Piles (hemorrhoids)
A natural treatment

Piles are one of the most benign complications of constipation.

The pain level, compared to other medical conditions, is not very high. And yet, it is a very frustrating condition due to the location of the problem, and the recurrence factor : the probability of getting hemorrhoids regularly if you are constipated is very high.

This article provides a set of natural treatments that can bring relief to painful piles. It focuses on two aspect. The first aspect is the management of an acute hemorrhoid crisis. The second aspect is prevention, to minimize the chance that you will get them in the future every time you need to push a little harder than usual.

As you have probably noticed already, I will use the terms “piles” and “hemorrhoids” interchangeably in this article.

Before we start, a few words of caution :

  • See your doctor if your hemorrhoid crisis does not seem to abate
  • The recommendations provided in this article are not suited to pregnant woman.
  • If you currently take medications, check with your doctor to ensure the plants mentioned in this article will not interfere with your treatment.

What causes piles ?

Piles are an abnormal dilatation of veins in the anal region. External piles are visible and localized below the anal sphincter, whereas internal piles are located above the anal sphincter and covered with the anal mucosa.

External piles are usually easier to treat because they are reachable – you can apply different types of preparation locally.

Why do piles develop ? If you think about the problem in a mechanical way, you can see that there could be 3 possible causes :

  1. The blood pressure in the abdominal and pelvic region is too high. Blood in this area is having a hard time to flow back up to the heart. This pressure ends-up creating an overstraining of the veins in the rectal area;
  2. The tissue that constitutes your veins is losing its elasticity, a situation very similar to varicose veins;
  3. There is inflammation, caused by food or by chronic diarrhea (for example in the case of diarrhea predominant IBS).

Let’s look at each of those causes in more details. Understanding those is important, because it will allow us to come up with short term remedies and a long term approach.

1. Abdominal blood pressure

An elevated pressure in the abdominal and pelvic area is the most common cause of piles. Here are the main factors that can create elevated abdominal tension :

  • Chronic constipation : the person is pushing too hard for too long and is facing resistance in the form of a fecal plug. The rectal veins have to take that pressure.
  • Sitting positions : office workers, truck, taxi and bus drivers, idle people staying at home and reading or watching TV – those people will often be the first affected by piles. The seated position puts all the vertical pressure of the body on the rectum.
  • Pregnancy : the baby is putting pressure on the abdominal veins, closing them partially and preventing a good venous blood return to the heart. The rectal veins have to take that pressure.
  • Lifting heavy weights : same problem as with constipation – too much pushing and straining.
  • Bicycling : the nature of the sport is such that the anal region is constantly under pressure, and very often irritated by the sweat. The area is not breathing enough and is constantly in contact with the plastic of the saddle.
  • Liver weakness : when a person suffers from hemorrhoids, the naturopath will often look at the liver. First because a good production of bile has a regulating effect on transit (the liver makes bile). Second, because a weak liver creates a blood stagnation around the portal vein, which puts an additional charge on the venous return from the lower portions of the body. More on this later.

2. Weakness of venous tissue

You may have inherited a weakness in your connective tissues. In other words, constitutionally, you are not making veins that are elastic enough to take the variations of pressure. Varicose veins and/or hemorrhoids may run in your family.

3. Inflammation

Certain foods irritate the anal mucosa and can trigger piles in the susceptible person. Spices will often do that. Those who put a little too much tabasco in their bowl of chilly on Saturday night may still remember the Sunday morning toilet session.

Some people are sensitive to coffee, alcohol, tomatoes and other acidic foods. This third cause is probably the easiest one to fix once you have identified the food that triggers the crisis using a food diary.


Plants for piles

In this section, I introduce the different medicinal plants that will help you to find relief. I will explain how to use them in the next chapters, both for the management of acute crises and for prevention. For now, we are just getting familiar with the plants.

Witch hazel (Hamamelis virginiana)

Witch hazel (Hamamelis virginiana) is a beautiful north american tree that you may find in gardens as it is often used for ornament. And when it comes to piles, witch hazel comes to the rescue.

Witch hazel for piles

The branches and leaves are very astringent, with a high tannin content: between 3% and 10% of the dry mass(1). The astringency tones up the inflamed and flaccid tissues, veins included. Because the plant is so astringent, it is also anti-inflammatory and hemostatic (it prevents bleeding), which may prove handy for bleeding piles.

