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Hemorrhoids, also called piles, are normally present veins in the anus and rectum that become swollen and inflamed. Over three-quarters of people in the United States have hemorrhoids at some time in their lives. The peak age is between 45 to 65 years.

Internal hemorrhoids (ones that are inside the anal cavity) usually cause painless bleeding at the end of a bowel movement. Blood can be a sign of a serious problem so it’s important to be evaluated by a health professional.

Other symptoms are a sensation of fullness, usually described as feeling the urge to have a bowel movement even when there is no stool. Straining worsens the discomfort.

There may be acute pain, itching, and irritation around the anus. This often occurs when the hemorrhoid has prolapsed and can be seen outside the anus or it can be caused when a blood clot develops or the hemorrhoid becomes twisted. There may be a painful lump or swelling around the anus. These may be serious and requires evaluation.

External hemorrhoids (outside the anus) can often be felt as a bulge in the anus. Although they can be itchy and painful, they sometimes don’t cause typical symptoms.

When people see spots of blood on the toilet paper and have pain with bowel movements, they often immediately think it’s hemorrhoids when the problem may really be a small but painful tear called an anal fissure.

Anal fissures are often caused by constipation. If stools are dry and hard, the anal sphincter is forced open wider than normal, resulting in a tear, or anal fissure. There are often some spots of bright red blood on the toilet paper.

Anal fissures also cause a sharp, stinging, often severe pain with the passage of each bowel movement (whereas hemorrhoids often cause bleeding but no pain).

Natural Remedies for Hemorrhoids

Here are five natural remedies that are used for hemorrhoids.

Fiber shows a consistent beneficial effect in relieving hemorrhoid symptoms and bleeding. It can soften stool and increase its bulk, which helps to reduce straining. Seven randomized trials with a total of 378 participants have found fiber improved symptoms including itching, discomfort, and pain.

There are plenty of ways to get more fiber. Start by eating foods high in fiber, such as whole grains and vegetables. Psyllium, a powdered fiber supplement, is another option, one that’s inexpensive and readily available. A typical amount of psyllium is one teaspoon of the husks in water followed by another glass of water.

Another option is ground flaxseeds. Whatever the source of fiber, it’s important to drink sufficient water or constipation may worsen.

Bioflavonoids are a type of plant compound that are thought to work by stabilizing and strengthening blood vessel walls and by decreasing inflammation. They have been found to reduce anal discomfort, pain, and anal discharge during an acute hemorrhoid attack. Side effects of bioflavonoids appear to be mild and rare, making them a promising treatment for hemorrhoids in pregnancy (the flavonoid tangeretin however, shouldn’t be used by people taking tamoxifen for breast cancer).

The major flavonoids found in citrus fruits, diosmin, herperidin, and oxerutins, appear to be beneficial. Daflon, a product made with citrus bioflavonoids was found to improve symptoms in pregnant women by day four of taking it and to reduce symptoms of pain, heaviness, bleeding, itching and discharge.

This drug store staple is made from the leaves and bark of a plant called Hamamelis virginiana. It is not be taken internally but is instead applied topically to the anal area in the form of witch hazel distilled liquid, ointment, or medicated pads.

Witch hazel is thought to decrease the bleeding of hemorrhoids by acting as an astringent. It may also relieve pain, itching and swelling associated with hemorrhoids.

The plant butcher’s broom (Ruscus aculeatus), which is also known as knee holly, box holly, and sweet broom, gets its name because it was once used by butchers in Europe to clean their chopping blocks. Butcher’s broom has a long history of traditional use for hemorrhoids and varicose veins. It is often used when there is underlying poor circulation in the veins.

How does butcher’s broom work? Although scientists haven’t confirmed the effectiveness of butcher’s broom for hemorroids, butcher’s broom extract contains anti-inflammatory and vein-contricting properties that are believed to improve the tone and integrity of veins and shrink the swollen tissue. The active compound is called ruscogen.

Butcher’s broom is usually recommended in capsule or tea form. The tea has a slightly bitter taste, so a bit of stevia or honey can be used to sweeten it. The tea can be made by steeping one teaspoon of the herb in a cup of hot water for 10 to 15 minutes. Butchers broom has also been shown to be effective when applied topically as an ointment or compress.

Butcher’s broom should not be used by people with high blood pressure, benign prostatic hyperplasia (BPH), by pregnant or nursing women, or by people taking alpha blocker or MAO inhibitor drugs unless otherwise recommended by their doctor.

The herb horse chestnut (Aesculus hippocastanum), like Butchers broom, is often recommended when there is poor circulation in the veins, or chronic venous insufficiency. In folk medicine, it is used to relieve symptoms such as swelling and inflammation and strengthen blood vessel walls. The active compound is believed to be aescin.

Horse chestnut can be taken as a tea or in capsule form. It can also be applied externally as a compress. People with an allergy to the horse chestnut family, bleeding disorders, or people taking blood thinners should not take horse chestnut. Only products made from the seeds or bark of the young branches should be used. Other parts of the plant are poisonous. Although uncommon, side effects have included kidney damage, severe bleeding, bruising, and liver damage.

Triphala. An Ayurvedic compound of three fruits. It is well-known as a bowel tonic that gently relieves constipation without being a harsh stimulant.

Topical application of chamomile or calendula. Can be applied as a compress or ointment.

The three basics that may reduce hemorrhoids symptoms are: