If you have hemorrhoids, you’re not alone. Up to 75 percent of people in the United States suffer from this painful condition at some point during their life.1 In fact, “hemorrhoids” was the health issue most searched for online in the United States in 2012, according to the Food and Drug Administration.1
Pregnant women also commonly suffer from hemorrhoids during the second and third trimesters, when the fetus puts a lot of pressure on the abdomen and hormonal changes cause hemorrhoidal blood vessels to swell. Childbirth also strains these blood vessels.
Hemorrhoids have been around a long time. They’re mentioned in ancient medical writings of every culture, including Babylonian, Hindu, Greek, Egyptian and Hebrew.
In ancient times, hemorrhoid treatments included poultices or bed rest.2 Stubborn cases were treated in a more extreme way: applying a red hot poker—ouch!2
Hemorrhoid sufferers even have their own patron saint, St. Fiacre, an Irish priest who lived in the seventh century.2
What Kind of Hemorrhoids Do You Have?
Hemorrhoids happen when veins in and around the anus and lower rectum swell up because of straining or pressure. In other words, they’re essentially varicose veins of the bum.
Hemorrhoids are classified as either internal (inside the anus) or external (under the skin near the opening of the anus).
Internal hemorrhoids often are small, swollen veins in the wall of the anal canal. But they can be large, sagging veins that bulge out of the anus. They can make their presence known loud and clear if the blood supply to the hemorrhoid is cut off, causing pain. If hemorrhoids bulge out, you also may see mucus and blood on the toilet paper or stool.
External hemorrhoids can get irritated and clot under the skin, causing a hard lump. This causes significant pain and swelling in the anal area.
Is It Hemorrhoids—or Something Else?
If you have hemorrhoid symptoms, it’s a good idea to have your doctor rule out other conditions with symptoms similar to hemorrhoids, such as fissures, local infections or rectal or colon cancer. Anal fissures also can cause pain during bowel movements as well as rectal bleeding. Anal fissures usually cause a burning or tearing pain, whereas hemorrhoids cause an achiness and feeling full even after you have a bowel movement.2
If you have diabetes or any condition that impairs your immune system, your hemorrhoid symptoms may really be due to perirectal abscesses.2
Other conditions that mimic hemorrhoids include fistulas, which can be uncomfortable and cause soiling of underwear, as well as ulcerative proctitis, colitis or Crohn’s disease. Perianal condylomas—genital warts or lesions—cause itching, local irritation, pain and bleeding that can be mistaken for hemorrhoids. A tear known as a rectocele in the divider between the rectum and vagina can cause fullness in the rectum, producing a similar sensation to an internal hemorrhoid. These tears are usually caused by childbirth and hysterectomies.2
You probably also associate anal itching with hemorrhoids, but often the itching has nothing to do with hemorrhoids. Sometimes external hemorrhoids swell up or skin tags caused by former hemorrhoids can prevent proper cleaning of the anal area, causing itching. But hemorrhoids themselves don’t produce significant itching.
If you’re experiencing itching in that area of your body, you may want to have your doctor look into other causes such as allergic reactions, perianal dermatitis, microorganisms, parasites, oral antibiotics, diabetes mellitus, liver disease or hyperhidrosis (abnormally increased sweating).2
What Causes Hemorrhoids?
Some homeopathic doctors believe hemorrhoids are caused by anger. Other people have proposed different emotional origins. According to Lise Bourbeau, an author who hosts Listen to Your Body workshops, hemorrhoids are caused by built-up emotional pressure due to stress and fear that you would rather not discuss and show.3 According to Bourbeau, hemorrhoids also can occur if you’re enduring a job you don’t like, and they often occur in people who are asking too much of themselves.
On a physical level, if you’re suffering from hemorrhoids, researchers believe the culprit behind your suffering could be one of many things, including weakness of the blood vessel wall, heredity, increased intra-abdominal pressure during bowel movements or resistance training, pregnancy or pelvic masses.4 As you age, many of these factors can cause the hemorrhoid cushion to deteriorate and the hemorrhoids start to bulge and drop into the anal canal. This makes them more vulnerable to irritation from the passage of stool.4
Lack of exercise, low-fiber diets, obesity and prolonged sitting may also increase your risk of getting hemorrhoids.5
The Risks of Surgery
For severe hemorrhoids, your doctor may recommend surgery. But this is not without risk. Injection sclerotherapy (when medication is injected into the blood vessel) has resulted in anaphylactic shock. Cryotherapy (using low temperatures) is associated with severe rectal pain and discharge.
Manual dilation often requires general anesthetic and admission to the hospital. If dilation is not performed carefully, the results may be fatal. Septic shock and death have resulted from rubber band ligation. Hemorrhoidectomy—the removal of hemorrhoids—is extremely painful and requires a four to six-week recovery.6-9
Because of the risks of all these treatments, less invasive options are becoming more popular. These include infrared photocoagulation, bipolar diathermy and electrocoagulation. During infrared photocoagulation, the doctor generates a beam of infrared light with a special device. The ensuing heat causes scar tissue, which cuts off the blood supply to the hemorrhoid. Infrared photocoagulation is a better option for grade 1 and 2 hemorrhoids, as the recurrence rates with grade 3 and 4 hemorrhoids is high.
