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Hemorrhoids

Hemorrhoids are veins in the rectum or anus that become swollen and painful. Sometimes they go away by themselves, but in other cases they can cause lingering pain, itching, and bleeding. There are two types of hemorrhoids: those that are just inside the anus or lower rectum (internal) and those that are outside the opening to the anus (external). You can have both at the same time. Internal hemorrhoids usually do not cause pain or discomfort, while external hemorrhoids often do. However, internal hemorrhoids can protrude outside the anus (prolapsed hemorrhoid) and become painful. In some cases, a blot clot (thrombosis) may form in the vein, making the hemorrhoid more painful. In severe cases, these hemorrhoids require surgery.

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Signs and Symptoms

Symptoms of hemorrhoids include:

• Anal itching
• Anal 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 tends to occur as we get older; about 75% of Americans have hemorrhoids at some point. Being constipated or passing large, hard stools may contribute to developing hemorrhoids. In many cases, however, there is no obvious cause. The increased pressure during pregnancy may also cause hemorrhoids. Contributing factors include the following:

• Some medical conditions (such as cirrhosis -- end stage liver disease)
• Pregnancy
• Sitting for a long period of time (especially sitting on the toilet)
• Obesity
• Chronic diarrhea
• Chronic constipation and straining
• Diet low in fiber or fluids

Diagnosis

Your doctor can often diagnose external hemorrhoids with a physical exam. For internal hemorrhoids, your doctor may do a rectal examination (inserting a gloved finger in the rectum). Your doctor may also use an anoscope or sigmoidoscope to look inside the anal canal.

Preventive Care

It's important to avoid being constipated so that you don't strain when having a bowel movement, so adding more fiber from fruits, vegetables, and whole grains to your diet can be helpful. You may want to consider fiber supplements. Drink plenty of fluids, at least 8 glasses per day, and exercise regularly.

Treatment Approach

Medications can ease pain and discomfort while hemorrhoids heal. In addition, 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 hemorrhoids:

• 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.

Medications

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

Surgery and Other Procedures

For cases that do not respond to home treatments, your doctor may recommend other procedures:

• Rubber band ligation. A tiny rubber band is placed around an internal hemorrhoid, which cuts off the blood supply and causes the hemorrhoid to fall off.
• Sclerotherapy. Used to treat varicose veins, in this procedure a chemical solution is injected into the vein, which causes the hemorrhoid to collapse.
• Doppler guided hemorrhoidal artery ligation. A relatively new procedure to help safely treat hemorrhoids.
• Surgery. If other options fail, your doctor may recommend a hemorrhoidectomy.
• Diode laser. This laser surgery requires less operation time, less pain and bleeding, and speeds healing time.

Nutrition and Dietary Supplements

• Psyllium and other forms of fiber may help soften stool and reduce the pain associated with hemorrhoids. Increase fiber intake to 25 to 30 grams per day, and drink 6 to 8 glasses of water per day. People with inflammatory bowel disease should check with their doctor to see if psyllium is appropriate for their condition.
• Probiotics, or "friendly" bacteria, such as lactobacillus and bifidus, can help prevent and treat hemorrhoids. People who are extremely immunocompromised should speak to their physician before taking probiotics.
• Drinking more water can greatly decrease constipation and straining during bowel movements, which can help prevent hemorrhoids.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

Witch hazel (Hamamelis virginiana), applied topically or used as a sitz bath, may temporarily shrink hemorrhoids and relive symptoms. Many "pads" used to treat hemorrhoids contain witch hazel.

Other herbs that are often suggested for hemorrhoids include:

• Goldenrod (Solidago virgaurea), used topically in traditional herbal medicine to reduce inflammation of hemorrhoids.
• Gotu kola (Centella asiatica), used for venous insufficiency or varicose veins. Gotu kola can interact with sedative medications. People with a history of liver disease should use Gotu kola with caution.
• Yarrow (Achillea millefolium), popular in European folk medicine, this herb has traditionally been used to treat wounds and bleeding hemorrhoids. Yarrow can interact with lithium and blood-thinning medications. People with allergies to ragweed should use yarrow with caution.

Scientific evidence to support the use of these herbs is lacking, but professional herbalists may prescribe them in appropriate circumstances.

Homeopathy

Although 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, includes their physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. A homeopath might select the following remedies to treat someone with hemorrhoids.

• Aesculus. For burning hemorrhoids with a sensation of a lump in the 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 health care provider if the hemorrhoids are still a problem after 1 to 2 weeks. To prevent hemorrhoids from coming back, eat 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, although it is unusual.

Supporting Research

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Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, Guyatt G. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006 Aug;93(8):909-20. Review.

Altomare DF, Giannini I. Pharmacological treatment of hemorrhods: a narrative review. Expert Opin Pharmacother . 2013;14(17):2343-9.

Belcaro G, Cesarone MR, Errichi B, Di Renzo A, Grossi MG, Ricci A, Dugall M, Cornelli U, Cacchio M, Rohdewald P. Pycnogenol treatment of acute hemorrhoidal episodes. Phytother Res. 2010;24(3):438-44.

Belcaro G, Gizzi G, Pellegrini L, et al. Pycnogenol in postpartum symptomatic hemorrhoids. Minerva Ginecol. 2014;66(1):77-84.

El Nakeeb A., et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol. 2008;14(42):6525-30.

Eshghi F, Hosseinimehr SJ, Rahmani N, Khademloo M, Norozi MS, Hojati O. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: results of a randomized, blind, placebo-control study. J Altern Complement Med. 2010;16(6):647-50.

Feldman: Sleisenger & Foredtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Elsevier Saunders; 2008.

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

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Ho Y, Tan M, Seow-Choen F. Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids. Dis Colon Rectum. 2000;43:66-69.

Jahanshahi A, Mashhadizadeh E. Sarmast MH. Diode laser treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012;84(7):329-32.

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Review Date: 2/2/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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