By Dr. Loretta Lanphier, ND, CN, HHP, CH

More than an embarrassing indelicate subject, hemorrhoids can be extremely painful and debilitating for many people. It seems that once a person suffers from hemorrhoids, the easier it is for them to show up again as uninvited guests.  Let’s see what we can find out about fighting them off, or even better, preventing them altogether.

What Are Hemorrhoids?

Hemorrhoids, or piles as they are sometimes called, are swollen inflamed veins found in the rectal and anal areas of our bodies. Some folks have them and may not even know it. Others experience quite intense and/or chronic pain and bleeding from their hemorrhoids. Certain activities such as straining while having a bowel movement may bring on hemorrhoids or aggravate existing ones.

It’s not something most of us go around talking about, but hemorrhoids are actually quite common. It is estimated that approximately 75% of Americans will suffer from hemorrhoids at some point in their lives. They first appear in most individuals after the age of 30. Many women experience them during pregnancy, but overall more males than females are thought to be afflicted with hemorrhoids. There are numerous treatments available for hemorrhoids, but the good news is that most of the time they can be prevented and controlled through lifestyle choices and self-care therapies.

What Are the Symptoms of Hemorrhoids?

The signs and symptoms of hemorrhoids are generally dependent on their type and location. The two major types of hemorrhoids are internal and external:

  • Internal hemorrhoids usually can’t be seen or felt by the patient. They are found below the lining of the anus or rectum. These tissues are very delicate, and can be easily injured while defecating. How do you know if you have them? A good indicator of internal hemorrhoids is blood, usually bright red, found on your toilet tissue or in the water of the toilet bowl. The membranes of the anal area do not have pain receptors, thus internal hemorrhoids are not usually painful. Sometimes internal hemorrhoids are forced out of the anus. These are referred to as prolapsed hemorrhoids, and they can cause pain and irritation. Sometimes they remain outside the anus, or they may move back and forth.
  • External hemorrhoids are the more problematic species. They tend to be very painful and itchy, and are prone to bleed more than the internal variety. They are easily aggravated by defecation and the wiping action of cleaning the area. Sometimes blood may pool and be trapped in an external hemorrhoid, forming a blood clot (thrombus). While these clots can be extremely painful, they are not associated with the danger of an embolism, as are some blood clots. An indicator that you might have a thrombus is the presence of blood on your underclothing.

What Are the Causes of Hemorrhoids?

The precise reason that hemorrhoids form is not known for certain. It is known that our upright posture exposes the veins of the anal and rectal areas to a large amount of pressure. There is also evidence that heredity plays a role in the development of hemorrhoids. If you have a family history of hemorrhoids, you are at a greater risk of experiencing them yourself. Whether this is a genetic connection, or due to the lifestyle culture of your relatives that was passed on to you (such as diet and exercise levels), is not fully understood. My guess is it is a combination of both. It used to be thought that people who engage in a lot of heavy lifting and/or spend a lot of time sitting for prolonged periods of time, such as in a work environment, were more prone to develop hemorrhoids. However, while these activities may irritate and compound problems with existing hemorrhoids, they are no longer considered to be causes. There are some known factors that both cause and worsen existing hemorrhoidal conditions. These include:

  • Obesity: Carrying around extra weight is a contributing factor to a multitude of disease conditions, and hemorrhoids are definitely one of them.
  • Aging: As we age the tendency for hemorrhoids increases for many people. This may be due in part to a less active lifestyle.
  • Chronic diarrhea or constipation: The diarrhea acts as an irritant to the anal area, and constipation causes forced bowel movements, which probably results in more hemorrhoids than any other single factor.
  • Pregnancy: Many pregnant women develop hemorrhoids, but they usually dissipate after childbirth.
  • Enemas and laxatives: While they may be appropriate and needed from time to time, excessive use of these increases risk for hemorrhoids.
  • Too much time on the toilet: Sitting on the toilet for prolonged periods of time has been shown to increase risk for hemorrhoids in some people. Hint:  Don’t use your bathroom time to read, or at least not for longer than normal times. Locate your “private office” elsewhere.

How Are Hemorrhoids Diagnosed?

