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General practitioner
Although hemorrhoids are not life-threatening, they can be very painful and have a significant impact on your everyday life. They most commonly affect adults between the ages of 45 and 65, but younger adults and children can also suffer from them. Hemorrhoids affect both women and men. Women are at an increased risk during pregnancy, as the baby exerts a lot of pressure or there is a lot of strain as a result of the birth process.
In a retrospective study in which researchers evaluated the reimbursement claims of 33,034 patients in Taiwan, they found a link between hemorrhoids and coronary heart disease, which subsequently developed. The scientists then conducted a follow-up study over a 12-year period and found that people with hemorrhoids had a 127 percent higher risk of coronary heart disease than people without hemorrhoids.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, half of the population in the United States will develop hemorrhoids by the age of 50. Other risk factors for hemorrhoids besides age and pregnancy are activities that increase abdominal pressure, such as straining during bowel movements, lifting heavy objects, obesity or sitting on the toilet for long periods of time.
Before we look at treatment options, let's first explain what hemorrhoids actually are and how they develop.
There are veins inside the anus and in the lower rectum. As soon as the veins inside the rectum or anus become inflamed or swollen, this is referred to as internal hemorrhoids. You cannot normally see or feel these. However, bleeding can occur if the hemorrhoids are irritated by strain.
Hemorrhoids can also form under the skin around the anus, known as external hemorrhoids. If these become irritated, they cause itching or bleeding. Some people have hemorrhoids and suffer no symptoms or pain. In this case, you will only find out if your doctor carries out an examination.
However, hemorrhoids are usually accompanied by the following symptoms:
Hemorrhoids are very similar to varicose veins in the legs. The veins bulge and swell, often in response to increased pressure from the abdomen. Sometimes, however, no cause can be identified. The swelling causes irritation to the vein wall, which triggers the symptoms just mentioned.
Everyone who suffers from pain and discomfort due to hemorrhoids wants quick relief. You can implement these tips practically from home.
Hemorrhoids are irritated veins. Using a bidet is an effective, soothing and inexpensive way to clean the anus after a bowel movement. If you don't have a bidet in your bathroom, you can easily install one on your toilet using a do-it-yourself kit.
Hemorrhoids are aggravated by straining during bowel movements. You should therefore ensure that your stools are as soft as possible. You can make an important contribution to this by eating enough fiber.
There are two types of dietary fiber:
Both are important for our digestion. Ideally, you should consume 50 g of fiber per 1,000 kcal for optimal health. Most people in industrialized countries do not even come close to reaching this value.
Take psyllium husks (psyllium) every day. These contain both soluble and insoluble fiber and can ensure soft stools. They also strengthen the cardiovascular system and contribute to weight control and blood sugar regulation.
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Constipation leads to hard, dry stools that are difficult to pass and irritate your rectum. One of the most common causes of constipation is dehydration. Adequate fluid intake is a key factor in optimal health. According to a Harvard University study, 54.5% of all children and adolescents are chronically dehydrated. This has an impact on health and even academic performance.
You can read your hydration status from your urine concentration and color. Ideally, drinking enough pure, filtered water is enough to turn your urine a pale yellow. This may mean that you need to drink more or less than the often-promoted eight large glasses of water (250 ml each) to provide your body with enough fluid it needs to form stools and detoxify waste products.
In many industrialized countries, people give little thought to whether they are in nature's intended position when using the toilet. Sitting on a toilet is not the best position and can contribute to difficulty passing stools, which can lead to hemorrhoids and other problems such as urological disorders, rectal prolapse and anal fissures.
The squatting position brings your digestive system into an anatomically correct position. This facilitates elimination and reduces constipation. Squatting on the toilet requires strength, flexibility and good balance. Use a simple footstool to adopt a squatting position on the toilet.
Sitting on the toilet for long periods of time puts extra pressure on the hemorrhoids, irritating the veins even more and increasing your symptoms. Keep your time on the toilet to a minimum and only sit as long as necessary to finish your bowel movement.
Although there is no scientific evidence of its effectiveness, witch hazel has been used for decades as a proven home remedy for the treatment of hemorrhoids. The Cleveland Clinic reports that witch hazel contains tannins and oils that have an anti-inflammatory effect. Some even claim that witch hazel can tighten the skin.
According to a study, natural witch hazel has astringent and antioxidant properties. Astringent means that the tissue can contract or shrink. The plant thus helps to reduce pain, itching and bleeding until the hemorrhoids gradually fade. However, it only relieves the symptoms and does not speed up the healing process.
The cooling effect is enhanced if you store the preparation in the refrigerator before use. Do not dilute witch hazel with alcohol, as this can dry out and irritate the tissue. Apply a small amount to a cotton bud and dab the solution onto your hemorrhoids.
Aloe vera has anti-inflammatory properties. Some over-the-counter haemorrhoid creams and pads contain aloe vera and can therefore relieve inflammation of the blocked veins.
According to the Cleveland Clinic, there are no research results to date on the effectiveness of aloe vera for hemorrhoids. However, the benefits of aloe vera have been confirmed for other inflammatory skin conditions. In this respect, you should simply give the plant a try, provided that it is pure aloe vera and not simply an ingredient in a cream or on a pad with other, possibly irritating ingredients.
This home remedy is suitable for treating painful hemorrhoids and is easy to make and use at home. Mix 2 tablespoons of Epsom salt with 2 tablespoons of glycerine. Put the mixture on a gauze swab and place it on the painful area. Leave the mixture on for up to 20 minutes. Repeat the application every four to six hours until the pain subsides.
This natural moisturizer has anti-inflammatory properties. Coconut oil can reduce irritation and swelling and reduce the urge to scratch.
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Ice packs and cold compresses can help to reduce pain, inflammation and swelling. However, never place ice cubes directly on the skin, but wrap them in a small towel first to prevent skin damage. Cool the inflamed areas in this way for about 15 minutes. Repeat the process every one to two hours until the pain subsides.
You can support the healing process by wearing loose-fitting clothing that does not rub. In this way, the hemorrhoids are not irritated by excessive perspiration and the symptoms are alleviated.
In the past, sitz baths were also known as hip baths. Only the hips and buttocks were bathed. This was intended to speed up the healing of patients recovering from rectal surgery or suffering from hemorrhoids, uterine cramps or prostate infections.
Warm sitz baths are in fact one of the simplest and most effective ways to relieve the pain of hemorrhoids. In Europe, sitz baths have a long tradition. Only the pelvis and abdominal area are in the water. Cooling sitz baths are used to relieve constipation or to tighten the bladder or bowel muscles.
Some people suffer from dizziness for a short time after a hot sitz bath. For sitz baths for haemorrhoids, however, the water should be warm and not hot anyway. A sitz bath can help to relieve the itching, overall irritation and spasms of the sphincter muscle that occur with pain caused by haemorrhoids.
For example, use small portable plastic tubs that fit on the normal toilet seat or simply fill your bathtub a few centimetres high with warm water. Many experts recommend a 20-minute sitz bath after each bowel movement and an additional two or three per day to relieve hemorrhoids.
After the bath, gently pat the area dry. Do not rub, as this will irritate the hemorrhoids. Alternatively, you can also use a hairdryer with a cold blower to dry the area. Soaking the hemorrhoids in warm water promotes blood circulation and thus helps to speed up the healing process. This will not cure the condition, but it will alleviate irritation.
Do not add shower gel, bubble bath or soap products to the water as this can cause irritation. Alternatively, you can use Epsom salt. This soothes the skin and helps to relieve irritation and symptoms associated with hemorrhoids.
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You have now learned about various options for relieving the pain and symptoms of haemorrhoids. However, the following remedies are not among them and should be avoided if possible. In the worst case, they can make the symptoms worse. As already mentioned, you should avoid all products containing soap. These dry out the skin and increase the risk of bleeding.
In addition, commercially available baby wipes and perfumed toilet paper also cause irritation and can increase itching and pain in the anal area. The use of apple cider vinegar is sometimes recommended. However, the Cleveland Clinic makes it clear that apple cider vinegar can burn the irritated skin and further aggravate the symptoms.
