Hemorrhoids: Symptoms, Causes, Treatments, and Natural Approaches 2024
What Are the Types of Hemorrhoids?
Internal
Internal hemorrhoids are found inside the anal canal and are typically painless, but they can itch, cause pressure, and complicate cleaning. They may bleed, leak mucus, or protrude from the anus.External
External hemorrhoids are located near the anus opening and can be painful but are usually manageable with home treatments.What Are the Symptoms and Signs of Hemorrhoids?
- Rectal bleeding: A sign of rectal bleeding is bright red blood during or after a bowel movement.
- Pain: Internal hemorrhoids are usually not painful unless they prolapse.
- A burning sensation.
- Discharge of mucus.
- Itching: Mucus released by hemorrhoids can cause skin irritation and itching.
- Moisture.
- Inflammation or swelling.
- Difficulties with perianal cleanliness.
Melena (black bowel movement) may indicate bleeding in the upper part of the gastrointestinal tract instead of rectal bleeding. Certain types of cancer, peptic ulcers, and many other medical conditions can cause this.
- Minor bowel control issues
- A feeling of fullness around the anus
- Irritation of the skin around the anus
- Severe pain
- Feeling the need to have a bowel movement
- Sensing that a bowel movement is not complete
- Anal itching
- One or more hard, tender lumps near your anus
- Anal pain, especially when sitting or during bowel movements
- Swelling
- Blood
- Anal fistulas (an abnormal connection between tissue) and fissures
- Discomfort while walking, sitting, or standing, with physical movements causing significant discomfort.
- Painful bowel movements accompanied by blood in the stool: A thrombosed hemorrhoid can burst, especially if the blood clot inside the rectal tissue is under pressure, thus causing bleeding.
- Itchy skin in and around the anus.
- Tender or hard lumps or bumps due to swelling in the anal area.
- A skin tag: After a blood clot dissolves, it typically leaves behind extra skin, known as a skin tag, which might cause itching or irritation.
What Causes Hemorrhoids?
- Chronic obstructive pulmonary disease (COPD)
- An enlarged prostate or urethral stricture
- Masses such as ovarian tumors or sizable rectosigmoid carcinomas
- Ascites (abnormal fluid buildup)
- Liver diseases such as cirrhosis
What Are the Stages of Hemorrhoids?
- Grade 1: prominent hemorrhoids without prolapse
- Grade 2: prolapse occurs after a Valsalva maneuver (the act of forcefully exhaling against a closed glottis), but it reduces spontaneously
- Grade 3: prolapse occurs after a Valsalva maneuver, and it requires manual reduction
- Grade 4: prolapse is chronic, and manual reduction is ineffective
Who Is at Risk of Hemorrhoids?
- Family history.
- Sedentary lifestyle.
- Obesity.
- Higher socioeconomic standing.
- Spinal cord injury.
- Rectal surgery.
- Anal intercourse.
- Inflammatory bowel disease (IBD).
- Impaired bowel function resulting from excessive use of laxatives or enemas.
- Dehydration.
- Age: Hemorrhoids are uncommon in individuals under 20 years old, with the peak prevalence observed between the ages of 45 and 65.
- Pregnancy: Hemorrhoids are a common issue during pregnancy, especially in the third trimester, affecting around 40 percent of expectant mothers. Treatment for this condition is typically conservative during pregnancy, with most interventions postponed until after delivery.
- Childbirth: Hemorrhoids can sometimes develop as a result of the strain experienced during childbirth.
- Chronic constipation or diarrhea.
- Sitting for long periods or on hard surfaces: Smartphone use on the toilet may cause people to sit too long.
- Low-fiber diet.
How Are Hemorrhoids Diagnosed?
- Physical exam: The health care provider examines the anus and rectum to identify swollen blood vessels indicative of external hemorrhoids. This is usually done with the patient in the prone jackknife position (lying on your stomach with hips flexed at a 90-degree angle, placing your head and legs lower than your hips) or lying on the left side.
- Digital rectal exam: The health provider inserts a gloved, lubricated finger (digit) into the rectum to check for issues.
- Anoscopy: The health care provider inserts an anoscope (a hollow, lighted tube) into the anus to view internal hemorrhoids in the anal canal (the last part of the colon). A side-viewing anoscope is ideal for evaluating internal hemorrhoids because it allows the hemorrhoids to prolapse into the viewing slot, thus giving the examiner a better understanding of their size and extent.
- Proctoscopy: The health care provider inserts a proctoscope (a lighted tube), which is slightly longer than an anoscope, into the anus to examine the entire rectum.
- Sigmoidoscopy: The health care provider examines the sigmoid colon, the lower section of the large intestine, using a sigmoidoscope (a short, flexible, and lighted tube) inserted through the rectum. The tube inflates the intestine with air for better visibility. This test helps diagnose causes of diarrhea, belly pain, constipation, abnormal growths, and bleeding and allows for biopsy if needed.
