxative promotes bowel movements, either by increasing the bulk of stool or stimulating the bowel. Generally, you need to wait about six weeks before undergoing another sclerotherapy session. Elevated feet. If you buy through links on this page, we may earn a small commission. 2005-2022 Healthline Media a Red Ventures Company. abscess, which is a painful collection of pus that typically results from a bacterial infection, sepsis, which is blood poisoning and is life threatening, peritonitis, which is inflammation of the tissue that lines your abdomen, anal stenosis, which causes the anal canal to narrow and makes it harder to have a bowel movement, constipation (often due to prolonged use of medications). You can expect to feel fully recovered with no pain at all after. Sometimes a foam version of the solution may be used, particularly when a larger vein is involved. Pain and infection are the most common risks associated with this type of surgery. Prescription pain medication may be helpful for severe pain. Varicose veins (adult). Full length article. Hemorrhoid surgery recovery is no different. Avoid direct exposure to sunlight (including sun tanning and tanning beds). To become a dermatologist, doctors must complete: Four years of college. Accessed Feb. 2, 2021. You may go back to your regular activities, especially walking. 2013;15(6):719-26. doi:10.1111/codi.12090, Kunitake H, Poylin V. Complications following anorectal surgery. A hemorrhoidectomy of multiple very large hemorrhoids may result in significant pain. A cut is made in the abscess or cyst and the fluid is drained. The chemical causes the hemorrhoid to shrink and stops it from bleeding. Dont stay in a hot tub for too long. Walking is good for your recovery, so dont be surprised if your healthcare provider recommends it. You may take acetaminophen if you need it for pain relief. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. doi:10.3748/wjg.v20.i45.16976. Others require hospitalization and anesthesia, and will require post-operative recovery. Sclerotherapy, a less invasive treatment that involves injecting the area around the hemorrhoids with a chemical solution to close off the veins; You should make arrangements for someone to drive you home from surgery and in the days after, while you still have pain. Remember that prescribed pain medications may cause constipation. This can also cause problems after your procedure. Accessed 6/12/2022. doi:10.3748/wjg.v21.i31.9245, Yeo D, Tan KY. Hemorrhoidectomy - making sense of the surgical options. One of the most common surgery related questions we get is what to expect after hemorrhoid surgery. The answer often depends on what type of procedure you had. World J Gastroenterol. Cosmetic purposes to improve the appearance of varicose and spider veins, Darkened skin in the form of lines or spots, Check for any underlying blood vessel disease, Recent illnesses or existing medical conditions, such as a heart condition or a past history of blood clots, Medications or supplements you take, especially aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox Ds), blood thinners, iron supplements or herbal supplements, Previous treatment for varicose veins and the results of the treatment. Even a simple 15-minute walk can help. Recovery from hemorrhoid treatment or surgery typically lasts one to six weeks. It involves injecting a chemical into the hemorrhoid. You should avoid heavy lifting and heavy pushing during bowel movements. To help the wound heal and reduce the risk of infection after surgery, you may be advised to avoid: Surgical options for treating varicose veins include the following: Sclerotherapy is an option for superficial varicose veins. In this post, we will go over some of the procedures available to remedy hemorrhoid problems and describe what you can expect after your hemorrhoid surgery. External hemorrhoids often itch. Week 2. Complications are rare. The collapsed vein is reabsorbed into local tissue and eventually fades. You should wear support hosiery or compression wraps for three to seven days to compress the treated vessels. This chemical solution irritates your blood vessel lining, making it expand, stick together and form a scar. Sclerotherapy tends to have the best success rates for small, internal hemorrhoids. