External Hemorrhoids

Hemorrhoids, whether external or internal, are very painful. They can come in different sizes and can be located around the rim of the anus, or inside the anal canal. They can cause a person to avoid social situations, as well as their daily activities. It can become difficult to walk or even sit for long periods of time. The good news is that they are treatable. They can be treated with natural home remedies, surgical procedures, and through ointments and hemorrhoid medication.

External hemroids are located outside of the anus and can look brown or red. They are just as painful as internal hemorrhoids, if not more. They can be rubbed against and irritated by clothing or sitting, and can stay inflamed for long periods of time. Your doctor can probably prescribe you some medication to reduce the inflammation of the hemorrhoids. The causes of external hemorrhoids are:

  • Heavy lifting
  • Pregnancy
  • Strain
  • Liver disease
  • Constipation
  • Diarrhea
  • Coughing
  • Sneezing
  • A low fiber diet
  • Vomiting
  • Obesity
  • Cirrhosis of the liver
  • Anal intercourse

There are more causes than listed, but obviously external hemorrhoids occur when there is applied stress and strain on the anal canal. Symptoms of external or internal hemorrhoids can be itchiness around the anus area, discomfort in the area, incomplete bowel movements, burning and bleeding.  It is important to speak with your doctor if you are experiencing any bleeding in the stool or seeing it on the toilet paper. It could be the reason for a different condition altogether so it is best to check it out.

There are external hemorrhoid treatment techniques to practice such as:

  • Ice can take away some of the pain of hemorrhoids as it will numb the area and help shrink the hemorrhoid.
  • Sitz baths come in very helpful when it comes to hemorrhoid pain. Try sitting in a bath of warm water a few times a day for comfort and pain reduction.
  • Witch Hazel is an excellent product that can cool the burning sensation you might be feeling. It is fantastic for bruises, wounds, cuts, sprains and other medical concerns.

There are also ways in which you can prevent yourself form having to go through the experience of external hemorrhoids such as:

  • Avoid heavy lifting as much as possible. Heavy lifting can cause an individual to develop internal or external hemorrhoids
  • Exercise every day. Whether it is ten minutes or three hours, start moving. A sedentary lifestyle can only make you more prone to hemorrhoids.
  • Eat right. Healthy eating and a daily diet of fiber, vegetables, fruits, and protein is great for your body and for your bowel movements.
  • Drink a lot of water to soften your stool and hydrate your body. Water is an excellent source that our bodies need a lot of. Don’t take it for granted!

Avoid drinking excessive amounts of caffeine or alcohol. They both have been linked to the development of external hemroids.

Internal Hemorrhoids

Internal hemorrhoids are known as a condition where the veins within the anal canal are put under pressure from strain and extensive blood flow, therefore, creating painful lumps of tissue. They cannot be seen from the outside and can also bleed just like external hemorrhoids. External hemorrhoids are found along the rim of the anus and are usually a bit different in color than internal hemorrhoids. Both conditions are painful and it can cause a person a lot of grief if left untreated. There are many causes for hemorrhoids such as lack of exercise, pregnancy, nutritional deficiencies, liver disease, strain, and heavy lifting.

The symptoms of hemorrhoids can be itchiness, bleeding, and burning. If you notice blood in your stool or on your toilet paper, chances are you might have internal hemorrhoids. Internal hemorrhoid treatment can be beneficial to getting rid of hemorrhoids. You can also prevent hemorrhoids by doing the following:

  • Drinking lots of water. This can keep your stool soft and allow easier passing of the stool. If the stool in the bowel gets hard it can cause constipation. Constipation is when you try to pass the stool, but cannot. It then can lead to a lot of strain and add to the development of hemorrhoids.
  • Eating a healthy diet of fruits and vegetables can help prevent someone from experiencing external or internal hemorrhoids. Proteins and fiber also very beneficial for a healthy bowel movement regimen.
  • Try using stool softeners to break up the stool within the bowel. This will help a great deal with preventing extra strain on the anal canal.

If you are dealing with internal hemorrhoids you can try taking a sitz bath. A sitz bath is when someone sits in a bath with warm water a few times a day. This may provide some relief. Another internal hemorrhoid treatment is by using an anascope. This is when the doctor inserts a device to see what state your internal hemorrhoids are in. They then use a device that lifts the top of the hemorrhoid so they can trim out the pressure inside. It is a quick procedure and people usually feel relief after a few days.

