Hemorrhoids

Hemorrhoids are considered to be a kind of varicosity of the hemorrhoidal plexus, a specialized arteriovenous shunt similar to the corpus caverrnosum of the genitalia, filled with oxygenated blood (hence the bright red color). External hemorrhoids are located below the anal sphincter, lined with squamous epithelium, whereas internal hemorrhoids are located above the sphincter and are covered by the rectal mucosa. (Berkow 1992; Rubin and Farber 1990, 383)

In many cases hemorrhoids are asymptomatic but they can protrude, bleed, and cause pain. Any kind of rectal bleeding should only be attributed to hemorrhoids after other, more serious conditions are excluded, such as diverticulosis or colorectal cancer. The volume of blood that is discharged following defecation is usually self-limiting, and rarely leads to complications such anemia or hemorrhage, but in chronic bleeding can be a cause of iron deficiency anemia. Over the course of the condition both external and internal hemorrhoids can protrude and then regress, and in most cases can be reduced temporarily by manually pushing them back inside the rectum. In some cases however they cannot be reduced manually and can become strangulated, ulcerated or thrombotic, causing severe pain. In some cases internal hemorrhoids can cause a discharge of mucus and a sensation of incomplete evacuation following defecation. External hemorrhoids often present some difficulty in properly cleansing the anal region, which can lead to irritation and itching. (Berkow 1992; Rubin and Farber 1990, 383)

Medical Treatment

The medical treatment of hemorrhoids consists primarily of stool softeners (e.g. docusate, mineral oil) or bulking agents (e.g. psyllium) may correct constipation and straining. The pain caused by a thrombosed hemorrhoid is treated with warm sitz baths and anesthetic ointments. Bleeding hemorrhoids are sometimes treated by injection sclerotherapy with 5% phenol in vegetable oil, used to cause the vein to harden and die, leaving a scar on the wall of the anal canal. Larger internal hemorrhoids that fail to respond to injection sclerotherapy are treated by rubber band ligation, in which the internal hemorrhoid is withdrawn through the band, resulting in its necrosis and sloughing. Many cases of hemorrhoids however cannot be ligated because of pain sensitivity, in which cases a hemorrhoidectomy may be performed. (Berkow 1992)

Holistic treatment

Hemorrhoids are viewed as a kind digestive disorder, caused specifically by poor pelvic circulation, promoted by liver congestion that results in a backflow in the portal vein, and as a result, an increase in the intra-abdominal pressure. Some cases of constipation occur only in association with constipation, with diarrhea, and in some cases only with dietary indiscretion (e.g. bread, ice cream). The approach to treating hemorrhoids is address the specifics of the symptomology, the concomitant symptoms (diarrhea, constipation), and the dietary indiscretions.

1. Relieve pain and bleeding

• cold water sitz baths, application of ice
  
• demulcents, fresh Aloe vera, Marshmallow (Althaea officinalis) root, Comfrey (Symphytum officinale) root, pulverized and applied topically as poultice
  
• astringents for bleeding and prolapse, e.g. Shepherd's Purse (Capsella bursa-pastoris), Beth root (Trillium erectum), Witch Hazel (Hamamelis virginiana), Yerba mansa (Anemopsis californica) Yarrow (Achillea millefolium), Canada Balsam (Abies balsamea) etc. as a decoction, taken internally and as a sitz bath
  

2. Enhance liver function

• bitters and cholagogues, e.g. Barberry (Berberis vulgaris), Yellow Dock (Rumex crispus), Radish (Raphanus sativus)
  
• oxbile, as part of a full spectrum digestive aid
  
• High-Strength Fargelin (contains oxbile), 3-5 pills bid-tid, (use with Bu Zhong Yi Qi Wan with Spleen deficiency)
  

3. Tone and strengthen the vasculature

• circulatory astringents, e.g. Stone Root (Collinsonia canadensis), Horse Chestnut (Aesculus hippocastanum); Yunnan Pai Yao, 2 caps tid
  
• Vitamin A, 10,000-20,000 IU daily
  
• Vitamin C, to bowel tolerance daily
  
• Vitamin E, 400-800 IU daily
  
• Bioflavonoids (mixed), 3-5 g daily
  
• Zinc citrate, 30-50 mg daily