Hemorrhoids

In 1815, Napoleon's troops were trounced by the British and Prussians at Waterloo. How could a brilliant strategist like Napoleon go down to such stunning defeat? History is mum, but legend suggests that the one-time French emperor may have had something other than warfare on his mind. As the story goes, he was suffering from a particularly painful-and clearly ill-timed­bout of hemorrhoids.

Hemorrhoids are varicose veins that develop around or inside the anus. Three veins are responsible for draining blood away from the anal area, explains Anne Simons, M.D. Normally, these veins expand during bowel movements, then shrink afterward. But if you repeatedly strain while defecating, the veins become permanently swollen.

As the swelling triggers pain nerves in the anal area, you start hurting. The swelling also weakens blood vessels in the anal area, making them more likely to rupture when you move your bowels. You may notice faint pink streaks of blood when you wipe-or bright red blood in the toilet or on your underwear.

Having hemorrhoids makes you a member of an enormous, uncomfortable club. An estimated one-third of American adults-some 80 million people-develop hemorrhoids and the rectal pain and bleeding that go With them. For about 9 million Americans, hemorrhoids become a chronic problem, creating discomfort during ordinary activities such as sitting and walking. In fact, anything that causes tightening of the muscles in the anal area-even sneezing and laughing-can aggravate symptoms.

Most people who develop hemorrhoids also have another common ailment: constipation. "Constipation is the underlying cause of hemorrhoids," says Alan Gaby, M.D. "The low-fiber diet that so many Americans eat produces smaller, denser, harder stools, which are difficult to pass. You have to strain to pass them, and when you do, you get hemorrhoids."

As the risk of constipation increases with age, so does the risk of hemorrhoids. But diet isn't solely to blame. "Compared with younger adults, older adults tend to get less exercise and drink less fluid, both of which contribute to constipation," Dr. Simons explains. "What's more, older people generally lose rectal muscle tone over time. They have to strain more to move their bowels, which makes them more likely to develop hemorrhoids."

For especially severe hemorrhoids, mainstream M.D.'s may recommend surgery. Milder cases usually respond well to a combination of alternative therapies, home remedies, and over-the-counter drugs. You have plenty of treatment options from which to choose.

Best Choices

Nutrition

Treat your veins berry well. Blueberries, blackberries, and cherries are rich in compounds that strengthen the walls of veins, including those in the anal area, says Joseph Pizzorno Jr., N.D. The stronger the veins become, the less likely they are to turn varicose. As a bonus, berries are high in fiber, which helps prevent constipation. Enjoy these fruits fresh, frozen, or canned.

Herbal Medicine

Wipe with witch hazel. According to James A. Duke, Ph.D., witch hazel is a soothing, cooling astringent that helps relieve hemorrhoid pain. In fact, it's the active ingredient in several over-the-counter hemorrhoid products, including Rantex Medicated Personal Cloth Wipes and Tucks Hemorrhoidal Pads. "But you don't have to spend extra for a brand-name product to benefit from witch hazel," he says. "Just buy witch hazel water in a drugstore and apply it to your hemorrhoids with a small cloth or cotton balls."

Allay pain with aloe. The gel inside the fleshy leaves of the aloe plant has astringent properties that help ease hemorrhoid pain, Dr. Duke says. In fact, the gel is such a versatile healer that you may want to consider keeping an aloe plant in your home. Then when you're bothered by hemorrhoids, just snip off a leaf, slit it open, and scoop out the gel. Apply it directly to the affected area.

If you don't have an aloe plant handy, you can use one of the commercial aloe gels that are sold in drugstores. Make sure that the label says "100 percent aloe gel" or something similar.

Buy a new broom. The root of butcher's broom, an herb native to the Mediterranean region, has a long history as a treatment for hemorrhoids. It remains a popular remedy in Europe, and with good reason. Butcher's broom contains compounds called ruscogenins, which reduce inflammation and help constrict distended veins.

Dr. Pizzorno suggests taking 100 milligrams of butcher's broom extract three times a day. Look for an extract that supplies 9 to 11 percent ruscogenins. If you can't find one in a health food store, check with a naturopath.

Sip kola. A medicinal herb that's native to India, gotu kola is a well-established hemorrhoid remedy. Dr. Pizzorno recommends taking 30 milligrams of gotu kola extract three times a day. Make sure that the extract you use contains 70 percent triterpenic acid, the compound that gives gotu kola its therapeutic powers. If you can't find such an extract in a health food store, you may be able to get one from a naturopath.

Get serious about psyllium. "Several studies have shown that bulk-forming fibers such as psyllium significantly reduce hemorrhoid pain, itching, and bleeding," Dr. Pizzorno says.

Psyllium is the active ingredient in many commercial laxatives, including Fiberall and Metamucil. You can use one of these products, following the package directions, or you can buy psyllium seed in a health food store. Dr. Duke suggests taking the herb three times a day, adding 3 to 5 teaspoons to water or juice. Whenever you take a dose of psyllium, be sure to drink at least one 8­ounce glass of water, too.

Home Remedies

Put your hemorrhoids on ice. Dr. Simons recommends treating swollen, inflamed hemorrhoids with an ice pack. The ice helps shrink swollen tissue, and the cold is soothing. To make your own ice pack, put some ice in a plastic bag and wrap the bag in a thin cloth. Apply the pack to the affected area for 20 minutes, then remove for 10 minutes before repeating. Continue this 20-minutes-on, 10-minutes-off cycle for as long as necessary.

Never put ice directly on your skin or leave it on for more than 20 minutes, Dr. Simons cautions. You could give yourself frostbite.

