Hemorrhoids are a common concern I see in my practice. Where they can occur in those of all ages, hemorrhoids are more common in those 40-70 years of age.
What are hemorrhoids?
Hemorrhoids are swollen, dilated veins that protrude from the rectal wall. They can be located either internally or externally in the lower part of the rectum or anus.
What causes a hemorrhoid?
Although it’s hard to know the exact cause of hemorrhoids, we know that they flare with any undue pressure put on the digestive tract. This could include straining to pass a bowel movement, sitting too long on the toilet, intercourse, obesity, pregnancy, or childbirth. Other associations include a low fiber diet and pelvic floor dysfunction. (1)
How do I know if I have a hemorrhoid?
Some signs of hemorrhoids include:
Painless bleeding
Anal itching or pain
Sensation of a lump or bulging felt at the anus
Leaking of stool
Anemia
How do I manage hemorrhoids?
Lifestyle Interventions
Avoiding straining while on the toilet is one of the first things to work on if you’re prone to hemorrhoids. Also, consider waiting to defecate until an urge is present to prevent prolonged time on the toilet seat.
Warm soaks or sitzs baths can also provide relief to irritated anal tissue.
Dietary Interventions
Fiber intake is essential in promoting bowel movement regularity, and we know that low fiber intake has been associated with higher risk of hemorrhoids. Fibers are plant compounds that are not digestible by the secretions of the human digestive tract.
There are two main forms of dietary fiber: soluble and insoluble.
Soluble fibers refer to those that dissolve to form a gel-like consistency in water. They come from sources such as pectin, gums, and mucilage. These are particularly beneficial for balancing blood glucose and cholesterol levels, which can also support weight loss, cardiovascular health and cancer prevention. These are also known as prebiotics which are feed our intestinal bacteria and can accelerate bowel transit time.
Insoluble fibers refer to those that comprise of a plants outer shell that do not dissolve in water. These do not feed the gut flora, but are important in bulking the stool to promote healthy bowel movements. These fibers slow intestinal transit time and come from sources such as whole grains, nuts, seeds, and skins of fruits and veggies.
Ideally, everyone would aim to achieve 25-35g of fiber daily!
Staying well hydrated is also important to soften the stool and promote bowel regularity.
Conventional Approaches
Typically first line treatment options will include topical analgesic creams, ointments, hydrocortisone suppositories, or astringent pads to alleviate itching and ease irritation. If constipation appears to be the main contributing factor, then stool softeners or laxatives may be considered.
If no improvement is see with these initial approaches, rubber band ligation may be an appropriate option to shrink and remove internal hemorrhoids.
Naturopathic Approaches
Aside from the aforementioned lifestyle and dietary modifications, naturopathic doctors will use botanicals and targeted nutritional supplements to support vascular and mucosal integrity.
This could include, but is not limited to, the use of:
Horse chestnut (Aesculus hippocastanum)
Gotu Kola (Centella asiatica)
Witch hazel (Hamamelis virginiana)
Chamomile (Matricaria recuzita)
Pycnogenol (Maritime Pine Bark)
Vitamin C
Probiotics
As always, be sure to consult your provider to learn which management strategy is best for you!
Disclaimer | This is not medical advice.
References
Bleday, R. Breen, E. Home and office treatment of symptomatic hemorrhoids. UpToDate. Literature review current through: Jan 2025. Topic Last Updated: October 25th, 2023.
Mott T, Latimer K, Edwards C. Hemorrhoids: diagnosis and treatment options. American Family Physician. 2018;97(3):172-179.
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