Although they aren't life-threatening, hemorrhoids may be painful and affect your daily activities.1 They more often affect adults from 45 to 65 years old, but younger adults and children may experience them as well. While they are common in both women and men, women have an increased risk during pregnancy, due to the pressure of carrying the baby and straining during delivery.2
In one retrospective study3 using reimbursement claims data from 33,034 patients in Taiwan, researchers evaluated the relationship between hemorrhoids and the subsequent development of coronary heart disease. Over a 12-year follow-up, the researchers found those with hemorrhoids experienced a 127% higher risk of coronary heart disease compared to those without hemorrhoids.
According to the National Institute of Diabetes and Digestive and Kidney Diseases,4 it's estimated half the people in the U.S. will have hemorrhoids by age 50. Aside from age and pregnancy, other risk factors for developing hemorrhoids include activities that increase your abdominal pressure, such as straining during a bowel movement, lifting heavy objects, obesity or sitting on the toilet for long periods of time.5,6
What Are Hemorrhoids?
To understand how to prevent hemorrhoids and why these tips help alleviate the pain and discomfort associated with them, it's helpful to know exactly what hemorrhoids are and how they are formed.
Inside the anus and lower rectum are veins. When those inside the wall of the rectum or anus become swollen or inflamed they are called internal hemorrhoids. You can't usually see or feel these hemorrhoids, but if they become irritated from straining, you may experience bleeding.7
Hemorrhoids may also form under the skin around the anus, called external hemorrhoids.8 When these become irritated they cause itching or bleeding. In some cases, hemorrhoids may not cause symptoms or pain, and you won't be aware you have them unless a physician does an internal examination. When symptoms do occur, you may experience:9,10
- Bright red blood after passing stool in the toilet or on toilet tissue
- An itchy bottom
- A lump outside the anus, which may need to be pushed back after passing stool
- Redness, soreness and swelling around the anus
- Pain or achiness while sitting around your anus
Hemorrhoids are similar to varicose veins in your legs. In other words, the veins bulge and swell, sometimes in response to added abdominal pressure. At other times, you may not be able to identify a cause.11 The swelling causes irritation to the wall of the veins, and the subsequent symptoms.12
Top Tips to Relieve Hemorrhoid Pain at Home
When you are experiencing pain and discomfort from hemorrhoids, it's likely you'll want relief as quickly as possible. In some cases, your relief may be as close as your kitchen cabinet.
Use a bidet — Since hemorrhoids are irritated veins, using a bidet is an effective, less irritating and low-cost way to clean your backside after a bowel movement. If you don't have one installed at home now, there are several do-it-yourself kits that make installing one on your current toilet safe and simple.
Soften your stool — Since hemorrhoids are aggravated by straining during a bowel movement, it's important to keep your stool soft. An important strategy is eating enough dietary fiber. Fiber comes in two types: soluble, which easily dissolves in water, and insoluble, which doesn't dissolve but stays intact as it moves through your colon.
Both are important for digestion. I believe 50 grams of fiber for every 1,000 calories is ideal to maintain optimal health, but most Americans don't get nearly this much.13
Taking an organic psyllium dietary fiber supplement daily, which contains both soluble and insoluble fiber, may assist in softening your stool and has benefits for your cardiovascular system, weight control and blood sugar support.
Stay hydrated — Constipation results in hard dry stool that is difficult to pass and irritates your rectum. One of the more common causes is dehydration. Staying hydrated is a key component of optimal health and, according to a Harvard study,14 54.5% of children and adolescents are chronically dehydrated. This has repercussions for health and academic performance.
Urine concentration and color is one of the best ways to track your individual hydration status from day to day. Ideally you want to drink enough pure, filtered water to turn your urine a light-colored yellow. This may mean drinking more, or less, than the often-repeated eight 8-ounce glasses of water per day, giving your body enough fluid to properly form stool and detoxify waste products.
