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Hemorrhoids

• Signs and Symptoms
• Causes
• Diagnosis
• Preventive Care
• Treatment Approach
• Other Considerations
• Supporting Research

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 surgical treatment.

Signs and Symptoms

Symptoms of hemorrhoids include:

• Anal itching
• Anal ache or pain, especially while sitting
• Bright red blood on toilet tissue, stool, or in the toilet bowl
• Pain during bowel movements
• One or more hard tender lumps near the anus

Causes

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

• Certain medical conditions (like cirrhosis – end stage liver disease)
• Pregnancy
• Sitting for prolonged periods of time
• Diet low in fiber or fluids

Diagnosis

Your provider will do an examination; this is usually enough to make the diagnosis of hemorrhoids. If you have had significant bleeding or other symptoms, your health care provider may perform a procedure called sigmoidoscopy, or colonoscopy. In this procedure a small instrument is inserted into the rectum in order to view the inside of your colon. The intention of these endoscopic exams is, in part, to look for another cause of bleeding or pain.

Preventive Care

Avoid straining during bowel movements. You can also help prevent hemorrhoids by preventing constipation. Drink plenty of fluids (at least eight glasses per day). Eat a high-fiber diet (fruits, vegetables, whole grains). You may want to consider fiber supplements.

Treatment Approach

Medications can ease pain and discomfort during the time it takes for the hemorrhoids to heal. In addition to medications, certain lifestyle measures can help you feel better and even prevent the recurrence of hemorrhoids.

Lifestyle

Try the following approaches to reduce the pain and itching from your hemorrhoids:

• Apply witch hazel with a cotton swab
• Avoid pressure on the area (for example, sit on an inflatable ring).
• Wear cotton undergarments
• Avoid toilet tissue with perfumes or colors
• Try not to scratch the area
• Sit in a warm bath (or use a Sitz bath – ask your doctor) for 10 to 15 minutes 1 to 2 times per day.
• Avoid straining during bowel movements.
• Limit the amount of time you sit on the toilet.

There are also dietary and other lifestyle steps you can take to prevent or treat constipation which will help you avoid hemorrhoids. See article entitled Constipation for more information.

Medications

• Over-the-counter corticosteroid creams can help reduce the pain and swelling. Hemorrhoid creams with lidocaine (also available over-the-counter) can reduce pain.
• Stool softeners help reduce straining and prevent hard stools.
• Bulk laxatives help prevent hard stools and constipation.

Surgery and Other Procedures

For cases that don't respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.

Nutrition and Dietary Supplements

Fiber

Soluble fiber, such as psyllium , may be recommended by a physician to help soften stool and reduce the pain associated with hemorrhoids.

Flavonoids

This group of antioxidants, found primarily in dark berries, can help maintain or regain vascular integrity. Loss of vascular integrity due to age or other causes can contribute to the development of hemorrhoids.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating symptoms. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine. Some remedies that such a practitioner might consider based on clinical experience include:

• Goldenrod ( Solidago virgaurea ) – used topically in traditional herbal medicine to reduce inflammation of hemorrhoids.
• Gotu kola ( Centella asiatica ) – used for venous insufficiency, pooling of blood in different locations such as the legs.
• Grape seed ( Vitis vinifera ) – used by European folk healers to stop bleeding, inflammation, and pain, such as the kind brought on by hemorrhoids.
• Roman Chamomile ( Chamaemelum nobile ) - This herb may reduce inflammation associated with hemorrhoids.
• St. John's Wort ( Hypericum perforatum ) – applied topically, may prove to be beneficial for reducing pain and inflammation from hemorrhoids.
• Yarrow ( Achillea millefolium ) -- popular in European folk medicine, this herb has traditionally been used to treat wounds and bleeding hemorrhoids.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of hemorrhoids based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. The following are examples of remedies from which a homeopath might select to treat someone with hemorrhoids.

• 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

Other Considerations

Prognosis and Complications

Most treatments for hemorrhoids are very effective. Talk with your provider if the hemorrhoids are still a problem after one to two weeks. To prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.This is especially important if you get hemorrhoids often.

The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.

Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.

Supporting Research

Duke JA. T he Green Pharmacy . Emmaus, Pa: Rodale Press; 1997.

Goldstein L. Ask the midwife. Prevention and care of hemorrhoids, including homeopathic remedies. Birth Gaz . 2000;16(2):13-16.

Gray DS. The clinical uses of dietary fiber. Am Fam Physician. 1995;51(2):419-426.

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

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

Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers, and haemorrhoids. Drugs . 2003;63(1):71-100.

MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. 2001;6(2):126-140.

Misra MC, Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg . 2000;87(7):868-872.

• Review Date: 4/1/2004
• Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine Shiva Barton, ND, Wellspace, Cambridge, MA.

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