If you thought you knew everything about treating this malady, or need to get a good foundation in understanding it, read on !
(1) A lot of people don't really know what hemorrhoids are. Did you ever see a person with big, bulging varicose veins on their legs ? That's what hemorrhoids are like. It's just that they're in your rectum.
(Observe also that some of the natural remedies for varicose veins may also be useful with hemorrhoids)
Actually, there is evidence that hemorrhoids are somewhat different in structure from true varicose veins.
(2) There are INTERNAL hemorrhoids and EXTERNAL hemorrhoids. The internal ones are higher up in the rectum and may initially cause painless rectal bleeding, can become more severe, eventually bulging ("prolapsing")outside the anal opening. A grading system is used to describe their severity (see previous page). The external ones arise at the entrance to the the anal opening. An excellent diagram showing these two types is on our "PICTURES" page of this site. Hemorrhoids that bulge externally cause itching, swelling, pain and bleeding.
(3)Please do not diagnose yourself, Have your physician determine if your problem is hemorrhoids or something else.
Painless (or painful) rectal bleeding (seen with internal hemorrhoids) has other causes. Every person with any sense knows this. Don't assume that you have hemorrhoids just because you have rectal bleeding. You may be deadly wrong. The younger you are, the more likely it is that you do have hemorrhoidal bleeding, but discuss this with your doctor.
(When I was in my early college years, I developed painless rectal bleeding while working a construction job. I had no idea what the problem was and just waited for it to go away, which it did, for a while. Several years later I ended up having hemorrhoid surgery after the problem escalated. In retrospect, I think I could have done things to prevent such worsening)
(4) Being vertical aggravates the problem.
Not too may four - legged creatures have hemorrhoids. This is one of several liabilities we have as bipedal creatures. When you are standing, the pressure in your hemorrhoids increases, and they tend to swell more. Periods of rest -- especially lying down -- can be very beneficial if you are suffering with hemorrhoids. (IF you have the time). Try to avoid long periods of standing if you are having a flare-up of hemorrhoids. PROLONGED SITTING can also aggravate !
Most of the YOGA poses used for hemorrhoid relief involve..yeah..getting upside down.
(5) Any straining aggravates the problem.
If you are or become CONSTIPATED, your hemorrhoids will tend to worsen. YOU MUST NOT STRAIN WHEN YOU HAVE A BOWEL MOVEMENT. Eat a diet high in fiber. If necessary , take a fiber supplement twice a day (e.g. Citrucel, with a lot of water). When you have a bowel movement, you must ALLOW your body to do its thing and NOT FORCE IT.
HEAVY LIFTING, naturally, aggravates the problem. Try to avoid it.
STANDING OUT IN THE COLD with insufficient clothing causes you to shiver and tense your abdomen (STRAINING !). Stay bundled up when you are outside in cold weather.
COUGHING causes abdominal straining and aggravates the problem. you must avoid coughing ! If you smoke, STOP NOW. Control your cough with remedies (but see note below on medication.)
I'm sorry to say, but I think that heavy duty laughter must also increase the pressure in hemorrhoidal veins . I'd love to have someone show a study that proves otherwise.
Does sexual activity seem to aggravate symptoms ? I know, you don't care ! But think about it.
(6)I personally believe that PERSONAL STRESS aggravates the problem . I'm not sure why. Muscle tension in the abdomen will increase intra-abdominal pressure and simulate straining, and stressed people get tense. There is evidence that increased tension of the anal sphincter muscles aggravates hemorrhoids. (Should I suggest ..."don't be a tight ass ?" I want to see a study to confirm the association first).
(7)MEDICATIONS can cause constipation and thus make hemorrhoids flare up. A perfect example is codeine cough syrup, which can be constipating, or narcotic pain pills for acute pain . There are many medications which can cause constipation. Verapamil, used for high blood pressure , comes to my mind right away. Any medicine with "anti-cholinergic" side effects can cause constipation. Ask your doctor. If you must be on such medications, DO SOMETHING to prevent constipation ! Consider more dietary fiber and fluids, fiber supplement, Colace. Some people take Senokot when they must use codeine, to prevent constipation.
(8)DIETARY INDISCRETION can cause constipation and worsen hemorrhoids. You must eat a high fiber diet. You have to be very intelligent about diet if you have hemorrhoid problems. Many hemorrhoid suffers have claimed benefit from INCREASING FLUID INTAKE daily. Many of us get so busy that we do not keep up with fluid needs. Keep in mind -- a fiber supplement like Citrucel or Metamucil can CONSTIPATE you if you do not take plenty of fluid with it.
Also, be aware that frequent use of caffeine and/or alcohol has a diuretic effect that creates a state of mild dehydration. It is easier to have constipation problems when this happens, the end result is worsening of hemorrhoid symptoms. Maintain good hydration.
