The Hemorrhoids are varicose veins of the anal mucosa and that of the rectum . A distinction is made between internal hemorrhoids , visible by anoscopy, and external hemorrhoids which protrude at the edge of the anus. Depending on their severity, there are several ways to relieve hemorrhoids or even remove them. The first concerns the rules of food hygiene ; you should eat a lot of foods containing fiber (vegetables and fruits) and avoid foods such as spices, alcohol, coffee.
Hemorrhoids are in short a dilation of the vessels of the hemorrhoidal plexus in the anal canal. Symptoms include irritation and bleeding. Thrombosed hemorrhoids are usually painful.
How to explain the presence of hemorrhoids?
The hemorrhoidal pad consists of an arteriovenous vascular complex supplied from the upper rectal artery by the upper and middle hemorrhoidal arteries. Drainage takes place through the hemorrhoidal veins which circulate through the sphincter apparatus. The hemorrhoidal pads are consequently covered with mucous membranes and lie in a thick submucosal layer guiding connective tissue and smooth muscle cells above the pectinate line (corpora cavernosa of the rectum). They are held in position by connective tissue fibers which exert a reaction towards the internal anal sphincter muscle.. Hemorrhoids occur when the vascular pad is more developed than normal. The typical locations of hemorrhoids are indicated at 3, 7 and 11 o’clock in the lithotomy position, with however high variability between individuals. They are distinguished from the rectal mucosa by a more purplish color.
What are the causes ?
The postulated cause of hemorrhoid enlargement is venous congestion with consequent hyperplasia of the rectal cavernous body and slippage of tissue in the anal canal. An increased resting tone of the sphincter as well as a prolapse of the hemorrhoidal plexus may be the cause of the venous outflow disorder. It is possible that a functional loss of the suspensory ligament located around and above the arteriovenous vascular complex and consisting of muscle fibers and elastic fibers of connective tissue, associated with subsequent descent of the mucosa , is an independent causative factor.
Further morphological and hemodynamic evaluations of the anorectal vascular plexus have further shown that the vascular convolutions have an intrinsic contraction mechanism composed of smooth muscle cells, which regulates the supply and outflow of blood volume as well as its rate of. discharge within the vessels. The destruction of this regulatory system with replacement of muscle cells by connective tissue fibers then leads to the formation of hemorrhoids. The composition of collagen also seems to come into play; studies have thus demonstrated an increase in matrix metalloproteinases within this collagen.
It is in fact easily imaginable that mechanical irritation (for example due to diarrhea, hard stools or manipulations) or an increase in intra-abdominal pressure (as in cases of pregnancy, visceral adiposity, ascites , etc.) exert an influence on these pathophysiological mechanisms , but these elements are not however proven to be the cause.
What is the role of the vascular pad?
The physiological role of the vascular pad is in particular to guarantee fecal continence , in collaboration with the sphincter apparatus. The juxtaposition of the folds of the mucous membrane helps to make the anal canal impermeable to liquid feces and air. This provides 15-20% of continence.
It is indeed necessary to distinguish between hemorrhoids (“internal”) and hemorrhoids formerly qualified as external (today called perianal veins), formed by a subcutaneous perianal vascular plexus covered with skin.
For internal hemorrhoids, the doctor may therefore use photocoagulation of the hemorrhoidal areas, or liquid nitrogen. Internal hemorrhoids usually show up as bleeding after a bowel movement ; blood can be seen on the paper and sometimes in the toilet bowl. Internal hemorrhoids can be uncomfortable but are not as painful as thrombosed external hemorrhoids. They sometimes cause the release of mucus and feelings of incomplete evacuation.
Regarding external hemorrhoids, several methods are still used: rubber band ligation which causes devitalization of hemorrhoids, photocoagulation, injection of products causing sclerosis, directly into hemorrhoids (4 to 6 successive injections – good results ). This last technique is also called sclerotherapy. External hemorrhoids can thrombose, resulting in a painful purplish swelling . Rarely, they ulcerate and cause a small hemorrhage. Cleaning the anal area can be difficult.
