Hemorrhoids (Anal Varicosities)

Hemorrhoids are varicose veins in the anal area that cause pain, itching, and bleeding. The three veins that serve the anal area normally expand, or dilate, during bowel movements and shrink afterward. Repeated straining to pass hard stools can result in permanent swelling. The enlarged veins then press on surrounding nerves, thus producing the itchiness and discomfort. They may be located inside or outside the anal opening. External ones tend to be more painful and the internal type bleed more easily. Usually, hemorrhoids are uncomfortable and annoying but not serious. For some people, however, they can cause extreme pain, particularly when defecating. The swollen veins may also rupture and bleed.

Hemorrhoids are very common, afflicting about one-third of Americans, or some 75 million people. They tend to run in families, but millions with no family history develop them. Contributing factors include excessive sitting, constipation, obesity, and pregnancy.

Diagnostic Studies and Procedures

External hemorrhoids can easily be seen. Internal ones are readily detected by a rectal examination, in which a doctor inserts a gloved finger into the rectum. To confirm the diagnosis, anoscopy or sigmoidoscopy may be ordered. For both procedures, a thin, flexible tube with a lighted tip and magnifying devices is inserted through the anus and used to examine its interior (anoscopy) or the lower part of the colon (sigmoidoscopy).

Medical Treatments

If constipation is part of the problem, a doctor may recommend use of a stool softener, as well as anesthetic sprays or creams to alleviate pain and itching. If these approaches are ineffective, removal of the hemorrhoids may be advisable. The simplest procedure is to strangle the hemorrhoid by using a small rubber band to cut off its blood supply. As the varicosed portion of the vein dies, the tissue sloughs away. When rubber band ligature is not possible, a relatively painless alternative is laser surgery, in which intense light beams are used to vaporize the tissue. Conventional surgery may be done in severe cases. The operation, which involves removing dilated veins from around or inside the anus, usually is performed on an outpatient basis.

Alternative Therapies

Acupuncture and Acupressure. Points for the treatment of hemorrhoids are located on the top of the head and at the base of the spine. Applying needles or finger pressure to these points may help relieve pain.

Aromatherapy. A bath with aromatic oils can help relieve pain and itching, particularly when combined with other remedies. Equal amounts of cypress, frankincense, and juniper oils are recommended. The patient should remain in the bath for 10 to 15 minutes.

Herbal Medicine. Western herbalists recommend astringent herbs, such as pilewort, which is taken as a tea or applied as an external ointment. Witch hazel may be combined with pilewort and used as a tincture or an ointment. Sitting for 15 minutes twice a day in a basin of warm water to which 1 cup of witch hazel has been added has been reported to alleviate hemorrhoids. Chinese herbalists recommend a tea called Itsuton, consisting of rhizoma rhei, radix angelicae sinensis, radix Scutellariae, radix glycyrrhizae, radix bupleurui, and rhizoma cimicifugae.

Homeopathy. Practitioners recommend sulphur if hemorrhoids are itchy but not bleeding and if constipation is a problem. Aloe gel is prescribed for use three times daily when hemorrhoids protrude and there is itching, bleeding, and diarrhea. Nux vomica is advocated when there is constipation.

Naturopathy and Nutrition Therapy. A high-fiber diet helps prevent constipation. Some naturopaths recommend taking two tablespoons daily of bran, mixed with yogurt or a fresh fruit salad. They also advocate a diet that includes at least four to six servings of whole-grain cereals, breads, and other complex carbohydrates, and four to six servings of fruits and vegetables a day.

Self-Treatment

To alleviate pain and shrink swollen tissue, use an ice pack made by putting several ice cubes in a plastic bag and wrapping a cloth around it. Apply this for 10 minutes, remove it for 10 minutes, then reapply it for another 20 minutes. Do not apply ice directly to the skin, as you may damage delicate tissue. You can also try non-prescription hemorrhoid products that contain astringents and ingredients to shrink hemorrhoids. Sitting in a tub of tepid water may also bring some relief.

Refrain from inserting any object into the rectum. After a bowel movement, wipe with moistened tissue or an anal cleansing pad sold in drugstores. Avoid scratching or rubbing. If constipation is a problem, use a stool softener but avoid long-term laxative use. Don't stay on the toilet any longer than necessary, since this position places a strain on anal veins. If possible, adopt a squatting position, or place the feet on a low stool to relieve pressure on the veins around the anus. If your job involves sitting for long periods, walk around at least once an hour, and stand whenever possible.

Other Causes of Anal Itching and Bleeding

Colitis, diverticulitis, colon polyps, and colon or rectal cancer can produce blood in the stool. Anal bleeding, pain, and itching may be due to an anal fissure, infection, or injury.