There are plenty of other options available to you, so you should not use apple cider vinegar. Tea tree oil is also repeatedly mentioned as a possible remedy. This is an antiseptic and anti-inflammatory essential oil that is said to alleviate the symptoms. However, there are no scientific studies on this method, so experts recommend not using tea tree oil.
Do not delay your bowel movements. If you ignore the urge to have a bowel movement, the stool will continue to harden and will be difficult to pass. This further increases the pressure on the hemorrhoids and the symptoms increase. Instead, try to develop a routine so that you empty your bowels regularly. If you have inflamed or irritated haemorrhoids, you should avoid blood-thinning medication such as aspirin, as this increases the risk of bleeding.
There are several non-surgical options available to your doctor to treat your hemorrhoids. Before deciding on an option, please discuss the pros and cons of each procedure with your doctor and make sure you are happy with your decision.
This procedure is used in the doctor's office to treat prolapsing or internal hemorrhoids. A special rubber band is wrapped around the hemorrhoid, cutting off the blood supply to the area. Within a week, the banded area shrinks and falls off, leaving behind scar tissue.
This procedure has the lowest risk of recurrence. However, it is not suitable for those who have to take anticoagulant medication or suffer from a bleeding disorder. This may result in increased bleeding, pain, blood clots or infection. This procedure must be repeated for each individual hemorrhoid. The doctor will use special equipment and monitor your condition the whole time. You should never attempt this on your own at home.
This procedure can be used to treat small hemorrhoids. The doctor uses a tool that emits infrared light. The heat causes scar tissue to form. The blood supply to the hemorrhoid is interrupted so that it begins to shrink. The doctor usually uses a local anesthetic to relieve pain during the treatment. If there are several hemorrhoids, several treatment appointments are often necessary. The recovery phase lasts several days. During this time, the patient must take care to reduce strain and pressure. They should also avoid constipation as much as possible to prevent the scar from reopening.
In this procedure, the doctor injects a solution directly into the hemorrhoid. The injection triggers a local reaction and causes the hemorrhoid to shrink. The procedure is effective and safe for anyone suffering from cirrhosis and bleeding hemorrhoids. Rubber band ligation is not normally recommended for these patients.
Despite the treatment, there is a risk that the hemorrhoids will return after a few years. Some experts are also of the opinion that this procedure is less effective than rubber band ligation.
In most cases, you can treat the symptoms of hemorrhoids yourself with home remedies. However, if you experience severe pain in and around the anus as well as bleeding that may be accompanied by abdominal pain, diarrhea or fever, you should see a doctor immediately.
Hemorrhoids can progress in severity until they are thrombosed. In this situation, the hemorrhoids are pushed out of the anus and are filled with blood clots. This makes everyday life extremely unpleasant for those affected.
The symptoms are similar to those of hemorrhoids, but the pain and itching increase, as does the swelling around the anus. Thrombosed haemorrhoids can also become infected and lead to an abscess, which causes additional symptoms such as fever.
Acutely thrombosed external hemorrhoids require medical treatment. In some cases they may resolve on their own, in others surgical intervention is required, especially if the hemorrhoids become strangulated and the tissue begins to die (necrosis).
The pain is most severe within the first 48 hours and then usually gradually subsides. Surgical intervention is therefore usually performed within the first 48 hours if the patient suffers from severe pain and the hemorrhoids are strangulated and cause necrosis.
Sources (in English):
Chang, S.S., Sung, F. C., Lin, C. L. & Hu, W. S. (2017, August). Association between hemrrhoid and risk of coronary heart disease. Medicine, 96(31): e7662, doi: 10.1097/MD.0000000000007662
Quagliani, D. & Felt-Gunderson, P. (2017, January-February). Closing America’s Fiber Intake Gap. American Journal of Lifestyle Medicine, 11(1): 80–85, doi: 10.1177/1559827615588079
Thring, T. S., Hili, P. & Naughton, D. P. (2011, October). Antioxidant and potential anti-inflammatory activity of extracts and formulations of white tea, rose, and witch hazel on primary human dermal fibroblast cells. Journal of Inflammation, 8: 27, doi: 10.1186/1476-9255-8-27
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