If you are concerned about the condition of hemorrhoids, it is a smart idea to consult with your doctor. They will be able to prescribe medications to you that will be able to treat the internal or external hemorrhoids.  Some treatments may include topical ointments and creams, or if the case is more serious they may recommend that you have a surgical procedure.  There are also a variety of home remedies one can use to treat hemorrhoids such as bathing in Epsom salts, Pomegranate peels drink, and coconut oil for pain relief. If you have constant pain you can also try ice to numb the area or apply Witch Hazel to the hemorrhoids for a cooling and healing sensation.

How Long do Hemorrhoids Last?

Hemorrhoids are known as a condition where the veins in the anal canal are put under pressure and strain, therefore, resulting in a painful lump of tissue that is either internal or external. People from all ages, race and sex can experience hemorrhoids and they can stop people from performing certain activities. People that have a sedentary lifestyle tend to get hemorrhoids more often than active people. If you work on a 9 to 5 job where you are sitting for approximately eight hours a day you can be more prone to this condition.

There are many causes for hemorrhoids such as heavy lifting, liver disease, excessive use of caffeine or alcohol, lack of nutrition, pregnancy and a low level of exercise. It is very important to exercise at least three times a week and approximately 25 to 30 minutes each time. If you keep a healthy diet of vegetables, fruits, fiber, and protein you can prevent hemorrhoids from forming. Constipation is also a cause of hemorrhoid development and this is because a person is constantly trying to pass stool and cannot, so they strain. By drinking a lot of water throughout the day, you can prevent the stool from getting hard and bulky. Stool softeners can also be of assistance in the prevention of constipation and hemorrhoids. They can break up the stool within the bowel and make it easier to pass.

You may be wondering how long do hemorrhoids last? It really depends on what type they are. There are external, and internal types, and there are also bleeding hemorrhoids. Bleeding hemorrhoids may take a little longer since they have been rubbed, opened and possibly scratched with wiping. It isn’t always comfortable to talk about hemorrhoids because of the location where they develop, but it is important to know what you are dealing with.

External hemorrhoids are found around the base of the anus and they look like lumps. Most often they appear to be a brown or red color. They will become irritated as they are touched or rubbed upon. It might be a good idea to wear loose fitting pants and underwear when experiencing these.

Internal hemorrhoids are swollen veins that are located inside the anal canal and not visible by the human eye. Sometimes when someone is straining to pass stool the internal veins might protrude outwards and this can be very painful.

The most common symptoms of hemorrhoids are:

  • Itchiness
  • Irritation and discomfort
  • Bleeding
  • Discharge of mucus
  • Inflammation and swelling

Getting back to the question of, ‘how long do hemorrhoids last’? They usually last for four to five days depending on the treatment that is given to them. If you treat them with ointments, Witch Hazel and with other healing substances, you might have more of a chance of getting rid of them faster. There are, however, quite a few people that suffer from more severe cases and have them for a few weeks. This is probably the best time to see a doctor as they can advise you on the best treatment for your individual case.

Hemroids Photos

Hemorrhoids are a common condition that can affect a variety of people from different cultures, sex and age. They can be very painful whether external or internal. Hemorrhoids occur when there is a lot of pressure in the anal canal vessels. Strain is the number one cause for hemorrhoids and can be produced through constipation, heavy lifting, pregnancy, poor nutrition, liver disease, and a lack of exercise. Symptoms of hemorrhoids can include itchiness, bleeding, burning, and a lot of pain. The pain can be caused when the hemorrhoids are rubbed either by wiping or when moving your body. Hemorrhoids are not something that is contagious and you cannot pick them up from being sexually active. If you have never seen a hemorrhoid, there are a variety of external hemorrhoid pics on the internet. You can also find photos of hemorrhoids in your local library. Be warned, hemroid photos are not pleasant to look at.

There are a variety of hemorrhoid prevention techniques such as:

  • Eating healthy by adding more vegetables, fruits, fiber and whole grains. Avoid eating a lot of dairy and flour based products as they can cause build up and constipation. Constipation can lead to straining, therefore, developing hemorrhoids.
  • Drink a lot of water. Drinking water can reduce build up of hard to pass stool in the bowel. It can soften the stool before you have a bowel movement, making it easier and less painful.
  • Exercise is very important. People that sit a lot tend to be more prone to developing hemorrhoids. If you are in a job environment that requires that you sit for almost 8 hours day, you should take little breaks to walk around.
  • Avoid lifting anything heavy. Heavy lifting is a great way to encourage hemorrhoid development.

