It may seem reasonable to treat hemorrhoids by cleansing the colon - shown in red in the picture on the left.
By removing the fecal material in the gastrointestinal tract by colon cleansing, one removes a substance that is irritating to the very delicate tissue of the hemorrhoid itself.
Many choose colon cleansing for hemorrhoids because they believe that the cleansing will provide a clean region around the hemorrhoid and thus will not become infected.
To a certain degree, these approaches are indeed helpful for hemorrhoids. Proper medical therapy dictates that the region should be kept clean and that the stool should be kept soft.
However, aggressive colon cleansing for hemorrhoids can actually make things worse.
Where do you draw the line? This article briefly discusses hemorrhoids, some colon cleansing methods, and when colon cleansing for hemorrhoids goes too far.
Hemorrhoids are the name given to swollen, distended blood vessels in the region of the anus and rectum. The walls of these blood vessels, usually veins, are very thin and are quite prone to bleeding. This bleeding is evidenced by blood in the toilet or on the toilet paper after defecation. Hemorrhoids can be itchy and painful in ways that are difficult to treat for some people.
Hemorrhoids are very common—as many as one in 20 people have hemorrhoids at any one time. These painful blood vessels are thought to arise from one or more common conditions.
Conditions that may cause hemorrhoids are straining to defecate, general blood vessel disease, liver disease (usually cirrhosis of the liver), pregnancy, chronic constipation, chronic diarrhea, obesity, and any state that interferes with blood return to the heart.
Certain popular myths, such as sitting on cold or hard surfaces for long periods of time do not seem to cause hemorrhoids at all (though these activities may exacerbate hemorrhoids). Hemorrhoids tend to be more common in families. so a genetic predisposition to hemorrhoids is possible. Aside from these causes, very little is known about the etiology of hemorrhoids, unfortunately.
One of the reasons that many people turn to colon cleansing for hemorrhoids is that hemorrhoids medical treatment often fails to deliver full relief.
Sadly, some patients are too embarrassed to even bring up the subject with their doctors in the first place. Those patients that do discuss the hemorrhoid disorder with their doctors often find that the hemorrhoids treatment is either too conservative or too aggressive.
Most people with hemorrhoids have first degree hemorrhoids. First degree hemorrhoids are almost always treated with conservative care including dietary changes, meticulous hygiene of the anal region, and topical and oral medicines that attempt to reduce pain and irritation.
Simply because they are labeled first degree does not mean that these hemorrhoids do not cause suffering—they do! It simply means that the hemorrhoids will usually be treated with medical and comfort care only.
The hope is that with conservative care of the area and by removing the possible causes (like straining to defecate) that the hemorrhoids will go away over time. Indeed, in some people this does happen and in others, it takes a bit longer.
Even if hemorrhoids are second or third degree, the initial treatment may be conservative.
Once conservative treatments are abandoned, however, physicians are left with only much more aggressive surgical treatment options for hemorrhoids, such as band ligation, surgical ablation, or hemorrhoidectomy surgery:
Patients often find these treatments to be quite helpful, but the treatments themselves are difficult to endure and are sometimes associated with a long recovery period.
When patients with first degree hemorrhoids have a significant amount of discomfort but do not find relief from routine medical care, some turn to colon cleansing for hemorrhoids.
There are various colon cleansing methods from oral medications that increase the volume and frequency of defecation, to rectal suppositories to high colonics that infuse a liquid into the colon itself.
If done properly, some of these colon cleansing methods may provide hemorrhoid relief in cases where medical therapy is lacking.
However, some colon cleansing approaches can actually worsen the hemorrhoids symptoms and the hemorrhoids themselves.
In many patients that are chronically constipated (and, by extension, have hemorrhoids) are usually constipated because their diet is lacking dietary fiber. Western diets have moved away from the inclusion of many natural fruits and vegetables toward highly processed foods. Sure, these processed foods may taste better, are sweeter, and more convenient, but the processing takes much of the natural fiber out of the original food. The farther away from its natural state, the less dietary fiber a food generally contains. Since our gastrointestinal system evolved to function on a certain amount of fiber each day and it is no longer getting that fiber in the diet, chronic constipation results.
Psyllium husk fiber is a main component of most over the counter fiber preparations. While it has traditionally been marketed as a laxative, it is only really a laxative for people that are chronically constipated (which is an alarming number of people in Western cultures). When added daily to a typical Western diet, it provides the dietary fiber that is missing. Psyllium is a bulk-forming laxative. This means that it is not absorbed by the small or large intestines but rather stays within the GI tract for its entire course. As it passes through a constipated intestine, psyllium acts as a sponge to bring water into the intestine. More water inside the colon makes defection easier because instead of hard, dry stool, the stool is soft and moves easily. In cases of mild diarrhea, psyllium husk actually absorbs the water that is already in the intestine and forms solid stools from those which were loose. Given this dual action, psyllium fiber should be thought of as a dietary fiber rather than as a laxative—it promotes regularity and stool consistency rather than simply promoting defecation.
Increasing dietary fiber can be a safe and effective colon cleansing method and a treatment for hemorrhoids.
