Hemorrhoids

Definition

Hemorrhoids are swollen tissues that contain veins and that are located in the wall of the rectum and anus.  They may become inflamed, develop a thrombus (blood clot), bleed, or become enlarged and protrude.  If they stay inside the anus they are called internal hemorrhoids.  Those that protrude outside the anus are called external hemorrhoids.

Chinese Medicine divides them into 3 stages:

1st stagesmall hemorrhoids which do not go protrude to the exterior, fresh bleeding upon defecation.
2nd stageprotrusion of tissues from the anus with bleeding, although the tissue retracts into the sphincter within a short period of time.
3rd stagebleeding with large protruding hemorrhoids that require physical pushing to place back into the interior of the anus.  They may exit the body with coughing, sneezing. laughing, when fatigued, or when standing for a long period of time.

Causes

Hemorrhoids can develop from repeated straining during bowel movements (which may be caused by hard stools and constipation), being overweight or pregnant, too many births, chronic diarrhea, prolonged sitting or standing, and liver disease (which increases the blood pressure in the portal vein).  Also, over indulgence of rich greasy and spicy food can cause the Qi of the mid Jiao to sink, thus losing it’s control over muscles resulting in hemorrhoids. While considering diet, it is also believed that a protein deficiency can lead to hemorrhoids.

Signs & symptoms

Bright red streaks of blood on stools (typically after a bowel movement) or spurting from the anus.  This commonly leaves blood-streaked toilet paper or may turn the water in the toilet red.  Generally the amount of blood is small so this rarely leads to severe blood loss or anemia.  External hemorrhoids may give a feeling that there is something in the anus.  There may also be leakage of mucus from the anus (which creates a feeling of not being finished bowel movements), and quite often there is irritation and itching around the area (due to difficulty of keeping the area clean).  

Sometimes an internal hemorrhoid will actually stick out of the anus, it should be gently pushed back into place with a finger.  Although pain is not usually a symptom, a hemorrhoid may swell and become painful if it has been irritated or a blood clot has formed.  

Differentiation

Differentiation between anal fissures and hemorrhoids should be taken into consideration.  An anal fissure is simply a physical tear in the anal sphincter that causes pain during bowel movements (like stool contains sharp objects) and leave blood-streaked toilet paper.  These are generally caused by constipation, straining, and large stools.  Anal fissures are stubborn long narrow sores that re-open and get irritated every time one has a bowel movement.  With inspection, a qualified healthcare professional can easily determine whether it is an anal fissure, hemorrhoid, or other problem such as a tumor.  Consult your healthcare professional if you suspect that you may have any of the above problems.

Prevention

keep stool soft.  Include plenty of water, fresh fruits and veggies, whole grains, and fiber in you daily diet.  
regular exercise promotes smooth bowel movements.
try to breath through your bowel movements (do not hold your breath),
DO NOT STRAIN.  Take your time, relax and enjoy!
 try to not sit or stand for prolonged durations too often.  Take short walks, stretch, and wiggle your mid-section to get the blood flowing through that area.
keep the anal area clean, although one should be gentle with cleansing.  
Try to use chemical free soaps such as pure olive oil soaps, or baby wipes.
squat during defecation, the toilet seat may make it more difficult to pass the feces by compacting the anal canal.  Try put platforms on either side of the toilet to raise yourself.
anal exercises, tighten and hold sphincter/anal muscles while contracting the abdomen, do not hold breath, hold and repeat as often as possible.
keep emotions smooth flowing, do not let them run your life!  Anger in particular can aggravate hemorrhoids.

When to call a health professional:

if rectal bleeding occurs for no apparent reason and is not associated with trying to pass stools.
if rectal bleeding continues for more than 1 week or occurs more than once.
if stools become more narrow than usual or have distinct grooves within them.
if home treatment does not produce pain relief after 1 week.
if a lump ever grows around the anal area (especially if one develops a fever).
if bloody stool appears together with a fever.

Treatment

Things to try at home first:

take warm baths.  They are soothing and cleansing, especially after you have a bowel movement.  Although sometimes too much bathing may worsen anal itching (pruritis ani).
wear cotton underwear and loose fitting clothes to decrease moisture in the area.
apply a cold compress to the area for 10 minutes, 4 times per day.
applying vitamin E oil or virgin olive oil may help with the pain of passage of the stools.
apply an herbal compress of Danelion (Pu Gong Ying), or Jiu Hua Gao, or Wu Bei Zi San to the area for 10 minutes, 4 times per day.
external wash or steam with salty water or Fu Feng Jing Xi Ji, Ku Shen, Pu Gong Ying, Huang Bai.
Enema; inject 250ml of Da Huang, Dang Gui, or Mu Dan Pi decoction into rectum (be sure and be near a toilet, soon after the liquid is inserted into the rectum, the urge to defecate is guaranteed).
add ‘blond psyllium husks’ to the diet daily to aid bowel movements (the husk of the seed ‘Che Qian Zi’)
do the same as above but use wheat bran.

