Hemorrhoids
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[ Definition ] [ Causes ] [ Signs & symptoms ]
[ Differentiation ] [ Prevention ] [ When to
call a health professional ]
[ Treatment ]
[ Western Herbal Treatment ]
[ Western Biomedical Treatments ]
[ Acupuncture Treatments ]
[ Chinese Herbal Medicine Treatments ]
[ Dietary Recommendations ]
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 stage- small hemorrhoids
which do not go protrude to the exterior, fresh bleeding upon defecation.
2nd stage- protrusion of
tissues from the anus with bleeding, although the tissue retracts into the
sphincter within a short period of time.
3rd stage- bleeding 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.
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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.
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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 Cartilage-
taken via rectal route to soften
stools, 2.2 grams in the form of a 2% suppository administered at least 3
times daily.
- Butcher’s broom- make a decoction and apply topically (wash or compress)
to relieve itching and burning
- Camphor- a 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 Balsam- preparations 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%.
- Poplar- 5 grams of the dried buds per day made into a topical
application daily.
- Sweet clover- wrap a handful of flowers in linen, thouroughly soak in
hot water, and place on the affected area 3-4 times per day.
- Witch hazel- apply compress to the affected area 3-4 times per
day. Liquid preparations are
available at any drug store.
Western Biomedical Treatments:
Sclerotherapy- an
injection of a substance that causes the veins to become
obliterated with scar tissue.
Rubber band ligation- if
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.
Surgery- may 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.
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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)
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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. TCM Health-info
recommends getting 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.
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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.
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