Hemorrhoids

Hemorrhoids are a condition in which veins in the rectal or anal area become swollen and painful and may bleed. Hemorrhoids may occur inside the entrance to the anus (interior hemorrhoids) or outside the entrance to the anus (exterior hemorrhoids). A blot clot (thrombosis) may form in the vein making the hemorrhoid more painful and sometimes requiring treatment.

Signs and Symptoms

• Constipation
• Straining while defecating
• Discomfort itching pain
• Tender swollen lumps in rectum
• Bleeding
• Sensation of fullness
• Mucus in stool

What Causes It?

Hemorrhoids are a type of varicose veins that simply occur with age. Being constipated or passing large hard stools may contribute to the formation of hemorrhoids. In most cases however there is no obvious cause. In addition to age and constipation other contributing factors include the following.

• Family history of hemorrhoids
• Certain medical conditions
• Pregnancy
• Sitting for prolonged periods of time
• Diet low in fiber or fluids

What to Expect at Your Provider's Office

Your provider will do an examination. If you have had significant bleeding or other symptoms your provider may perform a procedure called sigmoidoscopy or colonoscopy. In this procedure a small instrument is inserted into the rectum for inspection of tissues to check for other diseases.

Treatment Options

Treatment Plan

Medications can relieve pain and discomfort while your hemorrhoids are healing. Sit on an inflatable pillow to prevent direct pressure. Avoid straining during bowel movements. Stool softeners and high-fiber foods help reduce straining. Limit the amount of time sitting on the toilet. Take warm baths with soapy water or Epsom salts two to three times daily for 15 to 20 minutes.

Drug Therapies

Prescription

• Stool softeners—prevent hard stools and thus reduce straining; side effects include nausea cramps diarrhea
• Topical anesthetics—to relieve pain and discomfort; some people have an allergic reaction to these ointments
• Pain relievers—taken by mouth for severe pain of swollen hemorrhoids; side effects include addiction dizziness drowsiness nausea vomiting constipation

Over the Counter

• Bulk laxatives—prevent hard stools and thus reduce straining; for example psyllium (Metamucil); side effects include nausea vomiting diarrhea
• Rectal preparations—relieve itching and discomfort; side effects include local irritation burning blistering

Complementary and Alternative Therapies

Nutrition

• Eat in a relaxed atmosphere breathing and chewing food thoroughly.
• Eat smaller more frequent meals and avoid overeating at one sitting.
• Eliminate refined foods sugars caffeine alcohol and dairy products.
• Decrease saturated fats (animal products) and increase polyunsaturated fats (cold-water fish nuts and seeds).
• Increase fresh vegetables and whole grains as well as water intake.
• Stewed or soaked prunes one to three/day have a slightly laxative effect and may help soften stools.
• Flax meal one heaping teaspoon in eight ounces of apple juice provides fiber and essential fatty acids to help relieve constipation. Follow with an additional eight ounces of water.
• Vitamin C (1 000 mg two to three times per day) supports the integrity of connective tissue.
• Vitamin E (400 to 800 IU per day) promotes healing.

Herbs

Bioflavanoids a constituent found in dark berries and some plants help restore the integrity of the vasculature. The following are bioflavanoids that may be taken in dried extract form as noted.

• Catechin (150 mg two to three times per day) quercetin (250 mg three to four times per day) hesperidin (250 mg three to four times per day) and rutin (250 mg three to four times per day).
• Rose hips (Rosa canina) and green tea (Camelia sinensis) are also high in bioflavanoids and either one may be used as a tea. Drink three to four cups/day.
• Stone root (Collinsonia canadensis) and horse chestnut (Aesculus hippocastanum) can be used to strengthen blood vessel walls (60 drops tincture twice a day).

Topical applications may relieve itching and burning as well as promote healing. Apply one of the following two to four times a day.

• Witch hazel (Hamamelis virginiana) is an astringent that may reduce swelling (commercially available as Tuck's pads).
• A salve containing comfrey (Symphytum officinalis) and/or marigold (Calendula officinalis) soothes and promotes healing.
• A poultice made from grated potato is astringent and soothing.

Homeopathy

Some of the most common remedies used for hemorrhoids are listed below. Usually the dose is 12X to 30C every one to four hours.

• Aesculus for burning hemorrhoids with a sensation of a lump in anus that feels worse when walking
• Aloe for a sensation of pulsation in the rectum with large external hemorrhoids
• Collinsonia for chronic itchy hemorrhoids with constipation
• Hamamelis for large bleeding hemorrhoids with a raw feeling

Physical Medicine

Fill one basin with hot water one with cold water. Sit in hot water for three minutes then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day three to four days per week.

Acupuncture

Acupuncture may be effective in resolving stagnant congestive conditions.

Following Up

Talk with your provider if the hemorrhoids are still a problem after one to two weeks. If you frequently have hemorrhoids talk with your provider about diet and lifestyle changes to help prevent them in the future.

Supporting Research

Balch JF. Prescription for Nutritional Healing. 2nd ed. Garden City Park NY: Avery Publishing 1997.

Barker LR Burton JR Zieve PD eds. Principles of Ambulatory Medicine. 4th ed. Baltimore Md: Williams & Wilkins; 1995:1 347–1 361.

Duke JA. The Green Pharmacy. Emmaus Pa: Rodale Press; 1997.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998.

Kruzel T. The Homeopathic Emergency Guide. Berkeley Calif: North Atlantic Books; 1992:181–183.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998.

Olshevsky M Noy S Zwang M. Manual of Natural Therapy: A Succinct Catalog of Complementary Treatments. New York NY: Facts on File; 1989.

Stein JH ed. Internal Medicine. 4th ed. St. Louis Mo: Mosby-Year Book; 1994:486–492.

United States Pharmacopeial Convention Inc. Advice for the Patient. 15th ed. USPDI; 1995:2.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.