Western Herbal Treatment

Bovine Cartilagetaken  via rectal route to soften stools, 2.2 grams in the form of a 2% suppository administered at least 3 times daily.
Butcher’s broommake a decoction and apply topically (wash or compress) to relieve itching and burning
Camphora solution of 0.1-3% Camphor can be applied topically (wash or compress) 3-4 times daily.
Diosmin(citrus bioflavinoid) 1350mg plus Hesperidin 150mg twice daily for 4 days followed by Diosmin 900mg and Hesperidin 100mg twice daily for 3 days.  Also for prevention of relapse, take Diosmin 450mg plus Hesperidin 50mg twice daily for 3 months.
Hesperidin(citrus bioflavinoid) used together with Diosmin (above).
Peru Balsampreparations of 5-20% can be used for daily application.  
If being used over large areas of the body it is advised to keep the solution under 10%.
Poplar5 grams of the dried buds per day made into a topical application daily.
Sweet cloverwrap a handful of flowers in linen, thouroughly soak in hot water, and place on the affected area 3-4 times per day.
Witch hazelapply compress to the affected area 3-4 times per day.  

Liquid preparations are available at any drug store.

Western Biomedical Treatments

Sclerotherapyan injection of a substance that causes the veins to become obliterated with scar tissue.

Rubber band ligationif the problem is not responsive to sclerotherapy, the hemorrhoid is tied off with rubber bands.  This causes the hemorrhoid to wither and drop off painlessly.  This procedure is applied to one hemorrhoid at a time with an interval of 2 weeks or more.  In serious cases, 3-6 treatments may be required.

Laser destruction, infrared photocoagulation, or an electric current (electrocoagulation) may also be used.

Surgerymay be implemented after all else has failed.  This surgery usually involves the removal of the external sphincter ring.  This causes great difficulty with the control of the defecation response afterwards.

Local anesthetic ointments, Zinc oxide, petroleum jelly, and Hydrocortisone creams are also given.

Acupuncture Treatments

Of course treating specifically according to proper pattern identification is necessary along with the following recommendations.

Common Points: BL 32 (ciliao), Du 1 (changqiang), BL 35 (Huiyang), BL 57 (Chengshan), Erbai (extra).

The Taiyang Bladder meridian has branches that connect with the anus, the points above regulate the Qi of this meridian and remove the Blood Stasis.  

Also, on either side of T7 there are particular hemorrhoid spots, these along with the lumbar-sacral region can be 7 star needled once every 7 days.

Ear acupuncture: lower region of rectum (anus), Large intestine, Shenmen, brain, Spleen.  Needles are retained for 20-30 minutes.  

Treatment is given everyday.

Moxibustion can also be administered when it is not contraindicated with the pattern.

There are 5 major patterns associated with hemorrhoids in Chinese medicine:

(as taken from Maclean & Lyttleton: Clinical handbook of Internal Medicine, Spleen & Stomach)

The following are listed from early onset of disease to late onset of disease

Intestinal Wind: bleeding of fresh red blood before or after defecation, blood on the toilet paper, generally no pain or prolapse; often no clear systemic pattern.
Dry Intestine: associated with chronic constipation.
Damp/Heat: associated with inflammation, pain, swelling and systemic signs of Heat; can be associated with all degrees of hemorrhoids.
Spleen deficiency:  loss of muscle tone or failure of the Spleen to hold blood in the blood vessels, hence the bleeding.  2nd to 3rd degree hemorrhoids that prolapse when standing, walking, or with increased intra-abdominal pressure, need manual/physical reinsertion to the anus.  
Accompanied with systemic signs of deficiency.
Blood Stasis:  severe or continuous pain and distension, hemorrhoids may be irreducible or contain thrombus (blood clot), systemic signs of Blood stasis will show.