If you are suffering from hemorrhoids then there are some ways you can decrease the pain and treat them such as:

  • Topical creams and ointments can be used. Talk to your pharmacist or doctor about which ones are the best to use.
  • Witch hazel is a fabulous liquid ointment to use and can be found in most pharmacies or natural health stores. It is used for burns, cuts, wounds, scrapes and a variety of other conditions. It does not sting like rubbing alcohol and it can provide a cooling sensation for your hemorrhoid pain.
  • Try having a sitz bath. A sitz bath is when someone sits in warm water a few times throughout the day. The water will relieve you of hemorrhoid pain.
  • Ice can be a great way to numb the areas and cool the burning down.
  • An anti-inflammatory can be used to decrease some of the discomfort. Your doctor might prescribe a specific one for you so you should plan to consult with them.

After you have seen hemroid photos on the internet or in the library, you will see how painful they look. They usually rise up in a lump and have a blue or greenish color. Some of them can be red because of bleeding. If you have concerns about the development of hemorrhoids talk to a health professional.

Hemorrhoid Banding

Hemorrhoids affect millions of people around the year and most likely everyone will experience them once in their lifetime. They can be experienced by any age group, sex, and culture. Hemorrhoids happen when there is a congestion of blood and pressure in the anal canal. The anal canal is very sensitive to pressure and can develop hemorrhoids whenever there is strain present. The causes of hemorrhoids are pregnancy, heavy lifting, stress, poor nutrition, lack of exercise, liver disease and constipation.  People who drink excessive amounts of alcohol or caffeine can also experience hemorrhoids.

The symptoms of hemorrhoids include bleeding, itchiness, pain, burning, and all around general discomfort. Bleeding hemorrhoids can be recognized when there is a presence of blood in the stool or on the tissue paper after wiping. Hemorrhoids are very common and there is no major cause for concern if you develop them. If you are worried it might be a good idea to check with your doctor. If the pain is unbearable or there is an enormous amount of bleeding it is advisable to speak with your general practitioner.

Many people undergo surgical procedures such as the Ferguson technique or the Miller-Morgan technique. The Ferguson technique is the procedure that involves making three incisions and taking out the vessels that cause hemorrhoids. The vessels are then closed with sutures. The Miller-Morgan procedure is almost the same as the Ferguson except it involves leaving the incisions open so stenosis is avoided.

There is also another procedure called Hemroid banding. Hemorrhoid banding is becoming increasingly popular when it comes to the treatment of hemorrhoids. Hemorrhoid banding is commonly used to treat swollen hemorrhoids that are extremely painful. This technique is usually used to treat extremely painful hemorrhoids, thrombosed hemorrhoids, and protruding hemorrhoids.

Hemorrhoid band treatment involves the insertion of an anascope into the anus. The doctor will take a look at the rectum and use a banding tool on the hemorrhoid. The tool applies a tiny rubber band around the hemorrhoid. This is so that the blood flow will be cut off and the hemorrhoid will wither away within one or two weeks. Sometimes a local anesthesia will be used to numb the surrounding area of the hemorrhoid. The procedure of banding hemorrhoids is quick and usually painless.

If you want to prevent having to have any hemorrhoid banding treatment try to eat properly and exercise daily. After the hemorrhoid banding is done you can try using a few post procedure methods to heal. These include taking sitz baths which is when someone sits in warm water a few times a day. If you are experiencing any pain after hemorrhoid banding then this will reduce it. You can also apply Witch Hazel which is great for healing all wounds. It is known for healing bruises, sprains, scratches, cuts, and burns.

Some other post-procedures tips are:

  • Apply all the medications and ointments prescribed by your doctor.
  • If you feel like you have to go to the bathroom, go immediately and do not post pone. If you post pone a bowel movement, it can cause the stool to become more bulky and hard which can lead to pain when passing stool.
  • Do not lift anything heavy for a few weeks to avoid inflaming the hemorrhoid again.
  • Exercise at least three times a week.