- Colonoscopy: The health care provider examines the entire length of the large intestine using a colonoscope (a long, flexible, and lighted tube) inserted through the rectum into the colon. This test helps identify abnormal growths, inflammation, ulcers, or bleeding and allows for biopsy.
- Barium enema exam: This examination involves infusing liquid barium into the large bowel through a rectal tube, then inflating the bowel with air (i.e., carbon dioxide). The health care provider may also take X-ray images, thus making this a highly effective method for examining the large bowel.
What Are the Possible Complications of Hemorrhoids?
- Hemorrhage: Hemorrhage is the primary complication of internal hemorrhoids.
- Infections: Bacterial or fungal infections may occur due to difficulties keeping the rectal area clean.
- Anemia: Hemorrhoids can lead to blood loss over time.
- Iron deficiency: Iron deficiency can occur due to anemia.
- Blood clots.
- Inflammation.
- Skin tags.
- Ulceration: Persistent thrombosed hemorrhoids can cause ulcers, which can be painful and difficult to heal.
- Fecal incontinence: Hemorrhoids can prevent the muscles around your anus from closing completely, thus allowing small amounts of stool or mucus to leak out.
What Are the Treatments for Hemorrhoids?
1. Diet
Conservative therapy, such as dietary adjustments or stool softeners, is regarded as the first-line treatment for symptomatic hemorrhoids.Your doctor may recommend increasing your intake of high-fiber foods to make stools softer and easier to pass, which can help treat and prevent hemorrhoids. Since adequate water intake must accompany fiber to ensure stool is not only bulky but also soft, drinking water and other liquids (e.g., fruit juices and clear soups) enhances the effectiveness of dietary fiber.
- Skins and seeds of fruits and vegetables
- Popcorn
- Leafy greens
- Nuts
- Dried fruit
- Whole grains
- Fruits such as apples and bananas
- Oatmeal
- Cheese and other dairy products
- Chips
- Eggs
- Fast food
- Ice cream
- Meat
- Processed foods
- Sweets
- Some antidepressants
- Antacids with aluminum or calcium
- Antihistamines
- Some pain relievers
- Certain antihypertensive drugs
- Diuretics
- Anticholinergics
- Antispasmodics
- Anticonvulsants
- Parkinson’s disease medicines
- Iron supplements
2. Stool Softeners and Medications
Stool softeners can help reduce straining and constipation and alleviate congestion, enabling hemorrhoid cushions to revert to their natural, non-pathologic state. They include:- Polyethylene glycol: As an osmotic laxative, polyethylene glycol enhances stool softness by increasing its water content.
- Docusate: Docusate, an anionic surfactant, encourages water and lipid penetration into the stool.
- Pain relievers: Examples include acetaminophen, ibuprofen, naproxen, and aspirin.
- Laxatives: Bulk laxatives alone may improve symptoms of both bleeding and prolapse with equal effectiveness as injection sclerotherapy. Laxatives are not “addictive” and don’t increase the risk of future constipation.
- Anesthetic ointments: One example is anesthetic ointments containing lidocaine.
- Witch hazel compresses: Witch hazel has a long history of use among Native American tribes for its astringent and anti-inflammatory properties. When applied topically, witch hazel extract can be used as a compress to alleviate inflammatory and itchy skin issues.
3. Self-Care
Self-care practices that can be implemented at home include the following:- Regular exercise: Engaging in moderate aerobic exercise, such as brisk walking for 20 to 30 minutes daily, can help stimulate bowel function.
- Healthy bowel habits: When you feel the urge to defecate, go to the bathroom immediately to avoid stool backup and straining. Try to establish a regular bowel habit by scheduling a set time each day, such as after a meal, and limit time on the toilet to three to five minutes. Set a timer to avoid staying too long, if necessary. To avoid distractions, leave your smartphone outside the restroom. Also, try to avoid holding your breath while defecating.
- Proper behind-cleaning tools: After bowel movements, gently blot your anus with toilet paper moistened with water or a cleansing agent, or use baby wipes or pre-moistened towels. Avoid rubbing the area. Alternatively, rinse off in the shower or use a bidet. After cleansing, pat the area dry with a soft, absorbent towel. Avoid using soaps with perfumes or dyes.
- Sitz bath: “Sitz” comes from the German word “sitzen,” meaning “to sit.” A sitz bath can alleviate itching, irritation, and spasms of the muscle surrounding the anus known as the internal anal sphincter, by enhancing blood circulation. Fill your bathtub with warm (not hot) water to cover the anal area and soak for about 15 minutes. Do this several times a day, especially after bowel movements. Avoid including soap, bubble bath, or any additional substances in the water.
