You can treat hemorrhoids with creams, ointments, wipes, and even medical procedures—with good success—but one of the best ways to treat and potentially prevent this condition, especially in its early stages, is to eat more fiber.
Low fiber intake can lead to hard stools that raise colon pressure and can damage existing veins and cause hemorrhoids. Soft, smooth stools do not raise pressure in the colon. Some of the best hemorrhoid drugs in the world are also used to prevent and treat varicose veins (they’re both related to abnormal vein structure), and in the United States these drugs are called dietary supplements.
What is Hemorrhoids?
Simply put, hemorrhoids are a pain in the butt (pun intended). They are clumps of dilated blood vessels that bulge from the lining of the rectum; when they protrude, or prolapse, outside of the anus, they can become very painful. If there is extreme pain, bleeding, incontinence, or ulceration, you might have to consider surgery, but usually that’s not necessary.
This will drive some doctors crazy, but I like to think of hemorrhoids as varicose veins of the anal and rectal area because they share some (not all) features with varicose veins. Having one does not predispose you to having the other. However, there is little question that the drugs—and especially supplements— that are promising for treating varicose veins are also excellent for hemorrhoids. These supplements have the ability to increase drainage of fluid and improve the structure and function of the veins.
No supplements or drugs can cure hemorrhoids, but they can treat and reduce the recurrence. Lifestyle changes can reduce the risk of hemorrhoids, but no one can say for sure that they will reduce the chances of hemorrhoids becoming worse.
Home Remedies For Hemorrhoids
1. Fiber at least 20 to 30 grams a day (with no more than 5 to 15 grams coming from a fiber supplement)
Pretty much everyone with hemorrhoids should get more fiber, either through diet or supplements, to help reduce symptoms. Notice I say “reduce symptoms”; researchers aren’t 100 percent sure if fiber prevents hemorrhoids (I think it does). Fiber promotes soft, bulky stools that can be passed without straining, which is critical for reducing pain, bleeding, and healing time. It’s also important to increase your water intake to make the fiber work more effectively (by drawing water into the stool to soften it) and to reduce side effects from it. In studies, supplements with psyllium, sterculia, or unprocessed bran decreased bleeding, pain, itching, and prolapse; most have found that 10 to 20 grams a day of extra fiber can make a difference.
Some studies reported a higher rate of bloating with fiber supplements, which is why it’s better to increase the fiber you’re getting from diet versus pills or powders. I recommend trying to get 5 to 15 grams from a high-fiber breakfast cereal or bar that includes soluble and insoluble fiber as well as another 5 to 15 maximum from a fiber powder, like psyllium (eating a combination of soluble and insoluble fiber delivers the most benefits for heart and gastrointestinal health and helps prevent future straining and constipation).
2. Diosmin 1,000 to 3,000 milligrams a day in divided doses for 1 week for current hemorrhoids; 1,000 milligrams a day in divided doses for 2 to 3 months or longer to reduce symptoms of chronic or recurrent hemorrhoids
The most commonly tested drugs or supplements for hemorrhoids are preparations that include micronized purified flavonoid fractions (MPFF). This jargony-sounding name essentially means they contain a particular combination of plant compounds called flavonoids. Micronized means that the particles were reduced in size to less than 2 micrometers (that’s really tiny) to improve solubility and absorption. There are other MPFF products out there, but diosmin is the one to look for when it comes to hemorrhoids. Daf lon is the best known diosmin-containing product. A semisynthetic prescription drug in France and Europe, it typically contains 450 milligrams of diosmin and 50 milligrams of other flavonoids (a 90:10 ratio). Although it’s a drug in Europe, in the United States it’s a dietary supplement.
There is evidence that diosmin helps in many ways, including by preventing endothelial damage, reducing the inflammatory response seen in the microcirculation, and improving venous tone and lymph drainage. It can help reduce hemorrhoids and other venous problems, such as varicose veins. In fact, no other product has received more human research in the area of hemorrhoids and chronic venous insufficiency (CVI). A review of more than 10 randomized trials and 1,500 patients suggests that these flavonoid products (diosmin or Daflon) reduce the risk of bleeding by 67 percent, continuous pain by 65 percent, itching by 35 percent, and recurrence rate by almost 50 percent. That’ s impressive!
At the same time, however, there is no good research on potential drug interactions or potential side effects when using diosmin, but some clinical trials have reported a higher rate of gastrointestinal problems. I would be careful about combining it with aspirin or other blood thinners only because it can cause a reduction in red blood cell clumping and blood viscosity, which means it may increase blood thinning.
