Hemorrhoids are very common and often they cause considerable trouble. They are small tumors consisting of enlarged, tortuous and varicosed blood-vessels in the tissues of the rectum, appearing at the edge of or just within the anus and causing considerable pain during evacuation of the feces. Sometimes the mucous membrane is extended outside the anal orifice. The veins often become inflamed, and frequently become occluded by blood clots.
There may be external or internal hemorrhoids, also bleeding and itching hemorrhoids, but the cause is practically the same in all cases. The external variety may be seen at the margin of the anus as small, hard, rounded, purplish masses. The internal variety may or may not proirude through the anus.
Though piles are regarded by most members of the medical profession as a purely local disturbance, it has been proved that constitutional measures, without any local measures whatever, usually bring relief and often the ultimate obliteration of the piles; whereas local measures, surgical or injection treatment, may prove only temporarily of benefit.
Chronic constipation is a predisposing cause of piles. The attendant straining at stool aggravates the tendency to the condition. Among other causes are lowered tone of all tissues, obesity, protracted standing on the feet, liver congestion, enlarged prostate and heavy uterus. Such exertions as lifting heavy weights may cause piles. They frequently result also from diarrhea and dysentery and cystitis or inflammation of the bladder. However, few hemorrhoids would develop if the general circulation and especially the abdominal circulation were kept normal. But from inactivity of the abdominal muscles and a wrong diet various conditions result which lead to the development of hemorrhoids.
An inactive liver, often resulting from such conditions, prevents return flow of the blood through the hemorrhoidal vessels of the rectum and abdomen, resulting in a stagnant condition in the rectum – the starting point of the hemorrhoidal vessels. The backing up of this blood in the rectal tissues causes local engorgement and reduces tone. At first this is a temporary condition, but in time becomes chronic. When this state develops, especially when there are some of the other causes mentioned, hemorrhoids are very likely to develop, especially if there is straining at stool.
Symptoms. Piles usually develop slowly and may not be detected for some time after their beginning. Usually there are pain at stool, slight bleeding when the piles are internal, a feeling of soreness and irritation after evacuation, and usually a feeling of incomplete evacuation. There may be a feeling of weight in the rectum. Constipation becomes aggravated as a rule, because of the dread of evacuation on account of the attendant suffering.
Internal piles arc associated with bleeding, protrusion during defecation, the sensation of fullness in the rectum and possibly a mucous discharge. There may be enough bleeding to result in anemia. Often there is a tenesmus, or spasmodic tightening of the rectal sphincters. External piles often cause pronounced local itching. The mucous membrane may become inflamed, the piles increase in number and the pain and bleeding become profuse when the condition is neglected. The piles at first may be no larger than a pea, but may increase to the size of a plum.
Treatment. It is much better to prevent hemorrhoids than to await their development and then cure them, but usually this complaint is not considered until it has really developed. However, if a person lives on the proper diet, maintains normal elimination and maintains good tone of all the muscular system, internal as well as external, there need be no fear of the development of piles. Treatment must be constitutional and local. Constipation must be corrected. General muscular exercise is important, but particularly abdominal exercises, and especially on an inclined support (gravity exercises). The knee-chest position, also walking about the room on hands and feet are very helpful also.
Diet is one of the most important factors of treatment. The fast is excellent in this condition because it reduces congestion in the liver and in the hemorrhoidal vessels. A complete fast (or a fruit diet) may continue for from five to twenty days, or even longer if the condition is extreme and the weight normal or above normal.
The milk diet may follow the fast or fruit diet to advantage, provided constipation is not allowed to develop on the diet. It improves the quality and circulation of the blood, also tissue tone, more rapidly than any other diet. However, in many cases it is better to use a solid food diet, having an abundance of the green vegetable salads, cooked green vegetables, raw and stewed fruit and milk in some form, preferably buttermilk or sour milk, also fair quantities of whole grain cereals.
On the milk diet it usually is advisable to inject two or three ounces of olive oil into the rectum every night before retiring, but this may be used on the solid food diet also unless elimination is free. The cold sitz-bath taken morning and evening usually is of considerable value, though of course reaction to warmth must be prompt and complete. The very hot shallow bath or the hot sitz-bath may be used, followed by a similar cold bath or cold spray, usually with much benefit. It is of value also to inject one-half pint of cold water into the rectum or three or four ounces of witch hazel, either to be retained.
Rectal dilation is excellent in hemorrhoids also. This may be given by hard-rubber dilators, procurable in any drug store in a set of four. It is best to begin with the smallest size and change to a larger size every few days or each week. One should use the largest size that can be used comfortably. The rectal attachment of a portable electric vibrator also may be used once or twice a day for two or three minutes, with relief and real benefit.
Spinal manipulative treatment often is of great value, but this should be osteopathic or confined to some type of manipulation that reduces contractures along the lumbar spine. The hot-water bag or hot compresses may be used locally to the anus, but if used for from fifteen to thirty minutes it is better to terminate the treatment with as cold an application as possible for from one to three minutes.
Operation has been performed countless times in the case of hemorrhoids and still is performed quite frequently. But the modern treatment replacing surgery is the injection method. Often hemorrhoids return after either surgery or injection treatment, for the simple reason that nothing is done to improve the tone of the vessels and the circulation in general. Where the above treatment, in whole or in part, is used faithfully, the hemorrhoids usually will be greatly relieved within a short time and eradicated within a very few months, and they are not likely to return if general tone is maintained and a suitable diet for general health continued.