If you know or suspect you have hemorrhoids, an exam by your health practitioner is probably the first step you would want to consider. A visual inspection of the anus may reveal external or protracted hemorrhoids. A more thorough internal examination, via a gloved and lubricated finger in the anus, will often detect internal hemorrhoids, but not always. Sometimes the tissues may be too soft to be felt. There are more definitive forms of internal exams, but be sure they are absolutely necessary, and also make sure that your practitioner has the experience and skill level to safely administer them. Internal organs can be damaged by faulty exams. An anascope is an instrument that is inserted into the anus, and allows the doctor to see into the anal canal. More comprehensive internal exams can be accomplished through the use of asigmoidoscope to view the lower colon, or a colonoscope for viewing the entire colon. These exams may reveal other reasons for rectal bleeding that can be much more serious than hemorrhoids. These may include colorectal or anal cancers. Anytime you have rectal or anal bleeding, do not take anything for granted. If there is something serious going on, you want to identify it as early in the disease process as possible.

How Can I Prevent Hemorrhoids?

As with any health care issue, the best course of action is to prevent disease, not treat it after the fact. Hemorrhoids are very preventable through proactive diet and lifestyle choices. Here are some recommendations:

  • Diet: A high-fiber diet is the best way to go in preventing hemorrhoids and many other intestinal tract disorders. Lots of raw or lightly steamed vegetables, fruits, and whole grains will soften and increase the bulk of your stools. This will make for very cooperative bowel movements that will not subject your body to straining. It is also a good idea to go to the bathroom as soon as possible after you have the urge to do so. This allows you to defecate when the stool is moister, not dried out which leads to constipation and straining.
  • Liquids: Drinking large amounts of water every day will do wonders for your body in many ways. It is a great habit to keep your intestinal tract healthy, and drinking ample water will go a long ways toward keeping you regular.
  • Exercise: An active lifestyle will relieve and reduce pressure on your veins. This will reduce your risk for hemorrhoids. While regular cardiovascular activity is excellent for your health in many ways, even getting up periodically and walking around will help with hemorrhoid prevention. Long periods of uninterrupted sitting or standing have been identified as factors for increased hemorrhoid risks. Physical activity also helps to take off or keep off excess body weight. Obesity only makes hemorrhoids more likely and can worsen existing ones as well.

How Can Hemorrhoids Be Treated?

In the allopathic world, there are a multitude of treatments available for hemorrhoids. Many of them, not surprisingly, involve drugs and surgery. There are also many effective self-care options that avoid the risks of more invasive procedures. The one medical treatment that I would recommend is called rubber band litigation. You may want to consider this option as an affordable, safe procedure for the treatment of internal hemorrhoids. An applicator is used to place one or more small rubber bands at the base of the hemorrhoids. The idea is to cut off the blood supply to them so they will die and fall off. This usually occurs in a week to ten days or less. Once the hemorrhoid has fallen off, a sore remains that heals up in short time. The procedure generally is painless and does not require any anesthetic, as the tissues in this area have minimal pain receptors. Rubber band litigation is a very effective and safe tool for eliminating existing hemorrhoids.

As far as self-care goes, there are many practical steps you can take to relieve your hemorrhoids:

  • Witch hazel, which is the active ingredient in many over-the-counter (OTC) hemorrhoid remedies, is an excellent treatment to relieve hemorrhoid pain and itching due to its anti-inflammatory, analgesic, and astringent qualities. It may be applied with pads, or even purchased already imbedded in pads. Be careful when choosing hemorrhoidal OTC remedies, as many of them contain hydrocortisone.
  • Warm baths or sitz baths can be very soothing and healing for hemorrhoids. Soak several times a day if possible. Sitz baths that fit over the toilet can be found in medical supply stores.
  • Hygiene: Keeping your anal/rectal area clean is very important to healing. Warm water is best, as soap may be irritating. Dry gently so as to minimize aggravation to the area. Some folks find a hair dryer to be useful.
  • Wipe carefully: You may want to consider using a moist towlette (alcohol-free) instead of toilet paper while hemorrhoids are flaring up. If you do use toilet paper, find a soft one that contains no perfume.
  • Cold compresses or ice packs applied to the region can help to relieve pain and inflammation. Be sure to wrap them in cloth to prevent skin burns, and do not leave them on for more than 20 minutes at a time.
  • Eat lots of blackberries, blueberries, and cherries. These fruits are high in flavonoids, substances that naturally strengthen your vascular system.

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