Few studies have been done on witch hazel. What we do know is that it inhibits two enzymes that are responsible for connective tissue breakdown : alpha-glucosidase and leukocyte elastase(2). Historic use of the plant largely confirms the fact that it is beneficial for the treatment of hemorrhoids.

The leaves and branches are the parts used. Note that if you do not have access to witch hazel, you can use another very astringent plant instead. The bark of the oak tree (Quercus) for instance works very well too.

Horse chestnut

The fruit of the horse chestnut tree (Aesculus hippocastanum) provides astringent and vein-toning properties that are well adapted to treating piles. An alcoholic tincture of the fruit is the form typically used.

For those who like to make their own herbal medicine, the hard fruit is pounded to pieces with a hammer and macerated into alcohol for 3 weeks, then filtered and bottled. It can also be purchased online or in health food stores.

Horse chestnut for piles

Horse chestnut is very useful to relieve the symptoms of chronic venous insufficiency and hemorrhoids. Studies show that it inhibits two enzymes implicated in the weakening of our blood vessels and capilaries : elastase and hyaluronidase(3). The plant also reduces capillary permeability and the associated edema(3).

A low dosage of the alcoholic tincture is taken internally. See protocol recommendations further down in this article.

Butcher’s broom

Butcher’s broom (Ruscus aculeatus) is often combined to horse chestnut in preparations for piles. The plant increases venous tone thanks to its astringent and anti-inflammatory action(3).

Butcher's broom for piles

The root is the part traditionally used. Good quality tinctures can be purchased from the internet, either alone or as part of vein-toning mixes.

Centella asiatica

Centella, also called « gotu kola » in Ayurvedic medicine, has been known for decades as a tonic for people that cannot make good quality connective tissues (skin, mucosa, veins, etc).

Centella asiatica for piles

Several rigorous clinical studies exist and show that centella is very useful for venous problems. The plant improves the integrity of the vein tissues, raises our levels of antioxidants to protect those tissues in an ongoing manner, and lowers vascular permeability (the mechanism that makes veins look inflamed and puffy)(3).

The best preparations are those made from the fresh leaves, usually delivered as an alcoholic tincture.

Ginkgo biloba

Ginkgo is often used in the natural treatment of piles. Studies show that it is a useful plant to relieve the symptoms of hemorrhoids(4).

Ginkgo biloba for piles

It is not a plant that I use very often in my herbal clinic, so you won’t find it in the protocols outlined below. I wanted to mention it here for the sake of completeness.

This plant is best used in the form of standardized extracts, usually delivered as pills.


Piles treatments

In the rest of this article, I assume that your piles are still treatable by natural approaches and do not require a surgical intervention. If you are unsure about your situation, talk to your doctor.

Here I quote the famous German herbal doctor Rudolf Weiss(5) :

« It must be made clear right from the start that no herbal drug is able to eliminate the causes of hemorrhoids. […] recommendations are designed for symptomatic treatment of the troublesome symptoms, which are mainly caused by inflammation and thrombosis of the piles ».

What is Weiss trying to tell us here ? He is saying that even though herbs help us to ease the symptoms, only a change of lifestyle can make a difference in the long term.

In the rest of this article, I give different tools that you can use as part of your natural hemorrhoid treatment program. You don’t necessarily need to use them all. But you may want to try them all at one time or another. Some will work better than others for a particular person, and only trial and error can tell you which one will be the most effective for you.

I will tell you where to buy quality plant products at the end of the article. I will also give you an overall “shopping list” to create your hemorrhoid treatment kit.


1. Piles crises

1.1. Hot and cold sitz baths

The goal of the hot-cold sitz bath is to use a sudden change in temperature to create a toning and astringent effect, forcing the puffy piles tissues to shrink and go back inside. This method is particularly effective for external piles.

  • First of all, wash thoroughly the rectal area. The best moment to do this method is after a shower;
  • Prepare 2 buckets big enough to be able to sit inside. Place those buckets in the bathtub or in the shower – some water will probably overflow and you may end-up with a very messy bathroom if you don’t take that precaution;
  • Fill-up one bucket with moderately hot water, ideally between 95 and 98 degrees Fahrenheit (35°C to 37°C);
  • Fill-up the other bucket with cold water;
  • Sit in the hot bucket first, stay for about 1 minute, making sure the anal area is entirely soaking;
  • Quickly, move into the cold water and stay there for 30 seconds. The effect should be breathtaking if I may say, you want to shock your piles with the temperature change;
  • Repeat 2 to 3 times, moving from hot to cold water, and always finishing with the cold soak;
  • Dry the area thoroughly and check with your fingers the results – you should feel that your external piles have shrunk a bit.
  • Apply a soothing ointment or salve (see further down).

