Hemorrhoids: Treatment Options
Posted on December 24, 2013
Perhaps no other medical condition is the “butt” of so many jokes.
Yet the fact remains that hemorrhoids is an unpleasant inflammatory condition that can affect our work, make our lives miserable, and even require surgical procedures to treat.
In this article, we take a closer look at hemorrhoids...what they are, what causes them, and how to treat them once and for all..without the need for surgery.
What are hemorrhoids?
Hemorrhoids, which are also known as piles, are inflamed veins in the lower large intestine or anal area.
They are divided into two types: External hemorrhoids and internal hemorrhoids.
External hemorrhoids are far more common.
They are called external because the hemorrhoid is located in the skin immediately around the anus.
They are typically easy to find and palpate.
Because of their location, external hemorrhoids are highly prone to pain, itching, and bleeding when they come into contact with undergarments.
This is especially problematic with people who remain in a seated position for extended periods of time, such as office workers, truck drivers, or pilots.
Internal hemorrhoids, as the name suggests, are located internally, within the large intestine itself.
They are typically located beyond reach, but can enlarge to the point where it is palpable like an external hemorrhoid.
What causes hemorrhoids?
The causes of internal or external hemorrhoids are similar:
Low Fiber Diet - Diets low in fiber can cause constipation, which can trigger local inflammation and hemorrhoids in the large intestine.
Diets which are low in fiber and high in processed foods are especially problematic for hemorrhoids sufferers.
Obesity - Folks with a high Body Mass Index are especially prone to hemorrhoids. It is believed this is the case because of a combination of poor diet, constipation, and the stress placed on our lower organs from the excessive weight.
Constipation - This condition can also cause hemorrhoids because people suffering from constipation need to strain during a bowel movement. It is this straining which can trigger hemorrhoids. Constipation also forces sufferers to spend excessive amounts of time on a toilet, and this exposure of the lower large intestine to ambient air in that position can trigger hemorrhoids.
Pregnancy - Hemorrhoids are a universal problem amongst pregnant women, largely due to the issues mentioned previously of constipation and the extra weight being carried.
Genetics - For unknown reasons, chronic hemorrhoids can run in certain families.
Some researchers believe there is this genetic “weakness” in the tissues of the lower intestines which makes some families prone to frequent hemorrhoids.
But the reality is that we simply don’t understand the genetic links and causes of hemorrhoids.
Posture - Hemorrhoids are very common in office workers, pilots, truck drivers, and people in other occupations where remaining in a seated position is required.
Who gets hemorrhoids?
It’s not known exactly how many people have hemorrhoids. This is because hemorrhoids is largely self-treated, and so there is no way of accurately knowing how many are being treated for them.
However, researchers all believe that hemorrhoids are quite common.
For example, one study from the 1990s estimated that 4-5% of the entire adult US population suffers from hemorrhoids.
That’s roughly 8-10 million adults!
This percentage may be much higher in the 45 - 65 year old age bracket.
Also, this percentage is likely to be much higher in women of childbearing age simply due to pregnancy.
The elderly are also especially prone to hemorrhoids. This is due to a combination of poor diet, poor digestion, and excessive time spent in the seated position.
So, hemorrhoids are surprisingly common. But, perhaps it’s not so surprising, given our understanding of the many causes of hemorrhoids.
Are there other diseases that resemble hemorrhoids, but are not hemorrhoids?
Fortunately, there are no known diseases that resemble hemorrhoids.
However, if there is ever any doubt, a visual inspection by a physician or proctologist will rule out anything more serious.
Hemorrhoids Treatment Goals
The goals for treating hemorrhoids sound simple, but they’re not!
Basically, our treatment goals are:
> Immediate reduction in pain and itching
> Gradual reduction in inflammation
> Resolution of current hemorrhoid(s)
> Prevention of future hemorrhoids
Now before we get into the specifics, there is a major challenge we need to keep in mind.
That challenge is one of access, especially for internal hemorrhoids.
You see, for an external hemorrhoids, we can reach the actual hemorrhoid and apply various pain relievers and anti-inflammatory medicines directly to the actual hemorrhoids.
However, for internal hemorrhoids that we cannot reach, the application of treatments to the hemorrhoids is a big problem.
So we need to keep this access issue in mind as we discuss the various treatment options for both internal and external hemorrhoids.
Topical Treatments for Hemorrhoids
The word topical means that it is applied directly to the skin, such as a cream, gel, or a wipe.
There are many over-the-counter products for the treatment of hemorrhoids. But they all basically have similar ingredients:
Witch Hazel is a pleasant extract of the Hamamelis leaf that is a great astringent and anti-inflammatory.
When applied directly to a hemorrhoid, it immediately causes a cooling sensation as it shrinks blood vessels.
Witch Hazel is the key ingredient found in many moist wipes and pads, such as Preparation H Medicated Wipes and Tucks Medicated Pads.
Unfortunately, the effects typically wear off very quickly.
So witch hazel provides temporary relief of pain and itching, but it is not a long-term solution to the problem.
Needless to say, witch hazel in a pad or wipe is not useful against internal hemorrhoids.
