Hemorrhoids are normally present blood vessels in and around the anus that become swollen and inflamed. Over three-quarters of people in the United States have hemorrhoids at some time in their lives. The peak age is between 45 to 65 years.
What Causes Hemorrhoids?
One of the top causes of hemorrhoids is constipation. Straining puts greater pressure on these veins.
Hemorrhoids are a common, usually temporary problem among pregnant women caused by hormonal changes and increased pressure by the growing fetus, which forces the veins to work harder to pump blood.
Chronic Venous Insufficiency
Hemorrhoids can be a sign of general weakness in the veins. Contributing factors are standing or sitting for long periods, being overweight, not exercising enough, and smoking.
Inflammatory Bowel Disease
Ulcerative colitis or Crohn’s Disease may be the underlying cause of hemorrhoids.
An increased pressure within the portal vein blood from the intestines to the liver. Liver cirrhosis (scarring) is the most common cause.
Starting in the thirties, there is a progressive weakening of the support structures in the area.
- Internal hemorrhoids (ones that are inside the anal cavity) usually cause painless bleeding at the end of a bowel movement. Blood can be a sign of a serious problem so it is important to be evaluated by a health professional.
- A sensation of fullness, usually described as feeling the urge to have a bowel movement even when there is no stool. Straining worsens the discomfort.
- Acute pain, itching, and irritation around the anus. This often occurs when hemorrhoid has prolapsed and can be seen outside the anus or it can be caused when a blood clot develops or hemorrhoid becomes twisted. There may be a painful lump or swelling around the anus. These can be serious and need evaluation.
- External hemorrhoids (outside the anus) can often be felt as a bulge in the anus.
Although they can be itchy and painful, they sometimes do not cause typical symptoms.
Hemorrhoids Are Often Confused With Anal Fissures
When people see spots of blood on the toilet paper and have pain with bowel movements, they often immediately think it’s hemorrhoids when the problem may really be a small but painful tear called an anal fissure. Anal fissures are usually caused by constipation. If stools are dry and hard, the anal sphincter is forced open wider than normal, resulting in a tear, or anal fissure. There are often some spots of bright red blood on the toilet paper. Anal fissures also cause a sharp, stinging, often severe pain with the passage of each bowel movement (whereas hemorrhoids often cause bleeding but no pain).
One of the most common causes of hemorrhoids is inadequate fiber intake. Fiber shows a consistent beneficial effect on relieving hemorrhoid symptoms and bleeding. Seven randomized trials with a total of 378 participants have found fiber improved symptoms including itching, discomfort, and pain. Start by eating foods high in fiber, such as whole grains and vegetables. Psyllium is another option, one that is inexpensive and readily available. A typical dose of psyllium is 1 teaspoon of the husks in water followed by another glass of water. My favorite is ground flaxseeds, which I mix with brown rice or sprinkle on salads. To me, this tastes much better than psyllium. Whatever the source of fiber, it is important to drink sufficient water or constipation may worsen.
Bioflavonoids are a type of plant compound that stabilizes and strengthens blood vessel walls and decreases inflammation. They have been found to reduce anal discomfort, pain, and anal discharge during an acute hemorrhoid attack. Side effects of bioflavonoids appear to be mild and rare, making them a promising treatment for hemorrhoids in pregnancy (the flavonoid tangeretin however, should not be used by people taking tamoxifen for breast cancer). The major flavonoids found in citrus fruits, diosmin, herperidin, and oxerutins, appear to be beneficial. Daflon, a product made with citrus bioflavonoids was found to improve symptoms in pregnant women by day four of taking it and to reduce symptoms of pain, heaviness, bleeding, itching, and discharge.
Witch hazel compress or cream
This drug store staple made from the leaves and bark of a plant called Hamamelis Virginiana. It should not be taken internally but instead is applied topically to the anal area in the form of witch hazel distilled liquid, ointment, or medicated pads. Witch hazel decreases the bleeding of hemorrhoids by acting as an astringent. It also relieves pain, itching, and swelling associated with hemorrhoids.
This plant Ruscus aculeatus, which is known as knee holly, box holly, and sweet broom, gets its name because butchers in Europe to clean their chopping blocks once used it. Butchers broom has a long history of traditional use for hemorrhoids and varicose veins. It is often used when there is underlying poor circulation in the veins.
How does butchers broom work?
Butchers broom extract has anti-inflammatory and vein-contricting properties believed to improve the tone and integrity of veins and shrink the swollen tissue. The active compound is called ruscogen.
Butchers broom is usually recommended in capsule or tea form. The tea has a slightly bitter taste, so a bit of stevia or honey can be used to sweeten it. The tea can be made by steeping 1 teaspoon of the herb in a cup of hot water for 10 to 15 minutes. Butchers broom has also been shown to be effective when applied topically as an ointment or compress.
Butchers broom should not be used by people with high blood pressure, benign prostatic hyperplasia (BPH), by pregnant or nursing women, or by people taking alpha blocker or MAO inhibitor drugs unless otherwise recommended by their doctor.
Horse chestnut (Aesculus hippocastanum), like Butchers broom, is often recommended when there is poor circulation in the veins, or chronic venous insufficiency. It relieves symptoms such as swelling and inflammation and strengthens blood vessel walls. The active compound is believed to be aescin.
People with an allergy to the horse chestnut family, bleeding disorders, or people taking blood thinners should not take horse chestnut. Only products made from the seeds or bark of the young branches should be used. Other parts of the plant are poisonous. Although uncommon, side effects have included kidney damage, severe bleeding, bruising, and liver damage.
Other Helpful Herbs
It is an Ayurvedic compound of three fruits. It is well known as a bowel tonic that gently relieves constipation without being a harsh stimulant. Topical application of chamomile or calendula can be applied as a compress or ointment.
The three basics that can greatly reduce hemorrhoids symptoms are:
- Adequate water intake (a minimum of 6 glasses a day)
- Adequate fiber in the diet
A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer. Conventional treatment options include cutting off circulation to hemorrhoid (ligation), shrinking hemorrhoid chemically (sclerotherapy), burning hemorrhoid tissue with a special device (infrared coagulation), and surgery (hemorrhoidectomy).