Use a stool softener so you can prevent pain when having a bowel movement.

Hemorrhoid Surgery

Hemorrhoids can be quite painful and are experienced by everyone around the world. It does not matter what age, race, or sex you are.  Hemorrhoids develop when the veins in the anal canal get congested. There are different classifications of hemorrhoids first degree, second degree, third degree and fourth degree hemorrhoids.

  • First degree hemorrhoids bleed but they do not show up externally.
  • Second degree hemorrhoids show up around the anal area when an individual is having a bowel movement. They then return back to the inside of the anal canal when the person is finished.
  • Third degree hemorrhoids need to be pushed back into the anal canal manually.
  • Fourth degree hemorrhoids show up externally and usually become thrombosed. These types of hemorrhoids cannot be pushed back in manually.

There are a variety of causes for hemorrhoids. Many people experience this condition because they are pregnant, obese, have liver disease, or they lack nutrition. The number one cause for hemorrhoids is strain. For example, if a person suffers from constipation they put a lot of strain on the anal canal when trying to pass stool and this can cause hemorrhoids to develop. Heavy lifting and stress can also cause them to develop.

The symptoms of hemorrhoids include bleeding, itchiness around the anus, general discomfort, and in some cases mucus discharge. Bleeding hemroids can be recognized if there is blood in the stool, or blood shows up on tissue paper after a bowel movement. Bleeding hemorroids can be even more painful than the regular ones because they are an open wound, and walking or sitting for long periods of time can be difficult for many people.

A large portion of people that suffer with painful hemorrhoids choose to have hemorrhoid surgery. Traditional surgeries include the Ferguson Technique and the Milligan-Morgan Technique. The Ferguson Technique was developed by Doctor Ferguson in the year of 1952. It is the process of removing the hemorrhoid vessels and then closing the incisions with disappearing sutures. The Milligan-Morgan technique was created by Doctors Morgan and Milligan in the United Kingdom. This is like the Ferguson technique but instead of closing the incisions with sutures, the wounds are left open to prevent stenosis. There can be bleeding after hemorrhoid surgery, but this can be treated with ointments, Witch Hazel and other over the counter medications and home remedies for hemorrhoids.

Most of the time people do not need to have hemorrhoid surgery because the hemorrhoids can be taken care of at home. The best way to prevent having this condition is to eat a lot of green leafy vegetables, fresh fruit, fiber, and drink a lot of water. By drinking water the stools will be much softer to pass and can lead to less pain when having a bowel movement. People who eat a lot of dairy and bulky carbohydrates can cause constipation to occur. If constipation occurs there is a chance hemorrhoids will develop, so it is better to avoid it all together.

Home Remedies for Hemorrhoids

There are a variety of home remedies for hemorrhoids. Hemorrhoids are varicose veins in the rectum and anal area that swell up when there is strain on the bowel. They are painful and can burn and itch. They can stretch and rupture, causing them to bleed. Usually people with this condition will see blood in their stool or on their tissue paper. Hemorrhoids are extremely common around the world and people from every walk of life experience them.

They can cause a lot of burning, bleeding, pain and itching. It can become very uncomfortable for someone to walk or sit for long periods of time. Most of the time, hemorrhoids are common with countries that have a strong economy and technology presence. Today, many of us sit up to eight hours a day in an office or home office. Leading a sedentary lifestyle can create all kinds of problems and hemorrhoids are one of them. Other causes include straining through constipation. This is because there is so much pressure applied onto the bowel and rectum when trying to pass any stool for relief. Constipation is when stool hardens and becomes blocked up in bowel. This can also be a painful experience for many.

Hemorrhoids can be internal or external. The external hemorrhoids can be felt and also unfortunately scratched when wiping. They will appear to be a blueish green type of lump in the skin. Internal hemorrhoids are usually painless, but there could still be bleeding that occurs.

There are many causes for the development of hemorrhoids such as obesity, excessive alcohol or caffeine, a poor diet, bodily stress, as mentioned before, strain. You can prevent the occurrence of hemorrhoids by eating a healthy diet of vegetables, fiber, and fruits. Drink a lot of water to soften stool so it is not painful to pass.