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Surgeries for hemorrhoids can be divided into simpler, outpatient, and less invasive procedures you can do without anesthesia and more complex, inpatient surgeries. Some bleeding is not uncommon just after your procedure. You should avoid heavy lifting and heavy pushing during bowel movements. Your doctor may recommend a special diet. Mott T, et al. This is left in the cyst cavity for 5 minutes and then drained out. After 1-2 weeks, you should be able to return to your normal daily activities, but you still should not participate in activities that require a lot of effort. Hemorrhoid surgery recovery times and requirements vary depending on several factors. Youll have to wait at least three months after delivery before you can have sclerotherapy. Our website services, content, and products are for informational purposes only. This restricts blood flow, causing the hemorrhoid to shrivel up and fall off after around 3 to 10 days. When the procedure is complete, the treated area may be loosely packed with gauze to soak up fluid from the wound and stop any bleeding. Exercise can decrease constipation. Theyll select the appropriate chemical and concentration of it based on the size of the vein theyre treating. Avoid tight fighting clothing. This can lead to a shorter recovery period, but is a relatively new procedure and needs to be discussed with your physician and surgeon. Treatment of varicose veins and telangiectatic lower-extremity vessels. A doctor may suggest an aspiration or sclerotherapy. A compression pad may be taped onto the injection site to keep the area compressed while your doctor moves on to the next vein. doi:10.4240/wjgs.v8.i9.614, Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist's view. Opioids can also interfere with your ability to have a bowel movement after surgery, so ask your doctor how soon you can stop them to prevent this side effect. A doctor injects a chemical into small- and medium-size varicose veins, which scars and closes them. Also, at all times, its best to avoid long periods of standing. Surgery to remove the affected Bartholin's gland may be recommended if other treatments have not been effective and Bartholin's cysts or abscesses keep coming back. Veins that respond to treatment generally don't come back, but new veins may appear. After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take a month or more to see the full results. Medication. You should make arrangements for someone to drive you home from surgery and in the days after, while you still have pain. Sclerotherapy tends to be the spider vein treatment of choice. To avoid occasional flare-ups, try the following. Aetna covers 5 weight loss procedures, including the Gastric Sleeve, Gastric Bypass, Lap-Band, and Duodenal Switch, assuming your policy includes bariatric surgery. There are a number ofalternative ways of treating a Bartholin's cyst, but they'reless commonlyused or are not widely available. It is also effective for cellulite and fat deposits. This means the surface of the wound heals, but a drainage passage is leftin place. Aside from what you might think, staying active will be good for you during your recovery process. In larger veins, you may feel cramping for a minute or two during the injection. It generally takes less than an hour to complete. You will need to follow your surgeons instructions for taking care of your incisions and drains each day until they are removed anywhere from day 3 to 7. Tight-fitting clothes can constrict your legs, waist, or pelvic area. Four years of medical school. If youre having multiple treatments, you may have your next session two or three months after your first one. Learn more about the procedure and the risks, Are you experiencing the itching or painful sensation that comes along with having a hemorrhoid? Radiofrequency. However, alcohol acts as a blood thinner and will impact how effectively your blood can clot. If it turns out to be a Bartholin's cyst and it does not bother you, it's often better to leave it alone. Showering after vein ablation is fine, but you should avoid baths, swimming pools, and similar until the treated area has fully healed. Here, learn what it entails, and more. Hemorrhoidal artery ligation (HAL), also known as transanal hemorrhoidal dearterialization (THD), is another option to remove Grades 2 or 3 hemorrhoids. CVI offers minimally invasive treatment options, including Endovenous Laser Ablation (EVLA), Ambulatory Phlebectomy, Ultrasound-Guided Sclerotherapy, Surface Sclerotherapy, Elastic Compression Stockings and wound care for venous ulcers, performing more than 11,000 vein-related procedures annually. This article discusses recovery time after hemorrhoid surgery. You may take showers, but the water should be cooler than usual. This can cause serious problems, particularly if something does go wrong during your procedure. Itis sometimes combined with a procedure called alcohol sclerotherapy, wherethe cavity is filled with a 70% alcohol liquid after being drained. When it occurs in a vein near the surface of the skin, it is known as superficial thrombophlebitis, a minor disorder commonly identified by a red, tender vein. Youre experiencing severe pain in anal or abdominal areas. Recovery after hemorrhoid surgery depends on the type of procedure. They may itch, bleed, or cause pain. Some patients may have incontinence of small amounts of stool after a hemorrhoidectomy. This content does not have an English version. Pain may occur if the solution leaks from the vein into surrounding tissue. Continue to eat foods high in fiber even after you have recovered. However, thrombophlebitis can be much more serious, even life-threatening, affecting