Vasoconstrictors also tighten blood vessels and shrink tissues.
The most common vasoconstrictor for hemorrhoids is a drug called phenylephrine.
Phenylephrine is found in most hemorrhoid suppositories and ointments, such as Preparation H, Medicone, and Tronolane.
Vasoconstrictors can be used against internal (suppositories) and external (cream) hemorrhoids.
Repeated use of these products may provide relief and reduce the inflammation, but they tend to work very slowly.
Protectants literally protect the irritated hemorrhoid against further irritation.
They are a good idea to be used when constipation is the primary issue. Examples of protectants include zinc oxide cream, mineral oil, lanolin, or glycerin.
Hydrocortisone is an over-the-counter anti-inflammatory steroid.
It is present in many different creams and lotions, including those for hemorrhoids. Brands include Cortizone-10, Preparation H Anti-Itch Cream, and Tucks Hydrocortisone.
Prescription products containing hydrocortisone are also available, which have a greater amount of hydrocortisone than what is available over the counter.
Anesthetics are a terrific way to rapidly reduce pain and itching. They work by numbing the nerves to provide temporary relief.
However, note that anesthetics do not reduce inflammation. So you should not depend on an anesthetic alone when fighting hemorrhoids.
There are three anesthetics found in hemorrhoidal products: benzocaine, dibucaine, or pramoxine.
All of these work equally well, and are found in brands such as Americaine, Lanacane, and Nupercainal.
How to choose a safe hemorrhoid treatment
Astute readers will already note that there is a lot of overlap between these ingredients. For example, both witch hazel and hydrocortisone help stop itching.
So which one to use?
Long-time hemorrhoid sufferers know that there is no single topical product that works well.
Successful treatment of hemorrhoids takes a blend of products and approaches.
For example, a hemorrhoid patient might use witch hazel pads for flares and immediate relief, a topical anesthetic cream several times a day, and a suppository at night to help with sleep.
Other ideas and alternatives will be discussed below.
Ring cushions, or donut cushions, are soft, foam cushions with a hole in the center.
When you sit on these cushions, the weight it taken off of the anal area and shifted to the outer buttocks.
This reduction in pressure can provide a lot of relief, especially if you need to remain seated for extended periods of time.
Ring cushions come in two types: contoured (firm) and convoluted (soft). This video explains the difference and why you would choose one over the other.
As the name suggests, banding works by placing tight elastic bands around the hemorrhoid. This cuts off the blood flow, causing the hemorrhoid to shrink and fall off...a process that takes about a week.
Once it does fall of, care must be taken to protect the area from irritation, as it needs to heal.
This procedure involves shooting short bursts of infrared light onto the hemorrhoid. As with banding, this causes the blood vessels to seal off, and the hemorrhoid then shrinks.
Bleeding is a common, and sometimes alarming side effect from coagulation.
Sclerotherapy involves the injection of a chemical in the area around the hemorrhoid, causing it to shrink within a few days. Bleeding is also a common side effect of this procedure.
This involves the surgeon applying a generous amount of local anesthetic. Then, the hemorrhoid is excised out with a scalpel. This can be a crude, painful approach, and is usually reserved as a last resort.
With all of these procedures, there is a risk of bleeding and infection. So post-surgical care is critical.
Also, there is no guarantee with any of these procedures that the hemorrhoids will not return.
Oral Hemorrhoid Treatments
We include fiber here because fiber should be an essential part of any therapy for hemorrhoids.
Fiber is found in many foods, such as beans, fruits and vegetables, and whole grain cereals and bread.
Fiber helps in hemorrhoids by attracting water into the gut, promoting softer, gentler stools that are less likely to irritate an existing hemorrhoids.
Fiber supplements are an excellent way to supplement the amount of dietary fiber.
Just note that there are some products which contain real fiber, known as psyllium.
And, other products that contain methylcellulose, calcium polycarbophil, or other substances which behave like fiber, but are really not fiber.
Either approach will work, but psyllium is preferred because it is natural, and because it may have other health benefits.
The only effective pill-based product that we know of to treat hemorrhoids is Tush MD.
Tush MD combines psyllium, witch hazel, and bromelain in a single tablet.
Because it comes as an oral pill, you simply take one tablet 2-3 times a day during hemorrhoid flares.
Once they have subsided, taking a half or one a day will keep the stool soft to prevent further irritation, and the witch hazel and bromelain will provide soothing, anti-inflammatory benefits.
That sounds better than surgery or messy creams!
Natural Hemorrhoid Treatments
We see any number of natural herbs and oils which allegedly help treat and even cure hemorrhoids.
We have our doubts that any of these work other than providing some mild, temporary relief.
We would caution anyone from buying any product that claims to cure hemorrhoids instantly.
Hemorrhoids are a complex inflammatory condition, and no product will cure them instantly, unless it’s a surgical procedure.
How to Prevent Hemorrhoids
It’s difficult to prevent hemorrhoids, but not impossible. Here are some tried and proven tips:
> Sit on a donut cushion
> Increase your fiber intake through both diet and oral fiber supplements or Tush MD
> Minimize the amount spent on the toilet
> Increase your daily water intake