In studies, the most common dosages of diosmin used were 2,000 to 3,000 milligrams per day after meals for the first 3 to 4 days of experiencing hemorrhoids, followed by 2,000 milligrams per day on days 4 through 7. This dosage improved pain, bleeding, itching, and anal discharge. Other studies have used 1,800 milligrams of diosmin for 4 days (600 milligrams three times a day) and 1,200 milligrams for 4 more days (400 milligrams three times a day). There is also research showing that taking 2,000 milligrams a day over 60 to 80 days may reduce symptoms of chronic or recurrent hemorrhoids.
Some studies have followed subjects taking 1,000 milligrams of diosmin daily for a year, and this minimal long-term data is one reason I love this supplement. One study looked at pregnant women with hemorrhoids for 8 weeks before delivery and 4 weeks afterward. The researchers used 3,000 milligrams of diosmin daily for 4 days and then 2,000 milligrams daily for 3 days (known as a loading dose); the maintenance dose after that was 1,000 milligrams daily. About half of the women reported a benefit within a few days, and the researchers noted there was no impact on pregnancy, fetal development, birth weight, feeding, or infant growth. Now, this does not prove it’s completely safe during pregnancy, but I think it’s absolutely worth discussing with your doctorsince hemorrhoids are common in pregnancy.
3. Pycnogenol 100 to 150 milligrams a day in divided doses for 1 week with or without 0.5 percent Pycnogenol cream to treat active hemorrhoids
A standardized extract from the bark of the French maritime pine, Pycnogenol contains polyphenols, especially proanthocyanidins (PCOs), which appear to be the active ingredient with protective properties. You should always look for a Pycnogenol supplement with at least 80 to 95 percent PCOs. Unfortunately, these PCOs are not cheap, but other sources of these active compounds include peanut skin and grape seed extract. (The latter is a fairly well-known supplement, but it doesn’t have adequate research in the area of hemorrhoids.)
There have not been many studies with Pycnogenol and hemorrhoids, but the best one used a Pycnogenol supplement and topical cream (0.5 percent Pycnogenol) within 48 hours of the onset of hemorrhoids for 1 week. Subjects took 300 milligrams of the dietary supplement for 4 days and then 150 milligrams for 3 days (in three daily divided doses). When the cream was used with the supplement, symptom relief (especially pain) was significantly faster. Pycnogenol is often given with a 10-milligram fiber supplement, such as psyllium, but a high-fiber cereal is another option. The preliminary data for Pycnogenol and varicose veins is pretty impressive, and it has a good safety record, so despite few clinical trials directly with hemorrhoids, I’m comfortable recommending it. The one con: It’s pricey.
4. Horse chestnut seed extract
Horse chestnut seed extract (Aesculus hippocastanum) has been shown to reduce leg pain, swelling, and itching and ankle and calf swelling as well as the use of compression stockings in people with CVI, and many of the supplements that work well for varicose veins of the legs also work for hemorrhoids, as mentioned earlier. However, there has been very little published human research in the area of hemorrhoids, and I have no idea why.
The active compound in horse chestnut is escin (also called complex active triterpenoid saponins or just aescin), which has been shown to block the destruction of structural components in vein walls. However, in half the studies, up to one-third of subjects reported gastrointestinal upset and dizziness; in others, there were mild to minimal side effects reported. But, again, these were studies looking at leg veins, not hemorrhoids.
A human study that was conducted several decades ago gave subjects with hemorrhoids capsules containing 40 milligrams of escin three times a day for 2 months. The researchers saw improvements in as little as 6 days, and the escin group reported greater reductions in hemorrhoid symptoms compared to the placebo group, including less swelling and bleeding.
Yet, where are all the other human studies? This is a big mystery, kind of like the Loch Ness Monster and Bigfoot. So, it is with great reluctance that I give this supplement a basic free pass based on my experience with patients who’ve used it and its effectiveness in treating other vein problems. But take this with a grain of NaCl (a.k.a. salt— nerd joke). This should be the last supplement that you use on this list, along with the next one.
5. Rutosides (O-beta-hydroxyethylrutosides, a.k.a. rutin or oxerutin)
Rutosides (O-beta-hydroxyethylrutosides, a.k.a. rutin or oxerutin), types of flavonoids, appear to protect blood vessel walls from damage in multiple ways, including by discouraging cells from adhering to the walls so that they can continue to function normally.
