What are Hemorrhoids?

The disorder of hemorrhoids occurs when the hemorrhoidal veins , i.e. the vascular network found in the anus, dilate excessively. In this case varicose veins are created which can be more or less painful.

As we will see in the course of our article, hemorrhoids , which can be both internal and external, can be caused by a wide range of factors, both physiological and pathological in nature.

In principle, the dilatation of the hemorrhoidal veins occurs due to the innumerable series of efforts to which they are subjected and, consequently, bleeding or even prolapse occurs.

Many people in Italy suffer from hemorrhoids, according to the latest statistics about 40% of the population suffers from it and, to understand whether we have hemorrhoids or not, just refer to the symptomatological picture we will discuss in the next paragraph.

What are the symptoms that allow us to recognize hemorrhoids?

Among the main symptoms that occur in the case of hemorrhoids and which, therefore, make us understand that we are suffering from this disorder, we especially mention the following:

• the sensation of itching in the anus;
• discomfort and pain in the anus;
• congestion;
• l’edema;
• the bleeding;
• abnormal discharge of mucus and serum;
• the prolapse.

Furthermore, an accurate classification of hemorrhoids has been made , not only according to their location (i.e. whether they are internal or external hemorrhoids), but also according to the severity of the specific condition.

We therefore have four different degrees of severity of hemorrhoids which are respectively the following:

• Grade I hemorrhoids are still located inside the anus and are invisible from the outside. For this reason, anoscopic examination is used to identify them. Usually we realize that we have first-degree hemorrhoids only after bleeding, otherwise, in general, there is no pain;
• Grade II hemorrhoids , these also fall into the class of internal hemorrhoids, but it can happen that, at the time of evacuation, these tend to come out and then spontaneously return to the anal canal. Also in this case bleeding occurs, but unlike the previous type, with second degree hemorrhoids the patient feels discomfort;
• Grade III hemorrhoids , at this level the hemorrhoids begin to prolapse, or rather, come out and, to reposition them in the anal canal, a manual procedure must be carried out which is often very painful;
• Grade IV hemorrhoids are certainly the most painful of all. In this case the hemorrhoids prolapse completely and it is not enough to resort to manual repositioning to return the situation to normal.

What are the most common causes of hemorrhoids?

Hemorrhoids, as we have already mentioned above, can be caused by both psychological and physiological factors. Among the most common causes of hemorrhoids we certainly have the following:

• a condition of constipation not indifference;
• the presence of a pregnancy;
• an incorrect diet in which one exaggerates with the intake of particular foods, such as hot peppers, fried food and so on;
• the smoke;
• the abuse of alcoholic beverages;
• psychological stress;
• hormonal swings.

Unfortunately, determining the cause of each specific case is not a very simple undertaking, in fact, it is often practically impossible. However, valid solutions have been developed , especially from a pharmacological point of view, which we will discuss in this article.

Medicines for hemorrhoids: which ones can we use?

Intuitively, the choice of the best treatment for the treatment of hemorrhoids varies according to the severity of the situation. Indeed, in some cases the drugs are practically useless and the only solution is the surgical removal of the hemorrhoids, known as hemorrhoidectomy .

However, in mild to medium-sized cases, we can resort to some medicines , mainly for local use, which aim to reduce the inflammatory state, or medicines to be taken orally based on flavonoids which serve to improve the venous tone.

In any case, you must never forget to pay attention to your diet  because, as I will explain later, it plays a very important role in the course of the disease. Furthermore, the risk is also to nullify the benefits and hinder the effectiveness of the drugs that have been prescribed to you.

The drugs we will talk about today fall into macro categories and are respectively: flavonoids, anesthetics for local use and steroids.

Flavonoids: indicated for mild and non-bleeding cases

Flavonoids taken orally represent a valid therapeutic solution for hemorrhoids as they are able to perform the following functions:

• they are able to strengthen the vascular tone;
• reduce capillary permeability;
• facilitate vaso-lymphatic drainage;
• they perform a natural anti-inflammatory anti-inflammatory action.

In pharmacies we can find different formulations based on flavonodes that can be purchased without a prescription and can be used both as therapeutics and as preventives of future attacks. The flavonoids contained in these drugs are as follows.

Diosmin   and hesperidin  are the two prominent components of well-known medicinal preparations such as Daflon 500® and Arvenum 500® . These two substances act with a different but synergistic mechanism of action.

The former is able to normalize venous tone, reduce the edema associated with the inflammatory state and reduce the receptor response to catecholamines.

The second, however, is more specific in improving the health of the connective tissue by preventing the formation of proteolytic enzymes which are responsible for damaging the vascular endothelium. Furthermore, it effectively manages to carry out its anti-inflammatory action by inhibiting prostaglandins.

Troxerutin  is another  flavonoid that, for example, we find in drugs such as Flebinec®  which manages to improve the functionality of the microcirculation by reducing the inflammation associated with the disorder.

Local anesthetics: effective in reducing pain

Topical or local anesthetic drugs are used to relieve the painful symptoms of hemorrhoids, speeding up healing, especially when bleeding also occurs.

