What are haemorrhoids?
Haemorrhoids are dilated veins in the lower rectum. They can be considered external, whereby they are visible on the outer surface of the anus, or internal, whereby they are present just inside the anal area. Haemorrhoids are also called 'piles.'
What are the symptoms?
Common symptoms include bleeding, itching and pain. Often haemorrhoids don't have any symptoms.
If they become what is called 'thrombosed', or filled with a blood clot, external haemorrhoids can be very painful and form a purplish swelling.
Sometimes, when the clot has dissolved, 'skin tags' or loose skin can remain, and this may cause further problems with irritation and hygiene. Most of the symptoms of haemorrhoids occur because of enlarged internal haemorrhoids, rather than the external variety.
Bleeding due to haemorrhoids is bright red in colour, and most commonly occurs due to the internal type. The blood may be noticed on toilet paper, or may be passed into the toilet with a bowel movement. Darker blood, or blood mixed in with the stool may indicate that it is from further up the digestive tract than the rectum. In this case, it is very important to have it investigated by a healthcare professional to rule out a more serious condition.
Internal haemorrhoids may be uncomfortable and they can cause mucus discharge and a feeling of incomplete evacuation in some people. Occasionally haemorrhoids become 'strangulated', whereby the blood supply is cut off due to protrusion and constriction. This can occasionally cause tissue death and ulceration.
What causes haemorrhoids?
The exact cause, or causes, of haemorrhoids has not been established. There are, however, many commonly agreed on risk factors, which include:
- inadequate fibre intake
- sitting on the toilet for a long time
- standing for long periods (eg. at work)
- chronic straining to pass a bowel movement
- chronic constipation
- diarrhoea
- pregnancy
- childbirth
- genetic factors
- obesity
- ageing
How common are they?
Haemorrhoids are relatively common, but their true prevalence is unknown. Not all people with haemmorhoids seek medical attention, and many healthcare professionals and patients alike attribute any anorectal symptom to haemmorhoids.
Prevention
The following practices may help to prevent haemorrhoids:
- High fibre diet – eat a diet high in fruits, vegetables and whole grains. Increased fibre in the diet helps to soften and bulk the stool and reduce the need for straining.
- Adequate fluid consumption – try to consume at least 2 litres of water or herbal tea daily.
- Fibre supplements – adding extra fibre to your diet may help. Choose soluble fibres such as psyllium and slippery elm.
- Exercise regularly – regular exercise helps to reduce constipation.
- Avoid standing or sitting for long periods – standing or sitting for too long can put pressure on veins, especially when sitting on the toilet.
- Avoid straining on the toilet – holding your breath or straining when passing a bowel motion increases pressure on veins and may contribute to haemorrhoids.
Natural treatment options
Witchhazel distillate or tincture
Witchhazel has a long tradition of haemmorhoid treatment and is widely recognised for its tannins and astringent and haemostatic properties which makes it a great choice for haemorrhoid treatment. It can be applied directly to the rectum after each bowel motion using a cotton ball or damp tissue.
Sitz bath
A sitz bath, a type of bath in which the hips and buttocks are soaked in warm water, may provide effective symptom relief. Dried herbal remedies that are soothing and healing such as chamomile and calendula can be added to the bath water for added benefit.
Grape seed extract and horse chestnut may also be recommended as natural remedies to assist with haemorrhoids, but there is insufficient evidence for their efficacy.[11,12]
Flavonoids
Flavonoids (eg. rutin, hesperidin) are a type of natural antioxidant compound found in plants. The 'American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids' refers to the effective relief of haemorrhoidal symptoms in clinical trials using supplementary flavonoids.
References available on request