Some naturopathic tips to better understand and avoid hemorrhoids
- The factors triggering hemorrhoidal crises must however be identified and if possible avoided: constipation, prolonged sitting in the toilet, significant physical exertion, stress, etc.
- Certain periods or events in life increase the risk of hemorrhoids: pregnancy, childbirth (pushing efforts), menstruation, menopause, etc.
- Spices, some of which follow the digestive tract to the rectum and would reach the anus undigested, should be avoided as much as possible.
- Alcohol, coffee, meals rich in lipids, which could lead to abdominal venous vasodilation, should also be avoided as far as possible.
- The importance of anoperineal hygiene, in particular by avoiding the phenomena of friction, must be recalled.
- Regular physical exercise is recommended.
What about anti-hemorrhoidal herbal remedies?
The aescin contained in horse chestnut decreases the blood viscosity index, and exerts a tonic and vasoconstrictor action on the venous wall. Its venotonic and anti-inflammatory mechanism also involves interference with lysosomal enzymes: in vitro, it specifically inhibits hyaluronidase, an enzyme involved in the renewal of the main components of the perivascular amorphous substance, and responsible in particular for degrading hyaluronic acid, a glycosaminoglycan widely distributed in connective tissue and one of the main components of the extracellular matrix . It also protects proteoglycans, constituents of the vascular wall. In relation to its venous and capillary protective properties, horse chestnut is thus indicated in hemorrhoidal crisis, hemorrhoidal thrombosis, anal fissures, hemorrhoidal symptoms (sensation of burning, pain, pruritus, bleeding), as a treatment for background and prevention of recurrence of hemorrhoidal crises.
Cypress is used in venous circulatory disorders (varicose veins, hemorrhoids) especially during menopause (estrogenic properties). Rich in tannins, and in particular in proanthocyanidolic oligomers (OPS), the cypress nut exerts a venotonic, astringent, vasoconstrictor and antihemorrhagic action. The traditional use of cypress nuts to reduce the symptoms of venous insufficiency or hemorrhoidal disorders would be linked in particular to its action of protecting the connective tissue. In connection with its circulatory activity, cypress is used in venous and microcirculatory disorders.
Chrysantellum is traditionally used to improve microcirculation in cases of vascular disorders. Flavonoids decrease the permeability of blood capillaries and strengthen their resistance. In connection with its vasculoprotective and venotonic properties, chrysantellum is used in vascular affections, varicose veins and hemorrhoids.
Witch hazel is a plant with recognized therapeutic virtues, both orally and locally applied. The vasoconstrictor action is mainly due to the proanthocyanidins found in the leaves. Witch hazel has a protective action on the vascular walls, in particular in venous disorders and its complications: heavy legs, impatience, varicose veins, post phlebitic syndrome, varicose ulcers, hemorrhoids, edemas, etc.
This essential oil is used in venous and lymphatic circulatory disorders, as well as in the history of phlebitis. It is used in congestions and venous stasis, varicose veins and heavy legs, as well as internal and external hemorrhoids.
Medical bibliographic sources and clinical trials :
- Suter A, Bommer S, Rechner J. Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: a review of 5 clinical studies. Adv Ther. 2006
- Siebert U, Brach M, Sroczynski G, Berla K. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency. A meta-analysis of randomized controlled trials and large observational studies. Int Angiol. 2002
- Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012
- Bernard P. et al., Tonic pharmacodynamic value of galenic preparations based on witch hazel leaves, J Pharm Belg. 1972
- Longchampt A., “L’Hamamelis Hamamelis virginiana L.”, Pharmacy thesis. 1997
- European medicines agency, Community herbal monograph on Hamamelis virginiana L., cortex. 2011
- Aigner F, Gruber H, Conrad F, Eder J, Wedel T, Zelger B. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis. 2009
- Kisli E, Kemik A, Sümer A, Kemik Ö. Matrix metalloproteinases in pathogenesis of hemorrhoidal disease. Am Surg. 2013