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
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.
Medical treatments
Over the counter products used to treat hemorrhoids include the use of rectal suppositories
(Anusol®), stool softeners (Colace®, Surfak®), topical preparations
(Anusol®, Preparation H®), and medicated wipes (Tucks®).
Prescription medications are available as creams, ointments, and suppositories. The hydrocortisone (Anusol-HC®, Proctocort®)
contained in these products reduces inflammation, itching, and swelling.
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].
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires March 2005.
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Reliable and relatively consistent scientific data showing a substantial health benefit.
For an herb, supported by traditional use but
minimal or no scientific evidence. For a supplement, little scientific support and/or minimal
health benefit.