- Ice packs: Ice packs can be used to reduce swelling and pain. Apply a small ice pack to the anal area for a few minutes at a time, several times a day, as needed.
- Pushing the protruding part back in: If a hemorrhoid sticks out of the anal canal, gently push it back in. Leaving a hemorrhoid hanging out increases the risk of clotting or strangulation.
- Postures: Avoid prolonged sitting or standing, especially when hemorrhoids are irritated. If you need to sit for a long time, use a pillow for support.
- Clothing: Wear cotton underwear to prevent moisture buildup and irritation of hemorrhoids. In addition, wear loose clothing to reduce pressure on the anal area.
- Heavy lifting: Steer clear of lifting heavy items if you have hemorrhoids, as it can increase vein pressure and exacerbate the condition.
4. Office Treatments
Office treatments your health provider may perform include:- Rubber band ligation: Rubber band ligation is a medical procedure for treating bleeding or prolapsing internal hemorrhoids. It is also one of the most commonly performed procedures due to its safety and cost-effectiveness. The health care provider places a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrivel and fall off within a week. Scar tissue then forms, shrinking the hemorrhoid.
- Injection sclerotherapy: The healthcare provider injects a 5 percent phenol solution in vegetable oil or other sclerosing agents into an internal hemorrhoid. The solution forms scar tissue, which cuts off the blood supply, often shrinking the hemorrhoid.
- Infrared photocoagulation: The health care provider uses a tool to direct infrared light at an internal hemorrhoid. The heat from the infrared light creates scar tissue that cuts off the blood supply. It is beneficial for treating non-prolapsing, bleeding internal hemorrhoids or those that haven’t responded to rubber band ligation.
- Electrocoagulation: The health care provider uses a tool to send an electric current into an internal hemorrhoid, causing scar tissue to form.
- Incision of external hemorrhoids: The health care provider can alleviate the discomfort of a thrombosed external hemorrhoid by removing the clot’s contents. This is done under local anesthesia to numb the anal area. A small incision is then made to drain the clot and relieve pain.
- Excision of external hemorrhoids: Occasionally, a straightforward excision of a thrombosed external hemorrhoid can be performed to alleviate pain quickly. This involves infiltrating the area with a local anesthetic such as 1 percent lidocaine, removing the thrombosed part, and closing the wound with an absorbable suture. Afterward, a pressure dressing is applied, and the patient is advised to take sitz baths. This is the most invasive procedure of the five listed.
6. Hospital Treatments
Hospital treatments may also be carried out in outpatient centers.Hemorrhoidectomy is a procedure typically performed by a surgeon to remove large external hemorrhoids and prolapsing internal hemorrhoids that have failed to improve with other treatments. Anesthesia is also administered. Significant postoperative pain is frequent, alongside occurrences of urinary retention and constipation. Since there’s a possibility of permanent damage to the sphincter, the muscle regulating bowel movements, hemorrhoidectomy is reserved for cases of absolute necessity.
Hemorrhoid stapling, also known as stapled hemorrhoidopexy, is another procedure during which a surgeon uses a special stapling tool to remove internal hemorrhoid tissue and reposition a prolapsed internal hemorrhoid within the anus. Anesthesia is also administered.
How Does Mindset Affect Hemorrhoids?
Stress and anxiety can exacerbate symptoms of hemorrhoids. Stress can lead to digestive issues such as constipation or diarrhea, which can, in turn, increase the strain during bowel movements and worsen hemorrhoids.
Those with a proactive and positive mindset are also more likely to adhere to medical advice, treatment regimens, recommended healthy lifestyle changes, and coping strategies, which can help prevent and alleviate hemorrhoid symptoms.
What Are the Natural Approaches to Hemorrhoids?
1. Medicinal Herbs
- Chamomile (Matricaria chamomilla): Chamomile has a long history as a healing remedy and is known for its anti-inflammatory, antioxidant, and mild astringent properties. It’s been used for centuries to treat various ailments, including hemorrhoids. Recent research indicates that chamomile ointment and tinctures, especially Roman chamomile products, can help alleviate inflammation and discomfort associated with hemorrhoids, making it a promising option for relief.
- Horse chestnut (Aesculus hippocastanum): Aescin, the primary active compound derived from the horse chestnut tree, exhibits compelling evidence of clinically significant efficacy in addressing hemorrhoids and postoperative swelling. In a 1976 study mentioned in a 2001 review that involved 80 patients with acute hemorrhoids, participants were randomly assigned into two groups. The first group was given 40 milligrams of aescin thrice daily for up to two months based on their response, while the second received a placebo. After treatment, 81.6 percent of the first group reported significant symptom improvement compared to 32.4 percent in the placebo group. There were also substantial improvements in bleeding (94.8 percent in aescin versus 61.8 percent in placebo) and swelling (86.9 percent in aescin versus 38.3 percent in placebo).
