Hemorrhoids: Overview

Hemorrhoids are swollen hemorrhoidal plexuses in and around the anus and lower rectum that stretch under pressure, similar to varicose veins in the legs.  Internal hemorrhoids are found just above the anal canal, while external hemorrhoids are usually visible under the skin around the anus.  The presence of external hemorrhoids suggests a good probability of internal hemorrhoids also.

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Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.  Although many people have hemorrhoids, not all experience symptoms.  In many cases, hemorrhoidal symptoms will go away within a few days, but recurrences are common unless predisposing conditions are improved.

Incidence; Causes and Development; Contributing Risk Factors

Hemorrhoids are very common, and in both men and women.  About half of the population have hemorrhoids by age 50.

Hemorrhoids appear to be due to the much loved 'Western Diet'.  Health problems following its introduction into cultures have been described as coming in stages.

  1. The primal diet of plant eaters contains large amounts of unprocessed starch staples; there are few examples of subsequently mentioned diseases.
  2. With the commencement of the westernization of diet, obesity and diabetes commonly appear in privileged groups.
  3. With moderate westernization of the diet, constipation, hemorrhoids, varicose veins, and appendicitis become common clinical entities.
  4. Finally, with full westernization of the diet, ischemic heart disease, diverticular disease, hiatal hernia, and cancer become prominent.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms.

Risk factors for hemorrhoids include: heredity, pregnancy, sedentary lifestyle, straining during bowel movements (chronic constipation), chronic diarrhea, standing for long periods of time, sitting on hard, cold surfaces, liver stagnancy or disease (cirrhosis), benign prostatic hypertrophy and anal intercourse.  For most women, however, those hemorrhoids caused by pregnancy are only a temporary problem.

Signs and Symptoms

The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl.  However, an internal hemorrhoid may protrude or prolapse through the anus outside the body, becoming irritated and painful.  This may require manual reduction or replacement back inside.  Mucus discharge may be associated with itching.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms.  This condition is known as a thrombosed external hemorrhoid.  External hemorrhoids tend to regress when internal hemorrhoids are treated.

Treatment and Prevention

The best way to prevent hemorrhoids is to 1) keep stools soft so they pass easily, thus decreasing pressure and straining, 2) to empty bowels as soon as possible after the urge occurs and 3) keep your veins strong.  Exercise, including walking, and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.  Good sources of fiber are fruits, vegetables, and whole grains.  Veins are strengthened by bioflavonoids.

Conventional medicine often will use either rubber band ligation (a rubber band is placed around the base of the hemorrhoid which cuts off circulation and withers the tissue away within a few days) or Sclerotherapy (a chemical solution is injected around the blood vessel to shrink the hemorrhoid).  Severe thrombosed external hemorrhoids may require surgical incision and clot removal.  Internal hemorrhoids may be treated with stool softeners, sitz baths, and cold applications.

Alternative medicine also offers some effective treatments like galvanic (Keesey treatment) and infrared cauterization.  Both are non-surgical outpatient procedures with high success rates and few complications.  Some naturopaths are doing these procedures.  In addition, make sure you are drinking enough water to stay fully hydrated.

The most effective agents, though harder to find are aortic GAGs (glycosaminoglycans) from highly purified bovine sources.  These contain dermatan sulfate, heparan sulfate, hyaluronic acid, chondroitin sulfate and other GAGs.  Two double-blind studies have compared aortic GAGs to bilberry and HER (a flavonoid preparation like rutin and citrus bioflavonoids).  The aortic extract produced far better results in both hemorrhoids and varicose veins.

Flavonoids strengthen connective tissue, especially capillaries.  They help keep tissues from falling apart.  Varicose veins, hemorrhoids, bleeding between periods, and lymphedema can be aided by flavonoids.  Anthocyanosides from bilberry (European bilberry) act more effectively than the common flavonoids rutin and hesperidin.  The herb horse chestnut and witch hazel (topically) have a long historical use.


  • HER 1,000 – 3,000mg per day (better than rutin and citrus bioflavonoids).
  • Bilberry (Vaccinium myrtillus) (25% anthocyanosides) 80-160mg tid.
  • Butcher's broom (Ruscus aculeatus) (9-11% ruscogenin) 100mg tid.
  • Horse chestnut (aesculus hippocastanum) extract for 50mg of escin per day.
  • Grape seed extract 100mg bid-tid.
  • Vitamin C 500-1,000gm tid with Bioflavonoids 3,000-6,000mg per day.

Some doctors are using different forms of iodine (SSKI or Lugol's) to help shrink and relieve the pain of hemorrhoids.  A drop, placed on a finger and massaged into the affected area, can be very effective, though it may sting temporarily.  Consider mixing 20 drops with an ounce of flax oil and storing it in the refrigerator.  Apply twice per day; rapid relief should be on the way.


  • Shark liver oil is the active ingredient in topical ointments such as Preparation H.
  • Ozonated Olive Oil has been used successfully in hemorrhoids, as well as many other conditions.
  • A goldenseal salve can be helpful for irritations of an itchy nature as found in hemorrhoids.
  • Vitamin K can help stop bleeding hemorrhoids.  Good dietary sources are: alfalfa, blackstrap molasses, and dark green leafy vegetables.  Vitamin K can be taken as a supplement also.

Seek medical attention if...

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool lasts more than a couple of days.  Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

Signs, symptoms & indicators of Hemorrhoids:

Symptoms - Bowel Movements

Symptoms - Gas-Int - General

Conditions that suggest Hemorrhoids:

Symptoms - Gas-Int - General

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Risk factors for Hemorrhoids:



The hemorrhoidal plexuses drain through veins without valves, so factors that increase the pressure inside these veins – such as straining while on the toilet – can lead to hemorrhoids.

Hemorrhoids suggests the following may be present:



Copper Deficiency

A copper deficiency has been associated with weakening of connective tissue that can be a contributing factor for the development of hemorrhoids.

Recommendations for Hemorrhoids:


High/Increased Fiber Diet

Both soluble and insoluble fibers are important in helping to maintain regular bowel movements.  Insoluble fiber prevents and manages problems like constipation and hemorrhoids by producing a larger softer stool that passes through the digestive system faster and more easily.


Oxygen/Oxidative Therapies

Ozone / Oxidative Therapy

Capsules filled with ozonated oil and used as suppositories, or rectal insufflation of ozone gas have proven useful in treating inflamed hemorrhoids.  Ozone can kill bacteria which may slow tissue healing.

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