The GI tract seems perfectly happy to have dietary fiber housed within its walls and moves an appropriate amount of feces when it is present. Soft, but well formed stools decrease a person’s need to strain to defecate, which in turn removes that cause of hemorrhoids.
Removing one of the causes through colon cleansing may allow your hemorrhoids to heal.
Moreover, soft stools are less likely to irritate hemorrhoids as they pass. Just like a mosquito bite will heal faster if you leave it alone, hemorrhoids will heal faster if they are left undisturbed.
Stimulant laxatives are laxatives that irritate the lining of the intestine and cause it to secrete water into the GI tract. More water tends to soften stools and promote defection however the mechanism of action may be a problem.
Some stimulant laxatives have been pulled from the market because the stimulant approach to stool softening and colon cleansing may be harmful to the gut.
In fact, long term use (and abuse) of stimulant laxatives can lead to massive, intractable constipation because the bowel becomes dependant on the stimulant laxative in order to simply function. This constipation can cause terrible problems for the GI tract and greatly worsen hemorrhoids.
Therefore, this approach to colon cleansing or hemorrhoid treatment is not advisable.
Another method that people use for colon cleansing is osmotic laxatives.
These powerful agents are usually swallowed and act as a molecular sponge (through osmosis and diffusion) to pull water into the gut. This increased water loosens all stool in the small and large intestines and creates a strong sensation of the need to defecate.
Unfortunately, osmotic laxatives, while very potent at cleansing the colon, greatly increase the number of trips to the bathroom to move the bowels. If you have had bowel prep prior to a colonoscopy you have experienced the power of osmotic laxatives first hand.
While the stool will certainly be softened and loosened by this colon cleansing approach, the number of trips to the bathroom proves problematic for hemorrhoids.
The stool itself is not terribly irritating as it passes by the hemorrhoid, but the number of stool passages can itself lead to exacerbation of the hemorrhoid.
The act of moving the bowels stretches and deforms the fragile tissue of the hemorrhoid.
While some osmotic laxatives are a safe method for colon cleansing (used sparingly), they can actually make hemorrhoids worse over the short term.
High colonics are a process of colon cleansing in which a large volume of fluid is introduced into the colon which dissolves any stool present.
The fluid and dissolved stool is then removed from the colon under a gentle vacuum or by gravity.
This form of colon cleansing can be incredibly effective since it effectively removes all of the feces from the colon.
In many ways it seems like it would be an ideal method for hemorrhoid treatment as well. Bypass the anus entirely by dissolving and removing the feces before it reaches the hemorrhoid—no feces coming in contact with the hemorrhoid means no irritation.
In order to both introduce the fluid into the colon and to remove the dissolved fecal matter, a tube must be inserted into the anus itself.
While the colonic cleansing tube may be soft and pliable, it still must be passed across the extremely delicate and friable tissue of the hemorrhoid.
The act of placing or removing the colonic tube could break open the thin-walled blood vessel and cause it to bleed profusely.
The more times that this device is inserted, the greater the chance of damage and the slower the hemorrhoid will be to heal.
Therefore high colonics may not be an ideal method of colon cleansing for hemorrhoids.
Hemorrhoids are painful, irritating creatures found in one of the most sensitive of places on the body.
There are many reasons that have been proposed for why they occur.
Often there are just as many proposed solutions, including colon cleansing. Among all of the truth and fiction about hemorrhoids, most people with hemorrhoids will find that if they can keep the area from being aggravated and irritated, hemorrhoids will tend to heal if given enough time. This is easier said than done, since they are in a high traffic area. Any time that stools pass through the anus, they will pass across the hemorrhoid itself.
What is the ideal approach to hemorrhoids? If one could keep bowel movements to a minimum, that would help—the fewer times that the hemorrhoids are disturbed, the more likely they are to heal.
However, slowing down the bowel too far is not good, either. The longer that feces is held within the colon, the amount of water drawn out of the feces increases. Drier stool is more difficult to pass and increases straining, can break open blood vessels, and lead to pain and irritation.
Thus the optimal solution is to control the passage and consistency of feces. Ideally the stools should be soft, not loose, and quite easy to pass. Also, the number of bowel movements should be kept as low as possible without sacrificing this smooth consistency.
By increasing the amount of dietary fiber, one can see a change in bowel movements within a day or two. Dietary fiber intake can be adjusted to achieve the desired outcome.
In fact, increasing dietary fiber intake before hemorrhoids occur is an excellent way to avoid them altogether. Remember to account for the dietary fiber that is present in the diet, though, and adjust the amount of additional dietary fiber that is taken accordingly.
For severe constipation it may be useful to try an osmotic laxative once so that regular bowel habits can be established afterwards.
For severe diarrhea, it is important to see a primary care physician or gastroenterologist to rule out a more serious cause.
High colonics may be useful if the device can be inserted and extracted without traumatizing the hemorrhoid itself.
Keep in mind, though, the both osmotic laxatives and high colonics may lead to a rebound constipation in the days and weeks after they are used, which is not good for hemorrhoid tissue.
Davies RJ. Haemorrhoids Clin Evid 2006;15:180-3.
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990;98:380-6.
Author: Michael Sapko, M.D. Editor: Donald Urquhart, Psychologist.