PhytoScience - Article

Hemorrhoids

 

Hemorrhoids, which are also called piles, are swollen and inflamed veins in your anus and rectum. They may result from straining during a bowel movement or the increased pressure on these veins during pregnancy, among other causes.

A sometimes embarrassing topic of discussion, hemorrhoids are common. By age 50, about half of adults have had to deal with the itching, bleeding and pain that often signal the presence of hemorrhoids.

Fortunately, effective medications and procedures are readily available to treat hemorrhoids. In many cases hemorrhoids may require only self-care and lifestyle changes.

Signs and symptoms

Hemorrhoid symptoms usually depend on the location:

  • Internal hemorrhoids. You can't see or feel these hemorrhoids. But straining or irritation from passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. You may notice small amounts of bright red blood on your toilet tissue or in the toilet bowl water. Because internal anal membranes lack pain-sensitive nerve fibers, these hemorrhoids usually don't cause discomfort. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (prolapsed), it can cause pain and irritation.

  • External hemorrhoids. These hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain, swelling and inflammation. When irritated, external hemorrhoids can itch or bleed.

Causes

Hemorrhoids can develop from any increase in pressure in the veins in the lower rectum. Common sources of pressure and hemorrhoid causes include:

  • Constipation and the accompanying straining
  • Diarrhea and the continuous expulsion of loose stools
  • Sitting or standing for a long time, especially sitting on the toilet
  • Obesity
  • Pregnancy and childbirth

It's also possible to inherit a tendency to develop hemorrhoids.

When to seek medical advice

As a general rule, see your doctor if your hemorrhoids don't improve with self-care, cause pain, or bleed frequently or excessively.

A common sign of internal hemorrhoids is rectal bleeding. But rectal bleeding can occur for other reasons, so see your doctor to rule out more serious conditions or diseases. Other causes of bleeding in the lower gastrointestinal tract include colorectal or anal cancer.

If the onset of your hemorrhoids occurs along with a marked change in bowel habits or if you're passing black, tarry or maroon stools, consult your doctor without delay. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.

Seek emergency care if you notice large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

Screening and diagnosis

Your doctor may determine if you have external hemorrhoids simply by looking. For internal hemorrhoids, your doctor may want to conduct an examination with a rubber-gloved finger. But even this technique may be inconclusive because internal hemorrhoids are often too soft to detect by a rectal examination.

In this case your doctor may want to examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. A more extensive examination could include an examination of the entire colon and rectum using a flexible fiber-optic colonoscope. This will help exclude bleeding lesions not only in the rectum but also in the entire colon. Close follow-up is necessary, however, and continued bleeding despite hemorrhoid treatment requires additional examinations.

Treatment

In many cases hemorrhoid treatment involves steps that you can take on your own. But sometimes medications or surgical procedures are necessary.

Medications
If your hemorrhoids are producing only mild discomfort, your doctor may suggest over-the-counter creams, ointments or pads containing witch hazel or a topical anti-inflammatory agent containing hydrocortisone. This local treatment, in combination with daily warm baths, may relieve your symptoms.

Surgical or other procedures
If a blood clot has formed within an external hemorrhoid, your doctor can easily remove the clot with a simple incision, which may provide prompt relief.

For persistent bleeding or painful hemorrhoids, your doctor may recommend:

  • Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation and the hemorrhoid falls off. This simple procedure {called rubber band ligation} is done in the doctor's office and is effective for many people
    .
  • Sclerotherapy. In this procedure, your doctor injects a chemical solution around the blood vessel to shrink the hemorrhoid.

  • Infrared light. A one- or two-second burst of infrared light cuts off circulation to small, bleeding, internal hemorrhoids
    .
  • Surgery. If other procedures haven't been successful or if you have large hemorrhoids, your doctor can remove tissue in a procedure called hemorrhoidectomy. The surgery is done with either a local anesthetic combined with sedation, a spinal anesthetic, or a general anesthetic. Surgery can be performed on an outpatient basis or you may require an overnight hospital stay. While you may experience discomfort after the procedure, medications can be used to relieve your pain. Soaking in a warm bath also can ease your discomfort.

  • Stapling. This procedure, which blocks blood flow to hemorrhoidal tissue, is a relatively new treatment technique. While some experts point out that this procedure involves less pain than surgery and allows an earlier return to work, there are drawbacks as well. Stapling has been associated with a greater risk of hemorrhoidal recurrence and prolapse compared with open surgery. Talk with your doctor about what might be the best option for you.

Prevention

To help prevent hemorrhoids or hemorrhoidal flare-ups:

  • Eat high-fiber foods. Eat more fruits, vegetables and grains. Doing so softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids.

  • Drink plenty of liquids. The exact amount of water and other fluids you should drink each day varies and depends on your age, sex, health, activity level and other factors.

  • Consider fiber supplements. Over-the-counter products such as Metamucil and Citrucel can help keep stools soft and regular. Check with your doctor about using stool softeners. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add fiber to your diet slowly to avoid problems with gas.

  • Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.

  • Avoid long periods of standing or sitting. Sitting too long, particularly sitting on the toilet for long periods, can increase the pressure on the veins in the anus.

  • Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

  • Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

Self-care

You can temporarily relieve the mild pain, swelling and inflammation of most hemorrhoidal flare-ups with the following self-care measures:

  • Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a topical numbing agent.

  • Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn't necessary and may aggravate the problem. Gently drying the area with a hair dryer after bathing can minimize moisture, which can cause irritation.

  • Soak regularly in a warm bath. Do this several times daily.

  • Apply cold. Apply ice packs or cold compresses on the anus to relieve swelling.

  • Use a sitz bath with warm water. A sitz bath fits over the toilet. You can get one at a medical supply store or some pharmacies.

  • Don't use dry toilet paper. Instead, to help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn't contain perfume or alcohol.

  • Take oral medications. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) temporarily to help relieve your discomfort.

These self-care measures may relieve the symptoms, but they won't make the hemorrhoid disappear. See your doctor if you don't get relief in a few days, or sooner if you have severe pain or bleeding.

Complementary and alternative medicine

Some people with hemorrhoids turn to complementary and alternative medicine treatments to help manage symptoms, improve mood and reduce stress. These treatments may include prayer or spiritual healing, meditation, and vitamin and herbal supplements.

A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

  • Don't stop taking your prescribed medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.

  • Be honest with your doctors and health providers. Tell them exactly which complementary treatments you practice or would like to explore. There have been many cases {based on patients test results} where doctors have reduced or stopped medications due to the benificial effects from natural health products.

  • Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements may interfere with your prescribed medications. When purchasing a health product; look for information that may be found in small print that would indicate drug interactions or product warnings.

  • Natural remedies that lower inflammation can also be very beneficial; when indicated they may be preferred over some medications that have adverse effects with prolonged usage. Although long-term use of NSAIDs in high doses can provide great benefit in terms of anti-inflammatory effects, pain relief and cardioprotective effects, there is an increased risk of gastrointestinal complications ranging from stomach pain to ulcers, hemorrhage, and severe and potentially deadly gastrointestinal problems. Each year in the US, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths.

  • Witch Hazel: The bark, leaves, and twigs of witch hazel are all high in tannins, giving this plant astringent properties. Astringents are substances that can dry, tighten, and harden tissues. You may use an astringent on your skin to tighten pores and remove excess oil.

    The astringent tannins in witch hazel temporarily tighten and soothe aching varicose veins or reduce inflammation in cases of phlebitis (an inflammation of a vein). Witch hazel also contains procyanadins, resin, and flavonoids, all of which add to its soothing, anti-inflammatory properties. A cloth soaked in strong witch hazel tea reduces swelling and can relieve the pain of hemorrhoids and bruises.

    Almost all pharmacies carry some type of witch hazel preparation in the form of lotions, hemorrhoidal pads, and suppositories. Besides their use topically for hemorrhoids and veins, witch hazel lotions are useful on rough, swollen, gardener's or carpenter's hands. You can also use witch hazel internally to treat varicose veins, hemorrhoids, or a prolapsed uterus, although not the witch hazel/isopropyl alcohol preparation found in drug stores.

  • Aloe Vera: Aloe Vera is an excellent colon cleanser. Healing and soothing to the stomach as well as liver, kidneys, spleen and bladder. It’s also an excellent remedy for piles and hemorrhoids. Aloe Vera is a soothing herb that acts as a mild laxative. It also soothes inflamed tissue and reduces pain. You can drink Aloe Vera in a drink, in water or straight. You can apply aloe gel with a cotton pad or swab to the enflamed areas. Aloe Vera has a cooling effect when it comes in contact with exposed hemorrhoids.

  • Tumeric: Is a spice that comes from the root Curcuma longa, a member of the ginger family, Zingaberaceae. Cur cumin has historically been safely used in Ayurveda for its medicinal properties for various indications. Curcumin has demonstrated some anti-inflammatory activity. Several studies were identified on the antioxidant, anti-inflammatory, antiviral, and antifungal properties of curcuminoids. The anti-inflammatory properties have been shown to be beneficial with the treatment of hemorrhoids.

  • Mangosteen. Mangosteen has been demonstrated to exhibit potent anti-inflammatory properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of disease. Mangosteen can be used as an effective adjunct with standard therapies to reduce many of the side effects and helps to speed up recovery.

    When indicated; mangosteen juice, consumed daily, may be preferred over some medications that have adverse effects with prolonged usage. Mangosteen juice from the whole fruit puree has successfully been used to treat hemorrhoids and can even be applied with a cotton swab and used topically for a more rapid healing effect.

    In some cases, people experience a healing crisis or detoxifying effect {an increase or outbreak of symtoms that may last from 4 to 10 days} in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective in some of the most severe cases of hemorrhoids.

    Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat inflammatory conditions and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results. Mangosteen Science