Hemorrhoids -- What Are They?
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Hemorrhoids |
Also indexed as: Piles
Although the belief that hemorrhoids are caused by constipation has been questioned by researchers,2 most doctors feel that many hemorrhoids are triggered by the straining that accompanies chronic constipation.3 Therefore, natural approaches to hemorrhoids sometimes focus on overcoming constipation.
| Rating | Nutritional Supplements | Herbs |
|---|---|---|
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Fiber Flavonoids (hydroxyethylrutosides derived from rutin) |
Horse chestnut Psyllium Witch hazel |
| See also: Homeopathic Remedies for Hemorrhoids | ||
Reliable and relatively consistent scientific data
showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies
suggesting a health benefit or minimal health
benefit. An herb
is primarily supported by traditional use, or the
herb or supplement has little scientific support
and/or minimal health benefit. |
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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 hemorrhoids.9 Double-blind trials have produced conflicting results about the effects of Daflon in people with hemorrhoids.10 11 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 hemorrhoids. However, many different flavonoids occur in food and supplements, and additional research is needed to determine which flavonoids are most effective against hemorrhoids.
Topically applied astringent herbs have been used traditionally as a treatment for hemorrhoids. A leading astringent herb for topical use is witch hazel,13 which is typically applied to hemorrhoids 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 hemorrhoids.14 Some doctors recommend taking horse chestnut seed extracts standardized for aescin (also known as escin) content (16–21%), or an isolated aescin preparation, providing 90 to 150 mg of aescin per day.
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. Sinnatamby CS. The treatment of hemorrhoids. Role of hydroxyethylrutosides, troxerutin (Paroven; Varmoid; Venoruton). Clin Trials J 1973;2:45–50.
5. Clyne MB, Freeling P, Ginsborg S. Troxerutin in the treatment of haemorrhoids. Practitioner 1967;198:420–3.
6. 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].
7. 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.
8. Thorp RH, Hughes ESR. A clinical trial of trihydroxyethylrutoside (“Varemoid”) in the treatment of hemorrhoids. Med J Aust 1970;2:1076–8.
9. Buckshee K, Takkar D, Aggarwal N. Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997;57:145–51.
10. 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.
11. Thanapongsathorn W, Vajrabukka T. Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 1992;35:1085–8.
12. 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.
13. Wichtl M. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press, 1994, 268–70.
14. 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].
Copyright © 2001 Healthnotes, Inc. All rights reserved. www.healthnotes.com
Learn more about Healthnotes, the company.
Learn more about the authors of Healthnotes.
The information presented in Healthnotes Online 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 pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2002.
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Many people have small pouches in their colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum. Pouches (plural) are called diverticula. The condition of having diverticula is called diverticulosis. About half of all Americans age 60 to 80, and almost everyone over age 80, have diverticulosis. When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease. 
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What causes diverticular disease? |
Though not proven,
the dominant theory is that a low-fiber diet is the
main cause of diverticular disease. The disease was
first noticed in the United States in the early
1900s. At about the same time, processed foods were
introduced to the American diet. Many processed
foods contain refined, low-fiber flour. Unlike
whole-wheat flour, refined flour has no wheat bran. Diverticular disease is common in developed or industrialized countries--particularly the United States, England, and Australia--where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation. Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure might be the cause of the weak spots in the colon that bulge out and become diverticula. Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning. |
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What are the symptoms? |
DiverticulosisMost people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your doctor if you have these troubling symptoms. DiverticulitisThe most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications. |
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Are there complications? |
Diverticulitis can
lead to complications such as infections,
perforations or tears, blockages, or bleeding.
These complications always require treatment to
prevent them from progressing and causing serious
illness.BleedingBleeding from diverticula is a rare complication. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. Doctors believe bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary. Abscess, Perforation, and PeritonitisThe infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition gets worse, an abscess may form in the colon. An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes the infected diverticula may develop small holes, called perforations. These perforations allow pus to leak out of the colon into the abdominal area. If the abscess is small and remains in the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it. To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin and drains the fluid through the catheter. This procedure is called percutaneous catheter drainage. Sometimes surgery is needed to clean the abscess and, if necessary, remove part of the colon. A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal. FistulaA fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula forms. When diverticulitis-related infection spreads outside the colon, the colon's tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin. The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon. Intestinal ObstructionThe scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned. |
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How does the doctor diagnose diverticular disease? |
To diagnose
diverticular disease, the doctor asks about medical
history, does a physical exam, and may perform one
or more diagnostic tests. Because most people do
not have symptoms, diverticulosis is often found
through tests ordered for another ailment.
When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection. The doctor may also order x rays or other tests. |
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What is the treatment for diverticular disease? |
A high-fiber diet
and, occasionally, mild pain medications will help
relieve symptoms in most cases. Sometimes an attack
of diverticulitis is serious enough to require a
hospital stay and possibly surgery.DiverticulosisIncreasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20 to 35 grams of fiber each day. The table below shows the amount of fiber in some foods that you can easily add to your diet. Amount of Fiber in Some Foods
Source: United States Department of Agriculture (USDA). USDA Nutrient Database for standard reference. Available at www.nal.usda.gov/fnic/cgi-bin/nut_search.pl. Accessed September 19, 2001. The doctor may also recommend taking a fiber product such as Citrucel or Metamucil once a day. These products are mixed with water and provide about 2 to 3.5 grams of fiber per tablespoon, mixed with 8 ounces of water. Until recently, many doctors suggested avoiding foods with small seeds such as tomatoes or strawberries because they believed that particles could lodge in the diverticula and cause inflammation. However, this is now a controversial point and no evidence supports this recommendation. Individuals differ in the amounts and types of foods they can eat. If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, many medications affect emptying of the colon, an undesirable side effect for people with diverticulosis. DiverticulitisTreatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early. To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever. An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary. |
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When is surgery necessary? |
If attacks are severe
or frequent, the doctor may advise surgery. The
surgeon opens the abdomen and removes the affected
part of the colon. The remaining sections of the
colon are rejoined. This type of surgery, called
colon resection, aims to keep attacks from coming
back and to prevent complications. The doctor may
also recommend surgery for complications of a
fistula or intestinal obstruction. If antibiotics do not correct the attack, emergency surgery may be required. Other reasons for emergency surgery include a large abscess, perforation, peritonitis, or continued bleeding. Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. The surgeon creates a temporary hole, or stoma, in the abdomen during the first operation. The end of the colon is connected to the hole, a procedure called a colostomy, to allow normal eating and bowel movement. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon. |
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Points to remember |
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Additional readings |
Diverticular disease.
In: King JE, ed. Mayo Clinic on Digestive Health.
Rochester, MN: Mayo Clinic; 2000:125-132. StayWell Company. Diverticulosis and diverticulitis: Understanding and managing two common colon problems. [Diverticulosis y diverticulitis: Como entender y controlar problemas comunes del colon]. San Bruno, CA: StayWell Company; 1999. Brochure. Stollman NH, Raskin JB. Diverticular disease of the colon. Journal of Clinical Gastroenterology. 1999;29(3):241-252. |
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Other resources |
International
Foundation for Functional Gastrointestinal
Disorders (IFFGD), Inc. P.O. Box 170864 Milwaukee, WI 53217-8076 Phone: 1-888-964-2001 or (414) 964-1799 Fax: (414) 964-7176 Email: iffgd@iffgd.org Internet: www.iffgd.org The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory. |
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National Digestive Diseases Information Clearinghouse
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired. |
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NIH Publication No.
02-1163 January 2002
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