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 :
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 :
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.
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 :
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.
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.
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) 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.
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.
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 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 (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).
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, 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).
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 is often used in the natural treatment of piles. Studies show that it is a useful plant to relieve the symptoms of hemorrhoids(4).
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.
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.
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.
Don’t fill-up the buckets with too much water. The goal is to soak the anal area, not necessarily the genitals.
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 :
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.
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 :
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 :
See shopping list further down.
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.
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 :
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.
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 :
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.
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.
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.
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.
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.
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.
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 :
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 :
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.
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.
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.
(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