There are some fabulous home remedies for hemorrhoids and they are known as:

  • Witch Hazel. This liquid can be bought in most pharmacies and is a life saver. When applied, it can cool the hemorrhoids and reduce them in size. Witch Hazel is best known for cuts, scrapes, bruising and burning and helps get rid of pain fast.
  • Sitz Bath. This is when someone sits in warm water a few times a day. It can decrease pain and help to shrink the hemorrhoids.
  • Ice can be a great healer. It is greatly used to help with hemorrhoid pain and can cause the blood flow to slow in the veins.
  • Use Aloe Vera and apply it directly onto the hemorrhoids for a cooling sensation and burning relief.
  • Try mixing bayberry, goldenseal root, white oak and myrrh into a paste form and apply.
  • Try using warm tea and applying it to the area. This will also provide hemorrhoid relief.

If you are having immense pain and a large amount of bleeding, maybe it is a good idea to visit your doctor. A doctor can either prescribe you a medication such as an anti-inflammatory, or they can recommend other home remedies for hemorrhoids. Obviously, the best hemorrhoid home treatment is prevention which can be achieved with both exercise and a healthy diet.

Hemorrhoid Treatment

Hemorrhoids are very common and anyone can get them. They are experienced around the world by people of all ages and race. They are very uncomfortable and can cause a lot of pain when sitting for long periods of time, or when exercising or walking.  Hemorrhoids are experienced by men, women, and children, and they can be treated. There are a variety of hemorrhoids treatments out there on the medical market and you might want to speak with a pharmacist before you randomly pick one. They will most likely ask you what your symptoms are so they can provide you with the best treatment for hemorrhoids. There are many new hemorrhoid treatment to try and some of the best hemorrhoid treatment are natural and painless. The most painful hemorrhoids treatment is when a person undergoes a hemorrhoidectomy. This type of procedure can put someone out of commission for over four weeks and they can miss regular fun activities and work time.

A new hemorrhoid treatment is called PPH Stapled Hemorrhoidectomy. This kind of surgical procedure only takes up to 40 minutes and it is when the surgeon uses a circle shaped stapling device. The surgeon uses the shaping device to lift up the hemorrhoid tissue and then trim the tissue inside. This can help stop the blood flow to the hemorrhoid and it will eventually just shrink up and go away. This new hemorrhoid treatment is quick, painless and FDA approved. Many people are choosing it because they don’t want to suffer in the recovery process. Hemorrhoids are mostly the result of excessive strain on the rectum and anal area. When someone is constipated, they strain to have a bowel movement and this pushes the blood vessels to develop in size. Other causes for developing hemorrhoids include a poor daily diet, pregnancy, liver disease, obesity, stress, and excessive alcohol or caffeine.

People can prevent the condition of hemorrhoids by eating a regular diet of fresh vegetables and fruits, exercise at least three times a week, and lower their alcohol, caffeine and dairy intake.  The natural best hemorrhoid treatment are known as home remedies.

They include:

  • Sit’s baths. This is when you sit in a bath of warm water a few times a day. This can drastically reduce the pain and discomfort that is felt and can help the hemorrhoids to calm down and dissolve.
  • Water is nature’s source. Water can be taken at anytime of the day and it softens up the stool inside the bowel. This will make it much easier to pass stool.
  • Ice is also a great way to cool and numb hemorrhoids. It can ease the pain and reduce the inflammation in the hemorrhoids.
  • You can also use toilet wipes and apply some Witch Hazel. Witch Hazel is one of the best hemorrhoid treatment around as it cools the area and allows the hemorrhoid to shrink.

If you are seeing blood in the stool, or on the tissue paper when having a bowel movement, you should seek out a hemorrhoid treatment. It is advisable to consult with your doctor about these symptoms before you apply any over the counter product.

Hemorrhoid Symptoms

Hemorrhoids, also referred to as piles, can be difficult to experience. They are extremely common amongst men and women, and people can be of any age and culture. Hemorrhoids are usually more common in more advanced countries that have technology and economy on their side. This is primarily because people that deal with new age technology seem to sit more in the day. Whether they are sitting at a computer for up to 10 hours a day, or sitting in a conference or meeting, they are sedentary for that time period. Excessive sitting is a big problem where hemorrhoids are concerned and this includes sitting on the toilet.

Hemorrhoids are when people develop painful lumps from excessive strain on the rectum and anus. When there is strain present, the blood flows faster into the rectum and puts pressure upon the veins. This then results in the formation of hemorrhoids and it can be very uncomfortable to sit or walk for long periods of time. Hemorrhoids can come as just one, or in a pack. It depends on how much pressure has been applied.