Try a potty stool — If you live in the U.S., it's likely you haven't put much thought into the best position to be in while having a bowel movement. However, sitting on a toilet is not the best position and may contribute to difficulty defecating, leading to hemorrhoids and other problems such as urologic disorders, rectal prolapse and anal fissures.15
Squatting places your digestive system in an anatomically correct position to improve elimination and reduce constipation. Squatting on top of the toilet requires strength, flexibility and balance. Another option is to use a simple footstool to help get into a squatting position.
Limit your time on the toilet — Sitting on the toilet for long periods of time places additional pressure on hemorrhoids, increasing irritation to the veins and, therefore, your symptoms. Limit your time on the toilet to only what is needed to complete your bowel movement.
Apply cool witch hazel — While there isn't scientific evidence for use, witch hazel has been a home treatment of choice for decades. The Cleveland Clinic16 reports it contains tannins and oils that may help bring down inflammation and some say it tightens the skin as a natural anti-inflammatory.17
Natural witch hazel is an astringent that helps the tissue shrink and has antioxidant properties, according to one study.18 It helps to reduce pain, itching and bleeding until the hemorrhoids fade, but provides only symptom relief and cannot speed healing.
Some find greater relief when the witch hazel is cooled in the refrigerator. Do not dilute witch hazel with alcohol as this may dry and irritate the tissue. Add a small amount to a cotton swab and dab the witch hazel on the hemorrhoid.
Aloe vera — Aloe vera has anti-inflammatory properties and some over-the-counter hemorrhoid creams and pads are impregnated with aloe vera to help soothe the inflammation of the engorged veins.
The Cleveland Clinic19 reports there is no current research available for its use with hemorrhoids, but aloe vera has demonstrated benefit for other inflammatory skin conditions, and they recommend trying it, provided it's pure aloe and not used in a cream or pad with other ingredients.20
Epsom and glycerin — This home treatment may help painful hemorrhoids and is simple to compound at home.21 Mix 2 tablespoons of Epsom salts with 2 tablespoons of glycerin. Place on a gauze pad over the painful area and leave it in place for up to 20 minutes. Repeat every four to six hours until the pain eases.
Coconut Oil — This natural moisturizer also has anti-inflammatory properties. Applying coconut oil may help reduce irritation and swelling and may help reduce your urge to scratch.22
Ice packs — Ice packs and cold compresses may help combat the pain, inflammation and swelling. Do not apply ice cubes directly to the skin; first wrap them in a small towel to prevent skin damage. Leave them in place for about 15 minutes and continue to use them every one or two hours until the pain subsides.
Loose fitting clothing — You may support healing by wearing loose-fitting clothes that don't rub the area. It helps to prevent the hemorrhoids from becoming irritated by excess sweat and reduces symptoms.
It's All in How You Sitz
The word sitz comes from the German verb "sitzen" mean which means "to sit."23 A sitz bath was also called a hip bath and is a type of soaking done to include only the hips and buttocks. The purpose was to speed healing for patients who had undergone rectal surgery, or experienced hemorrhoids, uterine cramps or prostate infections.24
Warm sitz baths are one of the easiest and effective ways to reduce the pain of hemorrhoids. They are a European tradition in which only the pelvis and abdominal area are submerged in water. Others have used a cool sitz bath to help reduce constipation or tone the muscles of the bladder or bowel.25
On some occasions, you may feel dizzy when getting up from a hot sitz bath, but when using them for hemorrhoids, the water should be warm and not hot. A sitz bath may help relieve the itching, irritation and spasms of the sphincter muscle occurring with pain from hemorrhoids.
Small plastic portable tubs that fit over the toilet seat may be used, or you may use a regular bathtub with a few inches of warm water. Many experts recommend a 20-minute bath after each bowel movement, in addition to another two or three during the day to relieve hemorrhoids.26
Afterward, gently pat the area dry. Do not rub as it irritates the hemorrhoid. Alternatively, you may want to use the cool air from a hair dryer to dry the area. Soaking in mild temperature water helps to speed the healing process by boosting blood supply. It doesn't cure the condition, but it will help reduce irritation.
Refrain from adding shower gel, bubble bath or soap products to the water, as it can cause irritation.27 However, epsom salts in a sitz bath is soothing to the skin and helps reduce irritation and symptoms.
