1- Diet: The most important single tip for treating hemroids is consuming high-fiber diet like fresh fruits and vegetables and whole grain cereals. This will help increase the bulk of stools and prevent and/or constipation with the resulting decrease in straining. The recommended daily intake of fiber is 15-20 grams per day. This should be combined with sufficient water intake; at least 8 to 10 cups daily to avoid dehydration which increase the risk of constipation and resulting excessive straining. Avoid alcohols, coffee, and soda.

2- Exercise: regular light daily exercise helps to develop smooth bowel movements and avoid constipation. However, it is important to avoid lifting heavy objects as this leads to excessive straining which causes worsening of the case.

3- Bowel habits: Avoiding bad bowel habits does not only help in treating hemroids but also help in preventing their occurrence or recurrence. Avoid prolonged sitting on the toilet and avoid reading paper in the toilet, avoid excessive straining while passing stools, avoid holding stools for long time (go to toilet once you feel the desire to pass stools).

4- Squatting position: Recently, the modern sitting toilets have been linked to the higher incidence of hemroids in developed countries in comparison with developing countries in which people still use squatting position for passing stools. If you use a sitting toilet and have no access to a squat toilet, you can still try some alternative options which help you take the advantage of squatting. When you sit on the sitting toilet, flex your thighs extremely onto the abdomen and press your tip toes on the ground, this way, your position will be similar to a squatting position as much as possible. Another option is to obtain one of those chairs that are applied to the ordinary toilet and convert the toilet to almost a squat toilet.

5- Sitz baths: Frequent sitz baths daily, bathing the bowel area with warm water for 10 minutes helps rapid relief of acute hemroids symptoms as pain and discomfort.

6- Avoid sitting or standing for long time. If your job requires that you sit for a prolonged time, it is worth to try what is called hemroid pillow, which is a rounded cushion with a hole in the middle. It helps to relieve pressure on the hemroids area.

Also, you should note that there is no single treatment for hemroids that is the best for everyone and every case. So, knowing the most suitable option for you will help you cut the medical and financial costs and improving the outcome of treatment.

The following options should be considered when taking your decision:

Conservative hemroids treatment (Home treatment of hemroids): This is usually the first step in treating hemroids and should be tried first in any case before proceeding to fixative or surgical procedures. Conservative treatment includes dietary modifications to avoid or treat constipation, drinking sufficient water, local medicines like gels, creams and ointments to control the acute symptoms of hemroids like pain, discomfort and bleeding. Home hemroids treatment also includes the herbal remedies thas have been used for a long time to treat hemroids and has recently been introduced as combinations in commercial products such as Venapro or Avatrol.

Fixative procedures: These are special techniques that are used to cut the blood supply to the hemroids vessels which causes them to fall off. The blood supply is cut using rubber bands, laser, heat, or electric currents. This is considered the most suitble option in cases of internal hemroids especially those which bulge through the anus (prolapsed internal hemroids).

Surgical treatment (hemorrhoidectomy): surgical removal of hemroids should be considered in cases of prolapsed internal hemroids or external hemroids not responding to conservative measures.

What are the different types of hemroids?

Hemroids may be internal hemroids occurring inside the anal canal or external hemroids occurring outside the anus.

External hemroids may be painful and tender and feel like a fleshy mass near the anus. However, bleeding does not usually occur unless rupture or ulceration of occurs. In this case a fresh blood is present on toilet paper or on the surface of stools. It should be noted that a dark-red or brown blood is usually not due to hemroids and another cause must be identified.

In internal hemroids, pain may be absent or if present it is usually minimal and the main symptom is bleeding.

What is the relative efficacy/safety/cost of different treatments for hemroids?

Conservative treatment is the least expensive and safe of all other hemroids treatments. It is usually effective in simple non-complicated cases.

Fixative procedures are less risky and less expensive than surgical treatment with a shorter recovery period. They are also effective in mild to moderate cases.

Surgical treatment is the most risky, most expensive method of treatment with the longest recovery period of other treatment methods. However, surgical treatment has the best long term effect is the most effective method in severe or complicated cases or in cases not responding to other lines of treatment.

It is one of the established facts that hemroids have a much lower incidence in developing countries compared to developed countries. However, the explanation of this fact was not clearly identified.

This fact was initially attributed to high-fiber diet of people in developing countries. However, further studies have shown that those people have a wide variety of eating habits with some of them eating low-fiber diet but still have a much lower incidence of hemroids.