Signs symptoms of hemroids can be blood on the tissue paper after passing stool, blood in the stool, itchiness around the anal area, burning, and general discomfort. They are treatable so there is no need to be worried. There are a variety of hemorrhoid creams and topical ointments on the market today. Your doctor can prescribe you medication after they examine the hemmorhoids, or you can ask the pharmacist about the best over the counter medication. Pharmacists are used to people having problems with hemorrhoids and there is no need to feel embarrassed. They might ask you your symptoms of hemroids just to clarify which ointment they should recommend. If the condition sounds severe and there is a lot of bleeding, or if the person is in too much pain, they might recommend that they see a doctor instead.

The symptoms of hemroids can develop at any time and they can show up overnight. Hemorrhoids are usually caused by constipation as there is a lot of straining when trying to have a bowel movement. They can also be caused by obesity, liver disease, pregnancy, a poor diet, a lack of exercise and a variety of other reasons. Stress can even cause a hemorrhoid to appear and this includes mental and physical stress. Sometimes the hemorrhoid symptoms are not felt as much as others and this might be because they are internal hemorrhoids. Both internal and external hemorrhoids can cause pain, but external ones might produce more blood when scratched or touched. Sometimes you can push a hemorrhoid back into the rectum and it might stop some of the discomfort while sitting.

When visiting a doctor about hemorrhoids you may be asked what the hemorrhoid symptoms are. They might even examine them to distinguish what the best medication would be for pain relief. Usually, pain can be decreased if the patient takes an anti-inflammatory and applies a topical cream. The doctor might even ask you if hemorrhoids are common in your family as they are hereditary and passed down. Don’t feel embarrassed and be as clear about your condition as possible. This will be your first step to getting rid of your hemorrhoids.

What Causes Hemorrhoids?

Hemorrhoids can be a painful situation for a large majority of people. There are two forms of hemorrhoids such as internal and external. External hemroids and internal hemorrhoids occur when there is excessive pressure in the veins that carry the blood flow through to the anus. There are a variety of hemroids causes such as pregnancy, liver disease, and constant straining when an individual is trying to have a bowel movement.

Hemorrhoids are very common amongst people all over the world and can affect both men and women of any age. Cause of hemorroids can vary, and constipated individuals have the highest risk of suffering from them. Hemorrhoids, also known as piles, can make a person feel extremely uncomfortable. When the anorectal veins become inflamed and enlarged hemorrhoid lumps begin to form, pain can start to develop.

There are some people that can be prone to weak veins and this might happen because it runs throughout the family line. Weak veins can be hereditary and passed down through generations.  People that have weight problems can be exposed to the condition of hemorrhoids and it is people who are usually obese that suffer the most. Loss of elasticity in body tissue as we age is also a cause of hemorroids. There are many hemroids causes to mention such as portal hypertension, heavy lifting, occupational lifestyle, sedentary lifestyle, and excessive use of alcohol, or caffeine.

People that experience hemorrhoids more than others usually live in a first world country where everything is advanced. Think about the amount of time people are sitting in front of a computer either at home or at their place of employment. A lack in activity and a poor diet can result in hemorrhoids, as well as when people sit on the toilet for long periods of time.  This is when the rectal muscles feel a lot of strain and the pelvic floor muscles begin to relax.

The best way to avoid hemorrhoids all together is to maintain a proper weight for your height and body frame, eat a lot of protein, fresh fruits and vegetables, and try to fit exercise into your day. Exercise can be anything from a jog to cleaning the house.  It is also important to take vitamin supplements if you find you are not getting enough fiber in your diet. Constipation can cause a lot of pain and put large amounts of pressure on the rectum and anus.

If any of these hemroids causes apply to you then talk to your doctor about what is the right topical cream or ointment to use. In some cases doctors might prescribe a medication or anti-inflammatory for the pain of the hemorrhoids. An anti-inflammatory will bring down the swelling and provide the individual with more comfort when walking or sitting. If you find that your hemorrhoids are bleeding profusely, try using some Witch Hazel. Witch Hazel can offer a cooling sensation and it heals minor cuts, bruises and wounds. It can be found in pharmacies and some grocery store pharmacies.