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.
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.
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fail to respond to injection sclerotherapy are treated by rubber band ligation, in which the internal hemorrhoid is withdrawn through the band, resulting in its necrosis and sloughing.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.
Hemorrhoids are viewed as a kind digestive disorder, caused specifically by weak digestion and pelvic stagnation, promoted by liver congestion that results in a backflow in the portal vein, and an increase in the intra-abdominal pressure. Some cases of hemorrhoids occur in association with constipation, others with diarrhea, and in some cases only with dietary indiscretions or as a response to food sensitivities (e.g. flour products, ice cream, banana, pork, etc.). The approach to treating hemorrhoids is to 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
- antiinflammatory vulneraries and emollients, to relieve pain and bleeding, applied as poultice, e.g. fresh aloe leaf pulp, fresh plantain leaf, fresh marshmallow root, fresh comfrey root
- astringents for bleeding and prolapse, taken internally and a sitz bath as a decoction), e.g. notoginseng, shepherd’s purse, trillium, witch hazel, anemopsis, yarrow
- turmeric root mixed with the milk of milkweed (Calotropis gigantea)
- narayana taila mixed with a pinch of sphutikarika (purified alum)
- yogurt, applied topically
2. Drain pelvic congestion and enhance biliary excretion
- cholagogues, e.g. barberry, turmeric, yellowdock, stoneroot, white dead nettle, scute root, dandelion root, chiretta, boldo
- support phase II detoxification, e.g. broccoli sprout extract, N-acetyl-cysteine, curcumin, S-adenosyl-methionine
3. Tone and strengthen the vasculature
- circulatory astringents, to tone vasculature, e.g. notoginseng, amalaki, hawthorn, rosehips, bilberry, raspberry, horsechestnut
- vitamin A, 10,000-20,000 iu daily
- vitamin C, to bowel tolerance daily
- vitamin E, 400 IU daily
- bioflavonoids (mixed), 3-5 g daily
- general remedies: triphala churna, trayushanadi churna, avipattikara churna, chandraprabha vati, zhong guo zhi gen duan, hua zhi ling
- for bleeding: yunnan bai yao
5. Dietary changes
- avoid all foods which are sticky, heavy and/or greasy in nature, e.g. bread, pasta, pastries, ice cream, banana, sticky rice, fatty meats, red meat, etc.
- avoid very dry, cold and light foods, e.g. popcorn, rice cakes, ice water, puffed rice, etc.
- implement an elimination-challenge diet, e.g. cereals, legumes, nuts/seeds, dairy, beef, egg, citrus, etc.
- antiiinflammatory foods, e.g. green tea, leafy greens, artichoke, cabbage, wild fish, berry fruits, garlic and onion
- introduce live culture fermented foods, ½ – 1 cup daily with meals
- if dairy is tolerated, properly made buttermilk is helpful