Recent studies have shown a strong connection between the modern toilets in developing countries and the increased incidence of hemroids in these countries.

The following picture shows the squatting position.

What are the benefits of squatting position?

Perfect elimination: squatting helps make elimination easier and faster with minimal straining and more complete. You know that excessive straining is a major cause of hemroids.

Nerve protection: squatting protects pelvic nerves from stretching and damage.

Ileocecal valve support: squatting supports the ileocecal valve which connects the small intestine to the colon and normally prevents regurge of colon contents into the small intestine. In the modern sitting positon, the valve is unsupported leading to contamination of the small intestine with the colon contents.

Relaxation of the puborectalis muscle. This muscle helps to close the rectum to maintain continence.

What is the solution?

There is a tendency to change the design of the current sitting toilet to be more similar to squatting position. Until these designs are available, you can use certain platforms on ordinary toilet that gives you a full squatting position.

The following pictures is for a commercially available squatting platform called the Nature’s Platform.

Nature's Platform

The conservative methods for of hemroids treatment include the following:

(1) Dietary modifications in the form of increasing the amount of fibers in diet and drinking big amounts of water. This is beneficial in preventing constipation. Constipation will worsen the hemroids by traumatizing the bowl mucosa and straining the bowl muscles.

Also dietary modifications include avoiding certain foods which are proven to worsen hemroids. These include but not limited to nuts, alcohols, spicy foods, and coffee. Also, observe your diet for any other foods that may aggravate the symptoms, if you observe that a certain food is causing worsening the hemroids, avoid them for a few days to ensure that there is a positive link.

(2) Behavioral modifications: these include

• Use ice on the area of hemroids for 10 minutes followed by hot foments for 20 minutes.
• Do not rub or wipe the area after a bowl motion. You can use baby wipes.
• Avoid sitting or standing in the same place for a long time. Move around.
• If there is severe pain on the hemroids, bed rest may be beneficial in providing relaxation to the bowl muscles which will remove the pain.
• Take sitz baths several times daily in which the area is soaked with warm water for 15 minutes.
• Use soaps and bath washes that contain less chemicals.
• Use cotton undergarments which will absorb moisture including sweating which will worsen the hemroids symptoms.

(3) Medical hemroids treatments:

• Local zinc preparations have two benefits; they protect the anal skin and prevent itching.
• Suppositories such as H formula will temporarily relieve the symptoms, but they have side effects with prolonged use as they may damage the anal skin. So, do not use them more than 7 – 10 days.
• Local hydrocortisone creams are beneficial in decreasing the inflammation, and preventing itching. Weak concentrations are available over the counter, if they are not effective, your doctor can prescribe stronger concentrations for you.
• Local analgesic sprays are available over the counter that can relieve the pain of inflammation.

Surgical hemroids treatment includes the following methods:

• Milligan-Morgan Surgical Method
• Ferguson Surgical Method
• Procedure for Prolapse and Hemroids (PPH)
• Laser Hemroids Surgery

Yes, you can cure hemroids completely naturally without using any medications either locally or systemically.

It has been found that medical treatment  does not actually cure hemroids i.e. it is not a curative treatment, it is rather a symptomatic treatment which may temporarily relieve symptoms of hemroid just to recur again once the treatment is stopped. This is because medical treatment does not depend on treatment of the cause and it generally can be said that causative treatment is the only curative treatment. Treatment of the cause will break the cycle of hemroid pathogenesis and this will lead to reversal of the process and permanent cure for hemroids.

In addition to this disadvantage of traditional medical treatment of hemroid, the drugs used are chemicals which has many adverse effects especially if used for a long time.

So, medical treatment of hemroids is practically ineffective in either treating or even temporarily controlling the symptoms of hemroids, and for that reason, many surgeons rapidly shift to the other option that traditional medicine presents; surgery!

Surgical treatment of hemroids also has many disadvantages; the post-operative pain in very severe to the degree that it may require morphine or pethidine for analgesia, also the hemroids are liable to recur post-operatively.

So, it appears that traditional medicine does not present an easy and permenant solution for hemroids.

On the other hand, alternative medicine presents a completely natural method to cure hemroids in 48 hours. This method is called “H Miracle” and is based mainly on a secret Chinese remedy, specific 4 diet elements, special 60 second exercise, and other elements with which you can cure hemroid symptoms completely in 48 hours and you can get rid of a huge-sized hemroids in a matter of 4 days. To read more about this method, click here.