How do we treat hemorrhoids?

Aug 13, 2019

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"So, were you the only white people at your wedding?" My kids were looking at their grandparents wedding album. Emily said she thought my mom looked very pretty in her wedding dress. Then my sister, Michelle, told Emily that Michelle had tried on our Mom's wedding dress once, and it didn't even cover her butt. Michelle is quite a bit taller than our Mom, but I also think a mini-skirt inspired wedding dress was more common in the 60's than it is today. My Mom remembered the July before the wedding she kept running back to her nursing station to watch the TV on her shift. She thought it was amazing that they could see people walk on the moon. 5700 km away, my Dad was less impressed. His Nigerian friend, Shugun, kept having to drag him into the Grad Student lounge to watch the moon landing.

My Dad might have been a pain in the butt to Shugun about the importance of humans on the moon. Hemorrhoids, though, are a different kind of pain in the butt. Hemorrhoids are a normal part of the anal canal. They are sometimes called cushions and are made up of connective tissue, blood vessels and smooth muscle. The fact a person has a hemorrhoidal cushion is not considered abnormal. If the person starts getting symptoms like bleeding, itching, pain or protrusion, then the hemorrhoid is a problem.

Somewhere between 58 and 86% of us will have hemorrhoids annoy us at some point of our lives. They happen about equally often in men and women. The peak age for getting hemorrhoids is between 45 and 65. Hemorrhoids are divided into two groups: internal and external. Internal hemorrhoids are inside a line on the anal sphincter called the pectinate line. External hemorrhoids are outside the pectinate line. Uncomplicated internal hemorrhoids are often painless as there are no nerve endings where they form. External hemorrhoids can be painful as their area of formation has lots of pain nerve endings.

Internal hemorrhoids are further sub-divided into degrees. First degree hemorrhoids are just a swelling of the cushion because of straining while going to the bathroom. They are painless. Second degree hemorrhoids protrude a little after defecating but spontaneously return on their own. Third degree hemorrhoids protrude after defecating, but must be manually replaced. Fourth degree cannot be manually replaced. Fourth degree hemorrhoids are usually very painful, and if you have them, you should see your doctor.

What causes hemorrhoids? Constipation, pregnancy and age are probably all factors. What are hemorrhoid danger signs? Patients should go see their doctor if: their hemorrhoid protrudes and doesn't go back on its own, they are bleeding and painful, they bleed a lot or the blood is dark in color (as opposed to bright red). Patients under 12 years old with hemorrhoid problems should also see a doctor. Since hemorrhoids are embarrassing, by the time people admit to a pharmacist that they have hemorrhoids, the problem is probably bad enough that they should see their doctor right away.

How do you prevent hemorrhoids? Try to avoid constipation. One shouldn't remain on the toilet for more than 1-2 minutes. Straining on the toilet should be avoided. To avoid constipation, fiber and fluids are usually the first line of attack. Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fiber in the stool to make it bigger and softer. The next thing to do is increase the amount of fiber one eats. Unprocessed wheat bran is an excellent choice. Vegetables and fruit vary in their ability to absorb moisture. Carrots have the greatest absorption capacity of the vegetables, about half that of bran. Other high absorption vegetables are brussel sprouts, eggplant, spring cabbage and corn. High-absorption fruit include apples, pears, and oranges. Adding 20 to 30 g of fiber to your diet will help with symptoms of mild hemorrhoids. If you can't seem to eat enough bran and veggies, consider a fiber supplement like Metamucil with psyllium in it.

To relieve the irritation and itchiness of hemorroids, a sitz bath may help. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time 3-4 times per day. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience. One reason sitz baths are believed to work is they seem to relax the internal anal sphincter.

How do we treat hemorrhoids? If they are relatively mild, they can be treated with creams and suppositories. All of these treatments just help symptoms. None of them cure a hemorrhoid. They provide short term relief of pain, burning, discomfort and irritation while the swelling goes down on its own and healing starts. Hemorrhoids preparations can have a variety of ingredients in them. Some have local anesthetics like pramoxine to relieve pain. Prescription creams often have hydrocortisone to reduce inflammation and itching. Witch hazel is the astringent in many pads and wipes. Astringents promote drying of the skin which helps reduce burning, itching and pain. Protectants including shark liver oil help reduce irritation, burning and itching by forming a physical barrier on the skin.

There are newer oral over-the-counter treatments for hemorrhoids. They contain diosmin. One brand is called Hemoval. Another is called Venixxa. Diosmin is a flavonoid and might help hemorrhoids. It is unclear exactly what flavonoids like diosmin do. They might improve how well blood moves out of capillaries and back to the heart through the veins. They might improve lymphatic drainage and they might be anti inflammatory. One meta-analysis looked at 9 studies covering 783 patients each looking at flavinoids and hemorrhoids. In general, the flavinoids seemed to be better than placebo at reducing hemorrhoid symptoms, but not all the studies were wonderfully well done. On the plus side, Hemoval and Venixxa don't seem to have any significant side effects. So, they are probably reasonable over the counter hemorrhoid treatments to try.

I got an extra chuckle out my kids pointing out their grandparents had a decidedly non-white wedding because their wedding was in England. England has historically been, let's just say pasty. My Dad grew up on the north shore of Lake Superior in Wawa. My Mom just outside of Hamilton in Ancaster. But my Dad was going to school in Cambridge, UK and despite my grandfather telling her there was no way he would meeting her plane in England, my Mom flew over to marry him. My Dad didn't know many people in England at the time of his wedding, but he had to arrange officiants. He knew Doug Shinozaki, a Japanese Canadian friend from school in Hamilton. So, Doug became the Bestman. Dad's Nigerian friend Shugun had a Ugandan friend who had a wife. And Mrs. Philo Katongole graciously agreed to be the Matron of Honor. And that is how on September 6, 1969, at Cherry Hinton Road Congregation Church in Cambridge, UK, two young people from Canada had a wedding where people were "judged not by the color of their skin, but by the content of their character".

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 


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