Hemorrhoids

Also indexed as: Piles

Hemorrhoids are enlarged raised veins in the anus or rectum. Common hemorrhoids are often linked to both diarrhea1 and constipation.

Although the belief that hemorrhoids are caused by constipation has been questioned by researchers,2 most doctors feel that many hemorrhoids are triggered by the straining that accompanies chronic constipation.3 Therefore, natural approaches to hemorrhoids sometimes focus on overcoming constipation.

Checklist for Hemorrhoids

Rating Nutritional Supplements Herbs
2Stars Fiber
Flavonoids (hydroxyethylrutosides derived from rutin)		 Horse chestnut
Psyllium
Witch hazel
See also:  Homeopathic Remedies for Hemorrhoids
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of hemorrhoids? Symptoms of hemorrhoids may include painful swelling or a lump in the anus that can bleed and become inflamed, often causing discomfort and itching. There may also be bright red blood on the toilet paper, the stool, or in the toilet bowl.

How is it treated? Conventional treatment includes the use of rectal suppositories, stool softeners, topical preparations (Anusol®, Preparation H®, Hemorid®), and medicated wipes (Tucks®). Surgical treatment may be recommended for hemorrhoids that become very enlarged, protrude from the anus (prolapse), bleed frequently, or contain blood clots (thrombosis). Common procedures include freezing the affected tissue (cryotherapy), injecting chemicals into the hemorrhoid to shrink it (sclerosing solutions), surgically removing the hemorrhoid (hemorrhoidectomy), or placing rubber bands around the hemorrhoid for removal (ligation).

Dietary changes that may be helpful: Populations in which fiber intake is high have a very low incidence of hemorrhoids. Insoluble fiber—the kind found primarily in whole grains and vegetables—increases the bulk of stool. Drinking water with a high-fiber meal or a fiber supplement results in softer, bulkier stools, which can move more easily. As a result, most doctors believe that fiber in combination with increased intake of liquids helps to treat people with hemorrhoids. Nonetheless, few clinical trials compare the effects of fiber supplementation against the effects of placebo in hemorrhoid sufferers.

Nutritional supplements that may be helpful: A number of flavonoids have been shown to have anti-inflammatory effects and/or to strengthen blood vessels. These effects could, in theory, be beneficial for people with hemorrhoids. Most,4 5 6 7 but not all,8 double-blind trials using a group of semisynthetic flavonoids (hydroxyethylrutosides derived from rutin) have demonstrated significant improvements in itching, bleeding, and other symptoms associated with hemorrhoids when people used supplements of 600–4,000 mg per day.

Other trials have evaluated Daflon, a product containing the food-derived flavonoids diosmin (90%) and hesperidin (10%). An uncontrolled trial reported that Daflon produced symptom relief in two-thirds of pregnant women with hemorrhoids.9 Double-blind trials have produced conflicting results about the effects of Daflon in people with hemorrhoids.10 11 Amounts of flavonoids used in Daflon trials ranged from 1,000 to 3,000 mg per day. Diosmin and hesperidin are available separately as dietary supplements.

Some doctors recommend flavonoid supplements for people with hemorrhoids. However, many different flavonoids occur in food and supplements, and additional research is needed to determine which flavonoids are most effective against hemorrhoids.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Constipation is believed to worsen hemorrhoid symptoms, and thus, bulk-forming fibers are often recommended for those with hemorrhoids. A double-blind trial reported that 7 grams of psyllium, an herb high in fiber, taken three times daily reduced the pain and bleeding associated with hemorrhoids.12 Some healthcare professionals recommend taking two tablespoons of psyllium seeds or 1 teaspoon of psyllium husks two or three times per day mixed with water or juice. It is important to maintain adequate fluid intake while using psyllium.

Topically applied astringent herbs have been used traditionally as a treatment for hemorrhoids. A leading astringent herb for topical use is witch hazel,13 which is typically applied to hemorrhoids three or four times per day in an ointment base.

Horse chestnut extracts have been reported from a double-blind trial to reduce symptoms of hemorrhoids.14 Some doctors recommend taking horse chestnut seed extracts standardized for aescin (also known as escin) content (16–21%), or an isolated aescin preparation, providing 90 to 150 mg of aescin per day.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol 1994;89:1981–6.

2. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. Gastroenterology 1990;98:380–6.

3. Deutsch AA, Kaufman Z, Reiss R. Hemorrhoids: a plea for nonsurgical treatment. Isr J Med Sci 1980;16:649–54.

4. Sinnatamby CS. The treatment of hemorrhoids. Role of hydroxyethylrutosides, troxerutin (Paroven; Varmoid; Venoruton). Clin Trials J 1973;2:45–50.

5. Clyne MB, Freeling P, Ginsborg S. Troxerutin in the treatment of haemorrhoids. Practitioner 1967;198:420–3.

6. Annoni F, Boccasanta P, Chiurazzi D, et al. Treatment of acute symptoms of hemorrhoid disease with high-dose oral O-(beta-hydroxyethyl)-rutosides. Minerva Med 1986;77:1663–8 [in Italian].

7. Wijayanegara H, Mose JC, Achmad L, et al. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 1992;20:54–60.

8. Thorp RH, Hughes ESR. A clinical trial of trihydroxyethylrutoside (“Varemoid”) in the treatment of hemorrhoids. Med J Aust 1970;2:1076–8.

9. Buckshee K, Takkar D, Aggarwal N. Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997;57:145–51.

10. Cospite M. Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology 1994;45:566–73.

11. Thanapongsathorn W, Vajrabukka T. Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 1992;35:1085–8.

12. Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. High-fiber diet reduces bleeding and pain in patients with hemorrhoids. Dis Colon Rectum 1982;25:454–6.

13. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 268–70.

14. Nini G, Di Cicco CO. Controlled clinical evaluation of a new anti-hemorrhoid drug, using a completely randomized experimental plan. Clin Ther 1978;86:545–59 [in Italian].