As the name suggests, these are drugs that are applied directly to the rectal area and are mostly creams, lotions and ointments. Among these we have above all the following drugs:

• Lidocaine, contained in Luan® , Xylocaina® and Lidofast® , is sold in the form of lotion with a percentage ranging from 3% to 5%. Doctors generally recommend applying a light layer of cream directly to the perineum a couple of times a day, even 3 times if necessary. In addition to lidocaine as such, there are also pharmacological associations based on nifedipine+lidocaine ( Antrolin® );
• Benzocaine , like Foille® , is found in the form of a cream for topical use, generally with a percentage of 20%. After carefully cleansing the anal area, we can apply a light layer of product when needed, but without exceeding six applications a day;
• Pramoxine Chloridate , commercially known under the name of Tronotene®. This cream, like the previous ones, should be applied to the anal area after having carefully washed and dried the area concerned;
• Dibucaine , sold under drug names such as Nupercainal®. It is a medicine that is used for anal itching in general and has also proved to be useful for the treatment of the symptoms of hemorrhoids. Thanks to the active ingredient, not only can you take advantage of its analgesic function but also its disinfectant function, and applying it is very simple thanks to the practical applicator that we will find supplied inside the package.

Steroids

Steroids usually come in the form of creams, ointments, or suppositories that are taken rectally. The purpose of these medicines is to carry out an anti-inflammatory and, at the same time, soothing action, giving relief to the patient and accelerating healing times.

Among the most used drugs that fall into this class we certainly remember those mentioned below:

• Fluocinoclone, known on the market under the name of Proctolyn® , can be purchased in pharmacies in the form of a suppository but also as a rectal cream for topical use. Generally, the treatment with this active ingredient lasts for a month and should be applied, or taken, a couple of times a day;
• Fluocortolone , commercially known under the name of Ultraproct® , is available in the form of rectal ointment but also in the form of suppository. In this case the treatment varies according to the format we have chosen. In the case of the ointment this should be applied two or more times a day for the first 3 days of treatment. In the case of suppositories, however, the treatment must last for a week after the symptoms have regressed and it is recommended to take one suppository a day;
• Hydrocortisone is commercially known under the name of Proctosedyl® and is the most widely used corticosteroid drug for the treatment of hemorrhoids and is available in the form of rectal suppository, cream or lotion. In the first case it is recommended to take one suppository a day after evacuating. In the case of cream and lotion, on the other hand, the application should be done a couple of times a day, when the need is felt. Generally the treatment lasts a month, but it can vary according to the seriousness of the situation.

Are there any natural remedies for hemorrhoids?

In addition to the drugs for hemorrhoids that we have talked about in this article, in milder cases we can also resort to using some natural remedies . These are mostly plants among which we especially mention the following:

• Witch hazel , endowed with valid anti-inflammatory, astringent and healing properties which have proved to be useful in the treatment of hemorrhoids;
• Butcher ‘s broom , a plant rich in saponins which, like the previous one, has astringent but also vasoconstrictive properties. For this reason butcher’s broom (also known as butcher’s broom) is useful in the case of hemorrhoids, but also for the treatment of disorders affecting venous circulation in general;
• St. John ‘s wort , with well-known disinfectant, healing and astringent properties, is useful for relieving the painful symptoms of hemorrhoids and speeding up their healing;
• Cypress , whose essential oil is widely used for the preparation of products for hemorrhoids, especially those with 100% natural ingredients. It has pseudoanesthetic, antispasmodic and vasoconstrictive properties.

In any case, before using natural remedies for the treatment of hemorrhoids, remember to ask your doctor for advice as they may not be sufficient to solve your specific situation or could interfere with the use of other medicines.

How should we behave in case of hemorrhoids?

Obviously, as happens with any other situation that has to do with our state of health, when we realize that something is wrong, or if the symptoms we mentioned above appear, it would be should contact your doctor.

He will himself verify the seriousness of the situation, after having subjected you to the appropriate tests and, therefore, to advise you on the path to take to best solve your problem.

In any case, we too have our share and, to help restore the situation, we must first of all correct our eating habits and eliminate from our diet all foods that would worsen our condition, especially as regards spicy foods and alcohol.

Furthermore, if we are affected by hemorrhoids we must favor the evacuation of stools that are not too solid, but rather soft that come out without difficulty and, to do this, we must certainly increase the intake of fibers to favor intestinal transit.

Let’s see below which foods are recommended to promote the healing process from hemorrhoids:

• whole grains;
• fruit;
• Seasonal vegetables;
• I leguminous;
• The red fruits.

In most cases, in addition to making changes to our eating habits, the doctor will surely prescribe medicines for the treatment of hemorrhoids, especially when the situation is not minor.

How do we prevent this ailment?

To prevent hemorrhoids you need to follow some tips, including:

• avoid making an abuse of alcoholic beverages;
• pay attention to your diet, avoid foods that are too spicy, spicy, those rich in animal fats or sugars;
• avoid junk food;
• try to avoid stressful moments and/or situations;
• make sure your diet contains the right amount of fiber, vitamin A, B vitamins, vitamin C and vitamin E;
• hydrate your body by drinking at least two liters of water a day;
• Stop smoking;
• do the right physical activity.

Bibliographic sources

• Italian Society of Coloproctology SICUP: http://siucp.org/emorroidi/