Haemorrhoids

Also indexed as: Piles

What you need to know

The itching and burning caused by haemorrhoids can make it difficult to sit still. How can you ease the discomfort and fight flare-ups? According to research or other evidence, the following self-care steps may be helpful:

Choose foods with fibre
Eat more whole grains, bran, and vegetables, or take fibre supplements such as psyllium—along with plenty of fluids—to ease the passage of stools

Try a topical astringent
Relieve haemorrhoid symptoms by frequently applying a product that contains witch hazel

Get relief from flavonoids
Reduce symptoms with a daily dose of healthy flavonoids; take 1,000 to 2,000 mg of hydroxyethylrutosides or diosmin, or take horse chestnut extract containing 90 to 150 mg of aescin

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full haemorrhoids article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About haemorrhoids

Haemorrhoids are enlarged raised veins in the anus or rectum.

Common haemorrhoids are often linked to both diarrhoea and constipation.¹ Although the belief that haemorrhoids are caused by constipation has been questioned by researchers,² most doctors feel that many haemorrhoids are triggered by the straining that accompanies chronic constipation.³ Therefore, natural approaches to haemorrhoids sometimes focus on overcoming constipation.

Product ratings for haemorrhoids

Rating	Nutritional Supplements	Herbs
	Fibre Flavonoids (hydroxyethylrutosides derived from rutin)	Horse chestnut Psyllium Witch hazel
See also: Homoeopathic Remedies for Haemorrhoids
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms of haemorrhoids may include painful swelling or a lump in the anus that can bleed and become inflamed, often causing discomfort and itching. There may also be bright red blood on the toilet paper, the stool, or in the toilet bowl.

Dietary changes that may be helpful

Populations in which fibre intake is high have a very low incidence of haemorrhoids. Insoluble fibre—the kind found primarily in whole grains and vegetables—increases the bulk of stool. Drinking water with a high-fibre meal or a fibre supplement results in softer, bulkier stools, which can move more easily. As a result, many doctors recommend fibre in combination with increased intake of liquids for people with haemorrhoids. A review of seven placebo-controlled trials concluded that fibre supplementation has a beneficial effect on symptoms and bleeding in people with haemorrhoids.⁴

Other therapies

Surgical treatment may be recommended for haemorrhoids that become very enlarged, protrude from the anus (prolapse), bleed frequently, or contain blood clots (thrombosis). Common procedures include freezing the affected tissue (cryotherapy), injecting chemicals into the haemorrhoid to shrink it (sclerosing solutions), surgically removing the haemorrhoid (hemorrhoidectomy), or placing rubber bands around the haemorrhoid for removal (ligation).

Vitamins that may be helpful

A number of flavonoids have been shown to have anti-inflammatory effects and/or to strengthen blood vessels. These effects could, in theory, be beneficial for people with haemorrhoids. Most,⁵ ⁶ ⁷ ⁸ but not all,⁹ double-blind trials using a group of semisynthetic flavonoids (hydroxyethylrutosides derived from rutin) have demonstrated significant improvements in itching, bleeding, and other symptoms associated with haemorrhoids when people used supplements of 600–4,000 mg per day.

Other trials have evaluated Daflon, a product containing the food-derived flavonoids diosmin (90%) and hesperidin (10%). An uncontrolled trial reported that Daflon produced symptom relief in two-thirds of pregnant women with haemorrhoids.¹⁰ Double-blind trials have produced conflicting results about the effects of Daflon in people with haemorrhoids.¹¹ ¹² Amounts of flavonoids used in Daflon trials ranged from 1,000 to 3,000 mg per day. Diosmin and hesperidin are available separately as dietary supplements.

Some doctors recommend flavonoid supplements for people with haemorrhoids. However, many different flavonoids occur in food and supplements, and additional research is needed to determine which flavonoids are most effective against haemorrhoids.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Constipation is believed to worsen haemorrhoid symptoms, and thus, bulk-forming fibres are often recommended for those with haemorrhoids. A double-blind trial reported that 7 grams of psyllium, a herb high in fibre, taken three times daily reduced the pain and bleeding associated with haemorrhoids.¹³ Some healthcare professionals recommend taking two tablespoons of psyllium seeds or 1 teaspoon of psyllium husks two or three times per day mixed with water or juice. It is important to maintain adequate fluid intake while using psyllium.

Topically applied astringent herbs have been used traditionally as a treatment for haemorrhoids. A leading astringent herb for topical use is witch hazel,¹⁴ which is typically applied to haemorrhoids three or four times per day in an ointment base.

Horse chestnut extracts have been reported from a double-blind trial to reduce symptoms of haemorrhoids.¹⁵ Some doctors recommend taking horse chestnut seed extracts standardised for aescin (also known as escin) content (16–21%), or an isolated aescin preparation, providing 90 to 150 mg of aescin per day.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References

1. Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol 1994;89:1981–6.

2. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. Gastroenterology 1990;98:380–6.

3. Deutsch AA, Kaufman Z, Reiss R. Hemorrhoids: a plea for nonsurgical treatment. Isr J Med Sci 1980;16:649–54.

4. Alonso-Coello P, Mills E, Heels-Ansdell D, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:181–8.

5. Sinnatamby CS. The treatment of hemorrhoids. Role of hydroxyethylrutosides, troxerutin (Paroven; Varmoid; Venoruton). Clin Trials J 1973;2:45–50.

6. Clyne MB, Freeling P, Ginsborg S. Troxerutin in the treatment of haemorrhoids. Practitioner 1967;198:420–3.

7. Annoni F, Boccasanta P, Chiurazzi D, et al. Treatment of acute symptoms of hemorrhoid disease with high-dose oral O-(beta-hydroxyethyl)-rutosides. Minerva Med 1986;77:1663–8 [in Italian].

8. Wijayanegara H, Mose JC, Achmad L, et al. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 1992;20:54–60.

9. Thorp RH, Hughes ESR. A clinical trial of trihydroxyethylrutoside (“Varemoid”) in the treatment of hemorrhoids. Med J Aust 1970;2:1076–8.

10. Buckshee K, Takkar D, Aggarwal N. Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997;57:145–51.

11. Cospite M. Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology 1994;45:566–73.

12. Thanapongsathorn W, Vajrabukka T. Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 1992;35:1085–8.

13. Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. High-fiber diet reduces bleeding and pain in patients with hemorrhoids. Dis Colon Rectum 1982;25:454–6.

14. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 268–70.

15. Nini G, Di Cicco CO. Controlled clinical evaluation of a new anti-hemorrhoid drug, using a completely randomized experimental plan. Clin Ther 1978;86:545–59 [in Italian].

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01