Hemorrhoids

While hemorrhoids are not usually a topic for casual conversation, maybe they should be. Between 50 and 75 percent of us may suffer from them at some point. Ranging from annoying to downright painful, most hemorrhoids can be prevented or alleviated through a combination of lifestyle, diet, and supplements.

What are hemorrhoids?

Like varicose veins, hemorrhoids (or piles) are swollen blood vessels. To help control bowel movements, our bodies fill anal tissue with blood. Pressure on the veins in this tissue causes swelling and stretching that, over time, can form hemorrhoids in the outer rectum (internal hemorrhoids), the anus (external hemorrhoids), or both. Although hemorrhoids can be painful, they are seldom serious.

What are the common symptoms?

• bleeding during bowel movements, either as streaks of bright red or mucus on toilet paper or the surface of the stool—occasional bleeding from hemorrhoids is common, but generally self-limited; however, blood-thinning medication can aggravate it
• itching
• rectal pain, particularly if an internal hemorrhoid prolapses or protrudes outside the rectum into the anus, where it can be squeezed by the anal (sphincter) muscles
• hard, sensitive lump(s) near the anus

Note: anal bleeding can also indicate serious conditions such as colitis, Crohn’s disease, or colorectal cancer. See a health care practitioner to rule them out.

What causes hemorrhoids?

Although we can get hemorrhoids at any age, they tend to come with increasing age because the rectum walls weaken, making it easier for blood vessels to protrude. However, there are other causes.

Pressure. Straining, rushing, or holding your breath during bowel movements puts extra pressure on the rectum, as does persistent diarrhea, constipation, and overusing laxatives and enemas.

Delay. Delaying the need to go can worsen constipation and make stool harder and more difficult to pass.

Weight. Carrying excess weight as well as lifting heavy objects can also increase pressure.

Pregnancy. Being pregnant has a triple effect. Hormonal changes increase blood flow to the pelvis while relaxing supportive tissues, the weight of the fetus exerts pressure on those blood vessels, and labour further intensifies pressure on the anal area.

Heart and liver disease. Having long-term heart and liver disease may cause blood to pool in the abdomen and pelvic area, enlarging rectal veins.

Medications. Certain pain medications as well as some anticonvulsants, antacids, antidepressants, antihistamines, analgesics, and nonsteroidal anti-inflammatory drugs can also cause constipation, increasing the chances of developing hemorrhoids.

Heredity. Having parents who had hemorrhoids also makes it more likely to develop them.

How can we treat hemorrhoids naturally?

While hemorrhoids are generally not considered a serious condition, they can be quite painful. By tweaking lifestyle choices, we can help prevent or lessen their effects.

Bathroom habits

Changing some old bathroom habits or adding new ones can go a long way toward avoiding or alleviating some of the worst symptoms of hemorrhoids.

• Go when the urge strikes. Delaying bowel movements can cause or aggravate existing constipation and worsen hemorrhoid symptoms.
• Take enough time, but not too much. Rushing or sitting too long on the toilet increases rectal vein pressure.
• Establish a regular time for a bowel movement to train your body to be more regular. After meals or in the morning or evening are often good times. Drinking a hot beverage about 30 minutes before may help stimulate the colon.
• Place feet on a step stool when having a bowel movement to mimic crouching. This repositions the rectum, making it easier and less painful to pass stool.
• Use hypoallergenic baby wipes or wet instead of dry toilet paper to ease skin irritation.
• Take a warm shower or bath to cleanse anal area, but avoid soaps with perfumes or dyes.
• Use a sitz bath filled with warm water for 10 to 15 minutes several times daily. Alternatively, apply ice packs to shrink inflamed tissue.

Diet and exercise

According to Pamela Frank, ND, a Toronto naturopath, “Food sensitivities, such as to dairy and gluten, are extremely common. Removing them can lead to dramatic improvements in not only hemorrhoids but also other gut issues such as constipation, diarrhea, and bloating.”

Many simple changes that help with hemorrhoids are also good for general health.

• Eat high-fibre foods—fruits, veggies, whole grains, beans, and nuts—to soften stool and increase stool bulk, making it easier to pass. Some foods such as prunes and berries are natural laxatives. Don’t peel fruits that have edible skins, as that removes much of their fibre.
• Avoid low-fibre foods, including fast food as well as white pasta, pastries, cheese, and white rice, which can cause constipation.
• Drink eight glasses of water or nonalcoholic fluids daily to keep stool soft.
• Avoid caffeine and nicotine, which overstimulate the gut, making it lose its own natural rhythm.
• Take a tablespoon of mineral oil to lubricate the stool, allowing it to slide past the hemorrhoid with less irritation. This is a short-term remedy, as mineral oil interferes with the absorption of vitamins and can cause anal leakage.
• Avoid prolonged periods of standing or sitting.
• Exercise daily to speed up the digestive process and to limit the amount of water the body absorbs from the stool while in the intestines, keeping it bulkier and softer. In addition, aerobic exercise stimulates the natural contraction of intestinal muscles that help push stool out quickly and efficiently.
• Try stretching and certain yoga positions that may also help alleviate constipation.

Supplements and other natural products

In her practice, Frank recommends a number of natural remedies, though it is important to consult your own health care practitioner for recommendations that are most appropriate for you.

• Herbs such as horse chestnut and butcher’s broom, as well as vitamin C, work to strengthen blood vessels.
• Magnesium works to retain water in the stool to keep it soft and help bowels relax so stool can pass more easily.
• Probiotics help produce fuel for the gut mucosa and keep the gut healthy.

Other supplements and herbal remedies that may be helpful in preventing and/or treating hemorrhoids include the following, though checking with your health care practitioner is a good first step.

• Bioflavonoids, in particular diosmin and hesperidin found in citrus plants, may reduce bleeding and improve overall hemorrhoid symptoms, according to a 2012 review of clinical trials.
• Pycnogenol, an extract of French maritime pine bark, has proven effective in two studies.
• The herb Euphorbia prostrata appeared to be an effective and well-tolerated treatment in a recent pilot study.
• Traditional herbal remedies such as calendula, Collinsonia (stone) root, oak bark, slippery elm, and witch hazel are thought to dehydrate and shrink swollen hemorrhoids and help soothe irritated tissue. Researchers are now investigating many traditional herbs to isolate their active ingredients and study their efficacy.
• Psyllium husk or wheat dextrin fibre supplements increase bulk and soften stool. Note: start slowly and drink at least 8 oz (250 mL) of water with each supplement and six to eight glasses of water throughout the day, as fibre can swell and create obstructions.

 Debunking hemorrhoid myths

While these hemorrhoid myths persist, they’re simply not true.

• Sitting on cold pavement or other cold surfaces does not cause hemorrhoids. In fact, cold helps shrink swollen tissue.
• Eating spicy foods might give us heartburn, but it won’t give us hemorrhoids.
• Hemorrhoids don’t lead to cancer, though cancer patients may be susceptible to getting them.
• Anal sex doesn’t cause hemorrhoids, but can irritate existing ones.