millions of people each year. To avoid excessive blood loss, its particularly important that your blood clots as it normally does. However, theres also evidence of an increased rate of hemorrhoid and prolapse recurrence. Sclerotherapy results in few serious complications. Published online: December 2, 2022. Gastroenterol Hepatol Bed Bench. Kaiser Permanente. Seek immediate medical care if you experience difficulty breathing, chest pain or dizziness, or you cough up blood. Bruising where the injection happened can last several days or weeks. The goal of postoperative care is to minimize side effects and reduce the risk of complications. Treatment of Varicose Veins and Telangiectatic Lower-Extremity Vessels. To avoid worsening symptoms, dont delay seeking treatment. The procedure can also improve related symptoms such as: If you're pregnant or breast-feeding, doctors recommend waiting to have sclerotherapy done. Marsupialisation takes about 10 to 15 minutes and is usually performed as a day case procedure, so you will not have to stay in hospital overnight. Drink plenty of water and eat foods high in fiber. The sodium chloride irritates the lining of your blood vessel and cases it to swell up and stick together. After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take a month or more to see the full results. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone. Youll feel the needle pinch your skin, and possibly a mild burning feeling. The Johns Hopkins Vein Center provides advanced minimally-invasive procedures and treatments for a variety of vein disorders. Deep-vein thrombophlebitis (affecting the larger veins farther below the skins surface) is more serious. Not all of those people ever seek treatment and some find ways to live with or naturally remedy the pain. Radiological Society of North America. Ultrasound-Guided Sclerotherapy, Surface Sclerotherapy, Elastic Compression Stockings and wound care for venous ulcers, performing more than 11,000 vein-related procedures annually. Veins are thin-walled structures inside of which a set of valves keeps blood in the body flowing in one direction. If you have any of these rare side effects, contact your healthcare provider immediately: It doesnt take long to recover from sclerotherapy. Straining and pushing can make the pain much worse. Eventually, the vein will become scar tissue and disappear. Your healthcare provider uses a needle to inject a special solution into your varicose vein or spider vein. Deep-vein thrombophlebitis is associated with a number of different cancers. You can expect rectal and anal pain after having hemorrhoid surgery. When you follow up with your doctor, theyll probably recommend: These adjustments will reduce the likelihood of hemorrhoids recurring. Friedmann DP, Mishra V, Hsu JS. Generally, however, pain lasts for about 1 week after surgery. Dont apply hot compresses or any form of heat to the treated areas. Current Supplement October 2022 - Volume 117 - 10S. American Society of Colon and Rectal Surgeons (ASCRS), fascrs.org/patients/diseases-and-conditions/a-z/hemorrhoids-expanded-version, mainehealth.org/-/media/Maine-Medical-Partners/Files/Surgical-Care-Casco-Bay/Anorectal-Surgery.pdf, niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/treatmen, Everything You Need to Know About Hemorrhoid Banding, Hemorrhoids: Treatment, Recovery, and More, Everything You Should Know About Thrombosed Hemorrhoids, 6 Exercises to Treat (and Prevent) Hemorrhoids, How to Use Olive Oil for Constipation Relief. Some are outpatient, minimally invasive, and require no anesthetics. Since opioids are addictive and should be used temporarily, it may be best to begin with NSAIDs and Ativan, should you need it, and only use medications like oxycodone if absolutely necessary. What should you eat after hemorrhoid surgery? This procedure uses a scope and a probe to locate the arteries that are causing issues. This hinders the blood flow into these parts of your body, which can damage your veins. Hemorrhoids are swollen veins that can be internal, which means theyre inside the rectum, or external, which means theyre outside the rectum. Sclerotherapy effectively treats varicose and spider veins. (Don't shave or use lotion after the procedure until the injection site is healed either.) There are one million new cases of hemorrhoids each year in the United States alone. These can include walking, controlling weight, wearing low-heeled shoes and avoiding long periods of sitting or standing in one position. There are products available to assist that can make your bowel movements easier. (n.d.). Bouchard D, Abramowitz L, Castinel A, et al. Advertising revenue supports our not-for-profit mission. Varicose veins and spider veins. 2016;9(4):259267. Be sure to stand up and walk around often on long trips in airplanes or automobiles. Silver nitrate is a mixture of chemicals sometimes used to burn (cauterise) blood vessels to stop bleeding. 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