(The above correspond to the 3 stages discussed under ‘definition’ at the top of this page)

Chinese Herbal Medicine Treatments:

This section, if used by the layperson (not a practitioner of Chinese herbal medicine), should be viewed carefully.  The patterns below explain many different types of people.  One does not have to adhere to all the

symptoms within a pattern, sometimes patterns cross or do not show all symptoms listed.  A close look should be taken at oneself before committing to the administration of any recommended medication.  Severe adverse effects are possible although quite rare.  It is recommended to get proper advice from a qualified practitioner of Chinese herbal medicine.

There are 5 major patterns associated with hemorrhoids in Chinese medicine:

(as taken from Maclean & Lyttleton: Clinical handbook of Internal Medicine, Spleen & Stomach)

The following are listed from early onset of disease to late onset of disease

Intestinal Wind: bleeding of fresh red blood before or after defecation, blood on the toilet paper, generally no pain or prolapse; often no clear systemic pattern.
Dry Intestine: associated with chronic constipation.
Damp/Heat: associated with inflammation, pain, swelling and systemic signs of Heat; can be associated with all degrees of hemorrhoids.
Spleen deficiency:  loss of muscle tone or failure of the Spleen to hold blood in the blood vessels, hence the bleeding.  2nd to 3rd degree hemorrhoids that prolapse when standing, walking, or with increased intra-abdominal pressure, need manual/physical reinsertion to the anus.  
Accompanied with systemic signs of deficiency.
Blood Stasis:  severe or continuous pain and distension, hemorrhoids may be irreducible or contain thrombus (blood clot), systemic signs of Blood stasis will show. 

(The above correspond to the 3 stages discussed under ‘definition’ at the top of this page)

Intestinal Wind

fresh blood before or after defecation, may be on stool or toilet paper.  No pain, itch, distension, or swelling.  This pattern responds quite well to Chinese medicine treatments.

Tongue: not significant, Pulse: not significant

Herbal Treatment

Huai Jiao Wan – grind into a powder and form 9 gram pills with water.  
Take one pill twice daily.
Zhong Guo Zhi Gen Duan – bleeding (patent)
Yun Nan Bai Yao – bleeding (patent)

Dry Intestine

usually from chronic constipation with dry stools and repeated straining to

defecate.  Bleeding that may be before or after defecation.  If before it may be copious and literally ‘squirted out’ of the anus.  The hemorrhoid may protrude to the 2nd stage but can be pushed back easily. There may be pain and fullness. Accompanied by thirst and dry skin.

Tongue: may be dry with slightly yellow coating, Pulse: may be thready and rapid.

Herbal Treatment

The main idea here is to control constipation.

Qin Jiao Bai Zhu Wan – grind into powder and form into 6 gram pill balls.
Take 1 3 times per day on an empty stomach.
Ma Zi Ren Wan – available in prepared forms.
Zeng Ye Cheng Qi Tang – if stool is dry and very difficult to expel.
Run Chang Wan – moisten the bowels, particularly for the blood deficient patient (patent)
Huai Hua San – if bleeding is severe, combine any of the above with this formula.
Liang Xue Di Huang Tang – if patient is very Yang and robust with much Heat and dryness.  
Jing Wan Hong – topical ointment.
Gu Ben Wan – nourish Yin/body fluids, moisten dryness of body and stools (patent)
Ba Zhen Tang – nourish the blood and Qi.

Damp/Heat

inflamed internal hemorrhoids. Fresh red or plum coloured blood that comes either before or after defecation.  It may also coat the stool.  The bleeding is usually quite copious.  There may be swelling and pain and may correspond to either 2nd or 3rd stage of protrusion, although it can almost always be pushed back or recede on its own.  There may be itch, discomfort, burning, and pain at the anus.  The feeling of always needing to defecate may be present (tenesmus).  Thirst, dark scanty urine, constipation or hard to pass loose stools usually accompany.

Tongue: red body or edges, greasy yellow coating especially at the root,

Pulse: wiry rapid, or slippery rapid.

Herbal Treatment

Huai Hua San – powder and take in 9 gram dosages in a draft (mixed with 1 cup of hot water). Add Di Yu if bleeding is quite heavy.
Zhong Guo Zhi Gen Duan – Damp/Heat with bleeding (patent)
Huang Lian Jie Du Wan – Damp/Heat (do not take for too long, can harm stomach).
Jing Wan Hong – topical ointment.

*Watching the diet here is very crucial to the successful treatment at this stage.