Don’t fill-up the buckets with too much water. The goal is to soak the anal area, not necessarily the genitals.

1.2. Sitz bath with infused plants

The previous method used simple water and temperature changes. Here, we are going to use the power of medicinal plants to provide a toning and soothing effect.

Here are the plants to buy :

  • Pick one soothing plant among the following list : calendula dried flowers, plantain dried leaves, comfrey dried leaves, german camomille dried flowers ;
  • Pick one astringent plant among the following list : witch hazel dried leaves and/or twigs, yarrow dried aerial parts, oak bark (that one will require a decoction and not an infusion).

One of my favorite combination : calendula (whole flowers) and yarrow (leafs and flowers).

Take one big pinch of each plant and put them in a bowl. Boil a quart of water, pour over the herbs, cover and let the herbs infuse for 15 minutes. Filter, then dilute into another quart of water so that the resulting mix is lukewarm. Pour in a bucket and do a 10 minutes warm sitz bath.

You can also integrate this method with the previous one, replacing the hot water with a hot infusion of those plants.

1.3. External application of witch hazel

An external application of astringent plants like witch hazel will ensure that your piles will shrink faster. The two best are witch hazel and oak bark. Let us do simple - a witch hazel extract can be found in many stores, and is very easy to apply (see shopping list further down).

I highly recommend that you add a few drops of horse chestnut and butcher’s broom tincture in the bottle, 5 drops of each for a small 1 oz (30 ml) bottle.

Then do the following :

  • Store the bottle it in the fridge;
  • When you piles are inflamed, imbibe a cotton pad with the cold preparation and immediately apply to the area (the goal is to take advantage of the astringent effect of the cold temperature);
  • Keep the cotton pad for a few minutes to let the plant do its work;
  • You can repeat this several times a day.

1.4. External application of a soothing salve

The sitz baths and the cotton pad method will help tone-up and shrink the piles. After that, you need something soothing and anti-inflammatory that can stay with you for most of the day.

I recommend the application of a salve or a balm after the sitz or the cotton pad application. A salve contains an oil infused with medicinal plants, and beeswax. Nothing else, at least for the genuine salves made by genuine herb stores. The oil and beeswax provide lubrication to the area, preventing the inflammation caused by friction.

I prefer salves containing one or more of the following herbs :

  • Calendula, also called marigold (Calendula officinalis)
  • Comfrey (Symphytum officinale)
  • Plantain (Plantago major, P. lanceolata)
  • St John’s Wort (Hypericum perforatum)

See shopping list further down.

1.5. Herbal suppositories for internal piles

If you suffer from internal piles, external applications will only be of marginal help. The ideal vehicle to apply a herb internally is a herbal suppository. See shopping list further down for my recommendations.

1.6. Internal use of herbal tinctures

So far we have seen how an external application of herbs can provide relief. But those same herbs can work internally as well, toning up your blood vessels throughout the whole system and distributing their effect where needed.

In addition to the external methods, I recommend the following blend of herbal tinctures, taken in a little water twice a day :

  • Horse chestnut tincture – 5 drop
  • Butcher’s broom tincture – 20 drops
  • Centella asiatica tincture – 20 drops

I realize that this forces you to buy 3 different bottles of tinctures. But you can keep a good quality tincture for several years. If you suffer from regular piles crises, based on my clinical experience, this is a very good investment.

1.7. Plants for the liver

If you look in old herbal books, you will see that hemorrhoids treatments usually included a mix of plants for the liver. Why would old doctors worry about the liver at all, when it is the rectal area that is mostly concerned ?

There are two main reasons :

  1. An underworking liver can create blood stagnation and congestion around the portal vein. The venous return from the rectal area has to go through that congested region and faces resistance. This adds pressure to the rectal area.
  2. An underworking liver does not produce enough bile, and bile regulates transit (it acts as a natural laxative). Constipation is a key trigger of piles.

How do you know you have an underworking liver? Maybe your digestion runs slow, you have trouble digesting fats (lack of bile), maybe you have skin problems (liver and skin are tightly coupled), maybe you abused or still abuse your liver (food, alcool, drugs), etc.