In direct current electrocoagulation, the doctor uses a fine wire probe to transmit radio waves to hemorrhoid tissues. This causes molecules within the tissue to vibrate, leading to a rapid increase of the temperature and effectively killing the tissue.
Direct current electrocoagulation works better for grades 3 and 4 hemorrhoids and is associated with less discomfort and fewer complications. In a study of 120 patients who were treated with direct current electrocoagulation, all patients remained symptom free during the 23 months of follow up.10
In bipolar diathermy, the hemorrhoid tissue is exposed to electrical current. The current passes only through the tissue being treated, due to the use of a special forceps.
When hard stool rubs against the anal mucosa, this can lead to symptomatic hemorrhoids. Therefore, increasing your fiber intake is the first step in the battle against your varicose veins of the bum. And try to eliminate straining when you have a bowel movement.
In studies, fiber supplements reduced the risk of bleeding by approximately 50 percent and reduced symptoms in non-prolapsing hemorrhoids (i.e., external). Fiber supplements, however, did not improve the pain and itching in people with prolapsing, or internal, hemorrhoids.11
It could take up to six weeks after you increase your fiber intake for you to notice any improvement.12
To soften stool and increase bowel movements, you can also try magnesium supplements. You’ll want to take it up to bowel tolerance. In other words, take enough magnesium to soften your stools, but not enough to cause diarrhea. Each person is different, but aim for 500 to 1,500 mg per day.
You’re also going to want to increase the strength of your blood vessels. The flavonoid hesperidin is known for its ability to increase the tone of vessels. A recent analysis of the medical literature investigated the use of flavonoids for hemorrhoids. The analysis looked at 14 randomized trials and 1,514 patients and found that flavonoids decreased bleeding risk by 67 percent, persistent pain by 65 percent and itching by 35 percent. The flavonoids also reduced the recurrence rate by 47 percent.13, 4
Another study showed that a combination of hesperidin and synthetic hesperidin reduced rectal discomfort, pain and secondary hemorrhage after hemorrhoidectomies.14
The recommended dosage of hesperidin is 500 to 1,000 mg per day.
Just Touching the Surface
Preparation H® is the most commonly used topical treatment for hemorrhoids. The problem is that it contains parabens, estrogen mimics that have been linked to cancer. So a natural alternative is a better option.
Studies have shown that chamomile ointment as well as tinctures of chamomile used in a sitz bath can improve hemorrhoid symptoms. Chamomile tincture may also reduce hemorrhoid-associated inflammation.15
Witch hazel is another topical option. Researchers have found that it inhibits two enzymes involved in the breakdown of connective tissue. When the activity of these enzymes increases, the integrity of blood vessels are compromised.2
Another potential solution is Pycnogenol®, derived from pine bark. Both topical and oral Pycnogenol® improve hemorrhoid symptoms, and the combination of both forms appears to be particularly effective.
In a randomized, controlled study of subjects experiencing acute hemorrhoid pain, the group of patients given topical (0.5 percent) Pycnogenol® combined with oral Pycnogenol® had faster improvement in symptoms compared to subjects only given the oral Pycnogenol®. Hemorrhoidal bleeding was completely absent in all patients treated with Pycnogenol® for seven days and also at the 14-day follow-up. Researchers still observed bleeding in the control group.16
If you try supplementing with oral Pycnogenol®, aim for 100 mg three times daily.
I often recommend to my hemorrhoid patients that, before they have a bowel movement, they goop up their anal area with a lubricant to reduce friction. Coconut oil, a healthier option than Preparation H®, is soothing.
It’s also a good idea to exercise throughout the day. Get up from your desk every hour, or better yet establish a stand-up work station.
Exercise can also help reduce stress. When you’re stressed, you’re more likely to tighten the sphincter muscle and put pressure on the rectal area. Stress can also cause you to eat low-fiber, sugary foods that increase constipation.
Meditate, take deep breaths or sip a soothing cup of green tea to reduce your stress level. If you need a reminder to breathe deeply throughout the day, put a sticky note on your computer.
Finally, hydration is critical, so be sure to drink at least six to eight, 12-ounce glasses of water daily.
Relief Is in Sight
If you’re suffering with hemorrhoids, there are plenty of natural options that can help. Try these solutions and you may say goodbye to the pain and bleeding, not to mention ultimately saving yourself a costly and painful surgery.
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- Lohsiriwat V. World J Gastroenterol. 2012 May 7;18(17):2009-17.
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- Yang R, et al. Gastrointest Endosc.1993;39:766-9.
- Hood TR, Williams JA. Am J Surg. 1971 Oct;122(4):545-8.
- Quevedo-Bonilla G, et al. Arch Surg. 1988;123:650-1.
- Norman DA, et al. Am J Gastroenterol. 1989;84:482-7.
- Alonso-Coello P, et al. Am J Gastroenterol. 2006;101:181-8.
- Moesgaard F, et al. Dis Colon Rectum. 1982;25:454-6.
- Alonso-Coello P, et al. Br J Surg. 2006;93:909-20.
- La Torre F, Nicolai AP. Dis Colon Rectum. 2004;47:704-10.
- Srivastava JK, et al. Mol Med Report. 2010 November 1;3(6):895–901.
- Belcaro G, et al. Phytother Res. 2010 Mar;24(3):438-44.