Spleen deficiency (not holding blood, sinking)

hemorrhoids are quite painful and protruding (2nd or 3rd stage), bleeding may be heavy or scanty, pale face, easily fatigued, poor appetite, weak (lack muscle tone and vigor), bloating after meals, loose stools light headed, shortness of breath, poor memory, insomnia, palpitations, anxiety, panic attacks, may show heavy menses, easily bruised, spontaneous sweating, elderly, may see other organ prolapse.

Tongue: pale, swollen or thin with teeth-marks, Pulse: thready, weak, moderate, or hollow.

Herbal Treatment

Gui Pi Tang (Wan) – decoction (available in patent).
Bu Zhong Yi Qi Tang (Wan) – decoction or powdered and mixed with 1 cup of warm water in 9 gram doses, (available in patent).
Fu Zi Li Zhong Wan – for the patient with  Yang deficiency (coldness).  (available in patent).
Huang Tu Tang – good for stopping bleeding from Spleen not holding blood in vessels.

Blood Stasis

chronic hemorrhoids that have continuous or severe pain.  This is usually the late stage of one of the other above mentioned patterns.  It may also be closely associated with chronic Liver Qi stagnation caused by excessive emotions (especially anger).  Western etiology may connect this to Liver portal circulation disruption.  The hemorrhoids are quite large and are dark.  Bleeding can be fresh red or dark coloured.  may see spider veins around the inner ankles and knees.  Pain in the lower abdomen and rib area on palpation, dry mouth with no desire for drink, dry skin, dull complexion, dark circles around the eyes, dark purple lips.

Tongue: purple body, or purple spots, little or no coating, sublingual veins are dark, Pulse: choppy thready

Herbal Treatment

Huo Xue San Yu Tang – move blood, break up stasis
Tao He Cheng Qi Tang – move Blood, break up stasis, promote bowel movements, (available in patent).
Xue Fu Zhu Yu Tang – Move Qi and Blood, helpful for Liver Stagnation causes, (available in patent).
Tong Jing Wan – painful (patent).
Sheng Tian Qi Pian – good to combine with above formulas (patent).
Jing Wan Hong – topical ointment.

*This stage usually needs western medical intervention (i.e. surgery).  

TCM is beneficial to help in the recovery phase of western treatment.

Dietary Recommendations

consume more high fiber foods to aid in treating constipation, i.e. green leafy veggies, and whole grains.  
if you have the desire to eat a lot of vegetable and fruit, strongly consider lightly cooking or steaming them instead of always eating them raw.  Too much raw food can damage ones digestion,…keep a balance.
avoid consuming too much rich, greasy, spicy foods as the reek havoc on our digestive system.
try frying 250 grams of clams in some peanut oil, add 10grams of fresh
sliced ginger and some water then cook until the clams are very soft, then add some salt.  Eat this on an empty stomach, once every other day, 7 times as one treatment.
try eating 1-2 bananas with their peel on an empty stomach first thing in the morning.
try eating 1-2 figs on an empty stomach first thing in the morning, or boil fig leaves in water and use the liquid to wash the affected area, or simply add it to you sitz bath.
try steaming 60grams of dried figs in an adequate amount of water with 100 grams of lean pork, season to taste.  Eat at will for 1 month.
try 10 fresh or dried figs in 1 liter of water and simmer for 30 minutes until there is about ¾ of the water left.  Eat 5 of these figs per day and use the water to wash the affected area.
try boiling 30 grams of black fungus with 30 red dates over low heat, consume whole once per day for 10 days.
try boiling 60 grams of lily flowers in water with some honey.  Eat before breakfast for 1 week.
try peeling 2 bananas and steam them with an adequate amount of rock sugar.  Eat 2 times per day for 1 week.
AVOID nutmeg.
try boiling 2 dried persimmons until soft and eat 2 per day.
try incorporating wax gourds into your diet.
try baking dried chestnut shells until they look like charcoal, then grind them into a powder and take 6 grams with 30 grams of honey.
eel can help stop the bleeding of hemorrhoids.
get creative with lettuce seeds.
spinach helps promote great bowel movements.
try to increase your consumption of sour foods (not too much, this flavour is powerful); lemons, limes, hawthorne berries, pickles, rosehips, sauerkraut, crab apples, sour plums, vinegar, aduki beans, blackberries, cheese, grapes, olives, raspberries, sourdough bread, tangerines, tomatoes, yogurt.
use the seaweed agar-agar, it also is said to carry toxic and radioactive substances out of the body.
drink the juice or eat the leaves of fresh Wheat grass.
eggplant can stop bleeding.  Pregnant woman should not eat eggplant.