Control constipation. Because constipation is the leading cause of hemorrhoids, just taking steps to get things moving can keep you hemorrhoid-free. Above all else, eat a high-fiber diet featuring primarily whole grains, legumes, fruits, and vegetables.

Take care of business. The longer you sit on the toilet, the more stress you put on your anal veins-even if you're not straining to move your bowels. So enter the bathroom with a singular objective: to heed nature's call. Leave the newspaper and other reading materials outside.

Act natural. When you're on the toilet, try to relax and let things happen. Avoid straining or bearing down, advises Alan P. Brauer, M.D. Straining places considerable pressure on tender anal veins.

Squat when you sit. If you have trouble moving your bowels, try putting your feet on a small footstool when you sit on the toilet. You're in more of a squatting position, which helps many people go, Dr. Simons says.

Pick the right paper. Toilet paper often contains perfumes and dyes, which can irritate hemorrhoids. Stock unscented white paper in your own bathroom, and carry unscented white facial tissues to use when you're away from home. Also, always wipe with restraint.

Stretch your legs. Hemorrhoids are an occupational hazard of people whose jobs require them to sit for long periods. If you work sitting down, get up and walk around every hour or as often as you can, Dr. Gaby says.

Park your duff on a doughnut. For greater comfort while you're sitting, outfit your chair with an inflatable doughnut­shaped cushion.

Other Good Choices

Visualization

See 'em shrivel. For people with hemorrhoids, psychiatrist Gerald N. Epstein, M.D., director ofthe Academy of Integrative Medicine and Mental Imagery in New York City, recommends the following visualization exercise: Close your eyes and breathe deeply three times. While continuing to breathe deeply, see your hemorrhoids slowly shriveling up and disappearing. Picture your anal wall becoming smooth and healthy. Open your eyes. Practice this visualization for a minute or two every waking hour until your hemorrhoids heal.

Homeopathy

Attack from the inside or outside. A number of homeopathic medicines are effective treatments for hemorrhoids, says homeopath Dana Ullman. These include Aesculus, Hamamelis, Nux vomica, and Sulfur. Aesculus Hamamelis Collinsonia (ARC) is available as a topical ointment. Which of these will work best for you depends on your symptoms. Consult a homeopath.

Chinese Medicine

Cool off. Chinese medicine teaches that too much food in the gut causes an overaccumulation of Heat. When your Blood gets too hot, your anal veins swell and bleed to release the excess Heat.

Practitioners of Chinese medicine treat hemorrhoids with cooling foods, especially raw fruits and vegetables. In addition, they may prescribe cooling herbs such as rhubarb, skullcap root, coptis root, gardenia buds, and philodendron rhizome. Cooling beverages such as water, peppermint tea, and licorice tea can also help, says Efrem Korngold, O.M.D., L.Ac. To make the tea, add 1 to 2 teaspoons of dried peppermint or licorice leaves to 1 cup of boiled water. Steep for 10 minutes, then strain and drink.

Recharge your qi. For acupressure treatment, simply apply steady, penetrating finger pressure at each of the following points for 3 minutes.

• Governing Vessel 20, located on top of your head, where a line drawn from ear to ear would intersect with the midline of your body
• Stomach 36, located four finger-widths below your kneecap and one finger­width toward the outside of your shinbone
• Bladder 57, located in the middle of your calf, halfway between your knee crease and heel
• Large Intestine 11, located at the outer end of your elbow crease on the thumb side

If your hemorrhoids don't improve with acupressure treatment, consider consulting an acupuncturist instead. Professional needle stimulation of the same points may help when finger stimulation doesn't.

Ayurvedic Medicine

Defer to your dosha. In Ayurveda, the course of treatment for hemorrhoids is determined by your constitutional type, or dosha, explains David Frawley, O.M.D. For people with Vata doshas, he prescribes buttermilk, cumin, ginger, turmeric, and warm sesame oil. People with Pitta doshas often benefit from turmeric, barberry, and neem, but they should avoid members of the night­shade family, including tomatoes, potatoes, eggplant, and peppers. For people with Kapha doshas, treatment centers on ginger, bayberry, calamus, and pepper.

Swallow an unusual juice. Ayurvedic physicians recommend aloe juice as a stool­softening laxative. You can buy the juice in most health food stores. Follow the package directions for proper use. But experts caution against trying to make your own aloe juice. The leaves contain powerful compounds that can cause severe abdominal cramps.

Naturopathy

Spend some time submerged. Sitz baths, in which you immerse your posterior region in tolerably hot water, can relieve the discomfort of hemorrhoids and speed the healing process, Dr. Pizzorno says. He recommends taking 20-minute sitz baths a few times a day.

Over-The-Counter Drugs

Butter your butt. Cocoa butter soothes irritated hemorrhoids. It's an ingredient in several over-the-counter hemorrhoid products, including Anusol and Preparation H.

Numb the discomfort. Many over-the­counter hemorrhoid products-including Hemorid and Lanacane Creme-contain anesthetics. The problem with anesthetics is that some people are sensitive to them.

If you try a hemorrhoid product that's made with anesthetics and your itching or burning gets worse, stop using the product and try another remedy.

Medical Measures

For severe hemorrhoids, surgical removal may be the only way to get relief. If you have only a few hemorrhoids and they're easily accessible, a procedure called rubber band ligation may work. The surgeon wraps special elastic bands around the hemorrhoids, which cuts off their blood supply. Eventually, they fall off. But they may come back if you continue to strain at stool because of constipation.

Red Flags

Consult your doctor immediately if you have hemorrhoids and you experience any of the following:

• Significant anal bleeding
• Dark blood in your stools
• Significant, persistent fecal incontinence, indicated by brown spots on your underwear
• Increased pain