Hemorrhoids (Piles)

Dr. Weyrich's Naturopathic Proctology Notebook

Overview

Hemorrhoids (Piles) represent a swelling and possible prolapse of varicose veinous tissue lining the rectum and anal canal.

Symptoms of hemorrhoids include rectal bleeding, pain, itching, and sometimes protrusion.

Internal hemorrhoids are found in the rectal mucosa above the dentate line (transition zone from skin to mucus membrane). External hemorrhoids are found in the anal skin below the dentate line. External hemorrhoids may thrombose to form a painful swelling containing coagulated blood.

Etiology

Statistics show that 80% of Americans will get hemorrhoids at least once in their life. While genetic susceptibilities vary from person to person, the following exacerbating factors can be identified:

• Improper diet or drug use leading to constipation
• Liver congestion (portal hypertension)
• Pregnancy and childbirth
• Heavy Lifting and straining
• Poor Anal Hygiene
• Prolonged Standing or Sitting
• Abdominal masses

Diagnosis

Diagnosis is made by anoscopic exam, which is a brief in-office procedure. In the case of rectal bleeding that is not adequately explained by hemorrhoids, further evaluation is necessary, e.g. a colonoscopy. Rectal bleeding of undetermined origin is a serious condition that is presumed to be due to colorectal cancer until proven otherwise.

Hemorrhoids are classified by location (internal, external, mixed, anterior, posterior, lateral, right, left).

Internal hemorrhoids are graded as follows:

• First degree: short projections into the anal canal.
• Second degree: Hemorrhoids prolapse with straining but reduce spontaneously.
• Third degree: prolapse with straining but can be reduced manually.
• Fourth degree: permanently prolapsed.

Differential Diagnosis

• Fissure
• Condyloma (warts)
• Abscess
• Fistula
• Puritis ani
• Colorectal cancer

Treatment

Conservative treatments include:

• Dietary modifications to reduce constipation.
• Use of over-the counter or prescription laxatives and stool softeners (not recommended for long-term use).
• Use of over-the counter or prescription medicated ointments, creams, suppositories, and wipes.
• Warm-water sitz baths.
• Topical vasoconstrictors (e.g. phenylephrine, Preparation H).

Sometimes these conservative treatments will temporarily shrink hemorrhoids, but if the underlying cause is not addressed then hemorrhoids tend to return if they are not removed.

Dr. Weyrich offers a number of non-invasive treatments for hemorrhoids, including:

• Counseling in Therapeutic Lifestyle Changes to relieve constipation.
• Naturopathic treatments for liver congestion.
• Functional Diagnostic techniques to identify and treat the root cause of constipation or liver congestion.

Dr. Weyrich also offers the following minimally invasive techniques for reducing hemorrhoids, which can usually be performed during the same appointment as the initial examination:

• Destruction of internal hemorrhoids using treatments such as band-ligation, electro-cautery, and phenol in olive oil. These techniques are quick, relatively painless procedures that can be done in-office without anesthesia.
• Destruction of external hemorrhoids using techniques such as laser surgery to create a small, round incision that heals more rapidly than conventional excision techniques, while allowing removal of the clotted blood and the venous matrix that gave rise to the external hemorrhoid. These procedures are done using local anesthetics similar to those used in dentistry. Upon request acupuncture is available to reduce the use of local anesthetic, and conscious sedation with nitrous oxide is available to reduce anxiety during the procedure.
• In order to promote healing, post-procedure inflammation is controlled either using prescription corticosteroid creams or suppositories or naturopathic preparations.

Several treatments may be required to fully shrink the hemorrhoidal tissues.

Severe cases may not be amenable to the above minimally invasive techniques and require scheduling for surgical procedures that are also available at Comprehensive Health Services.

Prevention

The best prevention for hemorrhoids is to maintain regular bowel movements of proper consistency and to maintain good liver health.

Sequelae

Hemorrhoids may spontaneously reduce, but tend to come back and grow over time if not treated. Treatment reduces future risk, but does not guarantee that hemorrhoids will not return, especially if the underlying cause is not addressed.

Pathophysiology

There are three primary areas where hemorrhoids tend to form: right anterior, right posterior, and left lateral. Other areas may form smaller hemorrhoids as well.

ICD-9 Codes

ICD9-Code	Description	Comments
455.0	Internal hemorrhoid, uncomplicated
455.1	Internal hemorrhoid, thrombosed
455.2	Internal hemorrhoid, complicated
455.3	External hemorrhoid, uncomplicated
455.4	External hemorrhoid, thrombosed
455.5	External hemorrhoid, complicated
569.3	Anorectal bleeding, unspecified origin
569.42	Anorectal pain, unspecified origin

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References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

[Shacket2009] www.hemorrhoid.net/hemorrhoids.php

[Shackelford2007] Charles Yeo et al. Shackelford's Surgery of the Alimentary Tract, Sixth Edition, Chapter 147. Philadelphia: Saunders-Elsevier (2007).

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Copyright © 2007-2010 Dr. Weyrich (Naturopathic Medical license number 07-1008). The information on this site is for educational purposes only. It is not intended to diagnose, treat or cure any disease or illness. The statements on this website have not been evaluated by the Food and Drug Administration.

This web page is http://www.DrWeyrich.com/disorders/hemorrhoids.html   -   Phone Dr. Weyrich at (480) 423-6952