If you suspect that is your case (and unfortunately it is the case for most of my clients), I recommend adding a depurative plant to your herbal mix. A dandelion root tincture is a simple and effective approach, add 20 drops to the herbal mix mentioned in the previous section, twice a day. See shopping list further down.

1.8. Hemorrhoid cushions

Those hemorrhoid cushions look like a big donut et enable you to sit without putting pressure on the painful piles. See shopping list further down.

1.9. Walk

Do not stay inactive in a seated position all day. This puts tremendous pressure on your piles and will make your situation worse. Walking is one of the best activity to get the blood moving again in that area.


2. Piles prevention

The following recommendations won’t bring immediate results. They provide a long term preventive approach to tonify and strengthen the connective tissues of your veins. But they do pay-off on the long run.

2.1. Bioflavonoids

Bioflavonoids are nutrients found in many fruits and vegetables. They protect the cardiovascular system against accelerated aging. Red and dark berries contain a large amount. They should be consumed on a regular basis. Frozen berries are a good alternative to the fresh ones.

Some high-quality supplements can also bring those flavonoids in a concentrated form. See shopping list further down.

2.2. Vitamin C

Today we know that vitamin C is essential for collagen formation. And collagen is a key structure of connective tissues. I recommend a daily supplement of vitamin C, 500mg twice a day.

2.3. Internal use of herbal tinctures

We already talked about those plants. I recommend to take them on a regular basis, 2 weeks on and 6 weeks off (in other words, take them for 2 weeks every other month). The dosage can be lower than during a crisis, take the following mix only once a day instead of twice :

  • Horse chestnut tincture – 5 drops
  • Butcher’s broom tincture – 20 drops
  • Centella asiatica tincture – 20 drops

You can also take them when you feel you are starting to feel your legs are tired and heavy, or when you start to feel an itch, inflammation or hard vein in your rectal area. Take them for a period of 2 weeks.

If you believe that you have a tired liver, add :

  • Dandelion root tincture – 40 drops

2.4. Kegel exercises

Look up Kegel exercises on the web, and do your Kegels every day. They are a great way to tonify the muscles of the pelvic and anal area, and a good muscle tone allows the veins to function better.

2.5. Physical activity

If I have to take a big step back and give you one main reason why people are suffering more and more from piles, I would say this: sedentarity.

If you are serious about the prevention of piles, you have to put a program of physical activity in place. It could be gardening at home, walking around the block. It does not have to be fancy, it does not require an expensive membership to the gym. It is just about getting "off your butt" and "onto your feet", and getting moving again.


Shopping list

This is the overall shopping list for products we discussed in this article.

Whenever possible, I recommend Mountain Rose Herbs (links provided below) as an online store for all the herbal recommendations in this article. I have used their products for years, and I can vouch for them. This is one of the best herbal store I know.

  • Crises : A list of bulk herbs : (1) calendula flowers and (2) yarrow leaves and flowers from the Mountain Rose bulk herb catalog.
  • Crises and Prevention : A list of tinctures : (1) horse chestnut, (2) butcher’s broom, (3) centella asiatica tincture. You can buy those from the Mountain Rose tincture catalog. You may also want to buy (4) the dandelion root tincture in case you suspect a congested liver.
  • Crises : For the external application of an astringent plant with a cotton pad, you can buy witch hazel extract here (scroll at the bottom of the page).
  • Crises : For the external application of a soothing balm, I recommend the Sitting Pretty Balm (scroll at the bottom of the page).
  • Crises : If you suffer from internal hemorrhoids : I like the witch hazel suppositories sold by WiseWays Herbals.
  • Crises : If you want to try a hemorrhoid cushion - hemorrhoid cushion.
  • Prevention : For the flavonoid supplements, my favorite product is Life Extension’s Enhanced Berry Complete.

References

(1) Mills, Bone, « Principles and Practice of Phytotherapy » , 2000

(2) Erdelmeier CA, Cinatl J Jr, Rabenau H, Doerr HW, Biber A, Koch E. Antiviral and antiphlogistic activities of Hamamelis virginiana bark. Planta Med. 1996 Jun;62(3):241-5.

(3) MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. 2001 Apr;6(2):126-40. Review.

(4) Sumboonnanonda K, Lertsithichai P. Clinical study of the Ginko biloba–Troxerutin-Heptaminol Hce in the treatment of acute hemorrhoidal attacks. J Med Assoc Thai. 2004 Feb;87(2):137-42.

(5) Weiss, Fintelmann, « Herbal Medicine », 2000


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