(9)People with Irritable Bowel Syndrome can have hemorrhoid problems . Do you know why ? It is common for SOME IBS sufferers to have periods of constipation with their IBS, due to motility problems with the bowel, and failure to maintain appropriate dietary fiber intake. Again, be intelligent about managing your bowel disorder.
(10)EXCESSIVE CLEANSING of the anal area with soap and water can cause big problems if you are suffering with prolapsing internal hemorrhoids or EXTERNAL hemorrhoids. You remove natural oils from the skin surface in the area and increase friction when you move, walk, etc. THE AREA MUST BE KEPT LUBRICATED! THIS IS OF UTMOST IMPORTANCE!!! Apply an ointment to the area twice a day (I advise Anusol HC ointment, but even Vaseline can be used). Pregnant women consider PLAIN Anusol ointment or Vaseline, or an herbal ointment acceptable to your OB.
(11)When you are having external hemorrhoid pain/irritation, make sure that you use toilet tissue with added lotion (e.g. "Puffs Plus"). Regular (the cheaper the worse) toilet paper might be regarded as very fine sand paper. Do you really want that for YOUR delicate hemorrhoids ? If possible, wash yourself and DAB dry, don't WIPE.
Also, consider use of a bidet. (see previous page)
(12)THROMBOSED EXTERNAL HEMORRHOIDS can occur. It's just a particularly bad version of external hemorrhoids, and is associated with the presence of a large blood clot inside the hemorrhoid. The clot does not travel anywhere. It's real uncomfortable, and can be relieved by an incision/drainage (folks, don't try this at home!), which is really NOT a bad procedure in good hands. Really. There MAY BE non surgical alternatives (which may take longer)-- see recent reports on the use of topical nifedipine (or other topical calcium channel blocker, ask your MD) and nitroglycerin (less popular now) ointments, possibly in combination with warm "Sitz" baths and/or cold applications.
(12.5)When an external hemorrhoid heals, a small piece of skin may remain in its place. This is called a hemorrhoidal "tag." I get many questions about this from people. Hemorrhoidal tags can be left alone (I imagine one could have them removed for "cosmetic" or other personal reasons .......)
(12.6)When internal and external hemorrhoids improve, IT DOES NOT MEAN THAT THE PROBLEM HAS GONE AWAY. It is likely that internal hemorrhoids are still present, and the symptoms can return if you do not manage your (lower bowel) health well, forever.
(13)HEMORRHOID REMEDIES are on the shelves of your pharmacy. They are not powerful, but can help reduce symptoms. Lubrication is the key. Anusol HC has hydrocortisone which reduces inflammation. Some people will cleanse the area with TUCKS (wet wipes containing Witch Hazel).If you do so, apply a lubricant afterwards -- an OINTMENT (not a cream) appropriate for the area.
Suppositories -- especially Anusol HC -- can be used for bad internal/external hemorrhoids. Ome authorities feel they may not do much because they end up in the rectum, above the area of pain. There are all kinds of other products on the market -- Herbal , Allopathic (e.g. Proctofoam, a steroid foam or cream), Ayurvedic, Chinese, Homeopathic, etc. See previous page for references.
(13.5)USE OF SUPPOSITORIES. If you have been advised to use suppositories for your condition and have no experience with this, check out Inserting a Rectal Suppository in this web site.
(14) PREGNANT WOMEN! Hemorrhoid problems are more common in PREGNANCY. One's entire venous circulation changes in the pregnant state, and the large uterus can compress veins which return blood from legs and rectum, thus promoting vein swelling. Labor generates tremendous stress on hemorrhoids, so manage them the best you can BEFORE labor, and make sure to take great care after you have your baby. Get your OB's clearance before you use any herbal or medical treatment, especially if internal (pills).
Also, CHECK OUT the use of DAFLON -- a natural mixture of bioflavonoids, which has been used safely in pregnancy.
ALSO, check out Calcium dobesilate (Doxium} -- a remedy that has been used to lower elevated blood pressure in pregnancy and has been useful in healing hemorrhoids , is used in diabetic retinopathy ! It acts as COAGULANT, thus the main use would appear to be BLEEDING hemorrhoids. One reference suggested not using the product in EARLY pregnancy. Available in USA ?
(15)You can consider more dramatic therapies with an appropriate surgeon (if it comes to that), such as rubber banding procedure, infrared coagulation, stapling (yes!) and HEMORRHOIDAL ARTERY LIGATION. (see previous page for references regarding these procedures).
(If your doc is not aware of these alternatives, consider seeing a high level hemorrhoid specialist, even if you have to travel !). The last thing you want is traditional scalpel hemorrhoid surgery (excision), because of the post op pain and long recovery period.
(16) I would be remiss in not mentioning the use of a bidet for cleansing of the anal area (short of jumping in the shower every time you want to clean yourself). It make intuitive sense, after having a bowel movement, to cleanse the area with water instead of wiping it with a fine abrasive (also known as toilet paper).Please look for references in the main web page.
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