One of the most commonly tested rutoside products has been Venoruton (from Novartis in Switzerland, a prescription drug in Europe), but a potential equivalent can be found over the counter in other countries if you cannot get it from Europe.
Look for products containing rutin, which is close in molecular structure to the rutosides that have been used in studies; I believe it works about as well as they do, plus it’s cheaper! (Rutin is also found in asparagus and buckwheat and in the rinds of limes, lemons, grapefruits, oranges, and apples, for example.) In studies, dosages of rutosides for CVI have been 2,000 to 4,000 milligrams per day, and some research for hemorrhoids has used from 1,000 to 4,000 milligrams of rutosides per day.
The side effects of these supplements are rare and include gastrointestinal problems, allergic reaction to the products, headache, and hot flashes. Again, I’d look for this only if fiber, diosmin, and Pycnogenol aren’t working, which should hardly ever be the case.
What Supplements Are Useless For Treating Hemorrhoids?
There’s some good laboratory research showing that witch hazel can reduce inflammation when it is used topically, and it may even block enzymes that contribute to the breakdown of blood vessels and increase the risk of venous problems. The bark and leaves of the plant have astringent qualities (shrink or constrict body tissues), which make it a popular ingredient in many different products, including hemorrhoid cream.
But in terms of human studies, there is minimal research supporting its efficacy as a topical for hemorrhoids and nothing to suggest it has any efficacy as a dietary supplement or pill for hemorrhoids. I don’t mind it in my hemorrhoid cream because it contains several ingredients that work, but I wouldn’t take it as a supplement, especially since there’s also a lack of good safety research. Witch hazel is like saw palmetto for prostate enlargement; they’ve both worked their way into our culture, but essentially on a free pass! No thanks!
This herbal has anti-inflammatory properties and the potential to improve mild vein abnormalities of the leg thanks to one of its active ingredients, ruscogenin (a saponin glyco-side). Laboratory studies have suggested that butcher’s broom has a slight benefit against CVI as a supplement or topical agent because it may block the enzyme elastase, which is part of the enzyme system involved in breaking down blood vessel components. Now here is the problem: The exact quantity of ruscogenins that are effective is not known.
Plus, numerous older clinical trials done with butcher’s broom were terrible, and the research in the area of hemorrhoids is weak to nonexistent. Now let’s talk about side effects. Study subjects have reported dermatitis or an allergic reaction in rare instances, and in one small trial a few participants had to drop out because of swelling, nausea, and other gastrointestinal side effects. Butcher’s broom can also contain the compound tyramine, which should never be combined with certain prescription medicines, such as MAO (monoamine oxidase) inhibitor antidepressants. So, as you can see, I have many concerns about this herbal. I’m not saying it’s worthless; it’s just not worth it, especially for hemorrhoids.
Buckwheat or buckwheat herbal tea
Buckwheat contains rutins, and an older study of people with venous problems who used this for 3 months showed an impact on lower leg swelling that was better than a placebo. However, the average leg volume or size did not actually significantly change in the buckwheat group. And the placebo group claimed a variety of benefits. In other words, this study by itself does not impress me enough to recommend buckwheat supplements or tea for vein problems, especially hemorrhoids. I am happy about the rutin content, and it may indeed be found to be beneficial in the long term, but other clinical trials with buckwheat are lacking. Plus, it’s a common food allergen in several countries around the world, such as Japan, Korea, and Finland. The one condition I wholeheartedly recommend buckwheat (in honey) for right now, though, is cough reduction.
What Lifestyle Changes Can Help With Hemorrhoids?
Heart healthy = vein healthy (= butt healthy)!
Keep your blood pressure, cholesterol, and glucose normal; eat a healthy diet with fiber (see the next tip); and maintain a healthy weight. You get it (or you should get it!) by now.
Check your diet
Plant-based diets reduce the risk of hemorrhoids and constipation, whereas high-protein or low-calorie (below 1,200 calories a day) diets can increase the risk. If you’re a fan of high protein and low carbs, make sure the one type of carb you eat a lot of is fiber! (If you have to strain during a bowel movement—or it takes you a long time to go—then you need more.) A high-fiber cereal contains more than 10 grams of mostly insoluble fiber per serving, which means it will not create a lot of gas and bloating. (Soluble fiber promotes heart and colon health, and insoluble