Don't Use These for Hemorrhoid Pain
In addition to the methods of reducing pain listed above, there are a few things you should avoid doing as they increase your symptoms and discomfort. As mentioned above, steer clear of using any soap products on the area as it dries the skin and increases the risk of bleeding.
Additionally, commercial baby wipes and perfumed toilet paper are irritating and may increase itching and pain. While some have considered using apple cider vinegar, the Cleveland Clinic28 recommends avoiding this as it may burn irritated skin and exacerbate problems over time.
Since there are several other natural strategies to reduce symptoms, it's wise to steer clear of apple cider vinegar. Tea tree oil is another antiseptic and anti-inflammatory essential oil some recommend to decrease symptoms. However, as this strategy hasn't been well studied, experts recommend avoiding it.29
Do not wait to have a bowel movement.30 When you prolong the urge to defecate there's a tendency the stool will become harder and more difficult to pass. This increases pressure, straining and the symptoms of hemorrhoids. Instead, consider setting up a schedule to help establish regular bowel habits. When your hemorrhoids are inflamed and irritated, it's best to avoid blood thinning medications, such as aspirin, if it all possible, as they increase the risk of bleeding.31
Nonsurgical Hemorrhoid Relief
There are several types of nonsurgical treatments your physician may use to get rid of hemorrhoids. Before undergoing any of them, discuss the pros and cons of each with your physician and be sure you are comfortable with your decision.
One of my favorite preventives is the use of the polyphenolic bioflavanoid rutin which is a more potent derivative of quercetin. It works to heal hemorrhoids naturally by stabilizing and tightening the walls of blood vessels.
•Rubber band ligation — This procedure is used in the doctor's office to treat prolapsing or bleeding internal hemorrhoids.32 During the procedure, a specialized rubber band is placed at the base of the hemorrhoid, which cuts off the blood supply. Within a week, the banded area shrivels and falls off, leaving scar tissue.
While this procedure has the lowest risk of recurrence, it is not suitable for those using anticoagulant medications or who have a bleeding disorder.33 It may also lead to increased bleeding, pain and blood clots or infections. If you have several hemorrhoids, the procedure will need to be repeated. Specialized equipment is used, and the physician will monitor your condition; you should never attempt to do this at home.34
• Infrared coagulation — This procedure may be used to address small hemorrhoids. The physician will use a tool that directs infrared light.35 The heat causes scar tissue to form, which eliminates the blood supply and usually shrinks the hemorrhoid. A local anesthetic will be used to reduce your discomfort. With multiple hemorrhoids, you may require multiple treatments. The recovery period takes several days and care must be taken to reduce constipation and straining to prevent reopening the scar.
• Sclerotherapy — During this procedure the physician injects a solution directly into the hemorrhoid, triggering a local reaction and ultimately shrinking the hemorrhoid. The procedure is effective and safe for those with cirrhosis who have bleeding hemorrhoids, and is preferred over banding in this case.36
Despite treatment, there's a risk the hemorrhoids will return after a few years and some experts believe this procedure to be less effective than a rubber band ligation.37
When to See Your Doctor
In most cases, you'll be able to treat the symptoms of hemorrhoids at home using home remedies. However, you should seek medical care immediately if you experience severe anal pain and bleeding that may or may not be associated with abdominal pain, diarrhea or fever.38
Hemorrhoids may also progress to the point where they become thrombosed. In this situation the hemorrhoid is pushed outside of the anus and is filled with blood clots. This makes everyday activities exceedingly uncomfortable.
The symptoms are similar to hemorrhoids, but the pain and itching will increase, as will the swelling around the anus. Thrombosed hemorrhoids may also become infected and can lead to an abscess, which causes additional symptoms such as fever.39
Acutely thrombosed external hemorrhoids may require additional treatment from your physician. In some cases, they will resolve on their own, but in others it may require surgical intervention, especially if they become strangulated and the tissue begins to die (necrosis).40
The severity of the pain is most intense within the first 48 hours and will usually gradually resolve. As a result, surgical removal is usually offered with severe pain within the first 48 hours, and then only if the hemorrhoid progresses to strangulation and necrosis.41
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