- Sophora flower formula: In China, Japan, and Korea, the dried flowers and buds of Sophora japonica (aka Huaihua) have been historically used for treating hemorrhoids. In a 2013 study involving 48 hemorrhoid patients, a formula with a mixture of sophora flower, Cacumen platycladi, Japanese catnip, and bitter orange (all in equal parts) was given to 24 of them, while the rest received a placebo. After 14 days of treatment, 78.2 percent of the patients in the first treatment group showed no hemorrhoid symptoms, and only 40.9 percent of the placebo group still had symptoms. However, since adjustments in bowel habits and the use of sitz baths significantly improved symptoms for all patients, irrespective of whether they used the Sophora flower formula or not, further investigation with a larger sample size and varying dosages is needed.
2. Essential Oils
- Myrtle: A 2017 review of clinical studies found that myrtle (Myrtus communis) essential oil, applied as a lotion or ointment, greatly alleviated symptoms such as bleeding, pain (both acute and chronic), discomfort during defecation, anal irritation, itching, and anal heaviness in individuals with hemorrhoids. This essential oil was particularly effective for patients who didn’t respond well to standard chemical treatments such as anti-hemorrhoid ointments.
- Tea tree: Tea tree oil has antiseptic and anti-inflammatory properties and is sometimes used for sitz baths and topical applications in treating hemorrhoids. In a 2012 study, 36 patients with hemorrhoids were randomly assigned to two groups. The treatment group received a gel medical device that included hyaluronic acid, tea tree oil, and methyl-sulfonyl-methane. After 14 days, the treatment group experienced a notable reduction in anal pain, pain during defecation, visible bleeding, itching, and inflammation compared to the placebo group.
3. Acupuncture
In a 2018 study involving 76 patients with internal, external, and mixed hemorrhoids, all participants were treated with acupuncture for 24 days, resulting in 68 cases (86.5 percent of the total) considered successfully cured. However, the technique was deemed ineffective in 2.6 percent of the cases. Acupuncture and electroacupuncture can also be used to relieve postoperative pain in mixed hemorrhoids.4. Fermented Milk Containing a Probiotic
In a 2015 pilot study involving 40 women with hemorrhoids who had given birth naturally, participants were randomly assigned to two groups. The first drank one bottle per day of fermented milk containing at least 6.5×10⁹ CFU (colony forming units) of a probiotic called Lactobacillus casei strain Shirota, while the other group received a placebo. After six weeks, compared to the placebo group, the probiotic group experienced relief from constipation-related symptoms, improved bowel habits, and faster recovery from hemorrhoids. However, the authors commented on the small study size and advised that their findings be interpreted cautiously.5. Enzyme and Heparin Paste
In a 2002 study, a paste made of 10 powdered tablets of trypsin and chymotrypsin (enzymes) and 30 grams of heparin (a natural anticoagulant) ointment was applied directly over 67 participants’ hemorrhoid masses. After an average hospital stay of two days, the participants’ local pain was significantly reduced, and their bowel movements were comfortable. There was minimal itching in the affected area. Signs such as the size of hemorrhoids, perianal swelling, and tenderness were notably reduced.6. TONE and Dietary Fiber Supplement
In a 2017 study involving 102 patients with advanced hemorrhoids, the participants were prescribed 5 to 6 teaspoons of psyllium husk with 600 milliliters of water daily. They were instructed to follow TONE (Three minutes at defecation, Once-a-day defecation frequency, No straining, and Enough fiber). Among the 85 participants the researchers followed up with, 68.2 percent were highly satisfied, 12.9 percent were moderately satisfied, and 18.9 percent were dissatisfied. Most of them avoided surgery as a result of the study.7. Flavonoid Compound With Supplements
Flavonoids are natural substances in plants that are often beneficial to health in several ways.- 450 milligrams of micronized diosmin
- 300 milligrams of Indian pennywort (Centella asiatica)
- 270 milligrams of micronized hesperidin
- 200 milligrams of common grape vine (Vitis vinifera)
- 160 milligrams of vitamin C
- 160 milligrams of European blueberry (Vaccinium myrtillus)
- 140 milligrams of micronized quercetin
- 130 milligrams of micronized rutin
How Can I Prevent Hemorrhoids?
- Consuming high-fiber foods
- Drinking plenty of water or other nonalcoholic and non-caffeinated fluids daily
- Avoiding straining during bowel movements
- Avoiding reading or using a smartphone while sitting on the toilet
- Avoiding sitting for extended periods
- Avoiding regular heavy lifting
- Exercising regularly: Aim for at least 2.5 hours of moderate to vigorous activity each week. You can break this into blocks of 10 minutes or more throughout your day and week.
- Maintaining a healthy weight
- Properly managing constipation
- Taking a stool softener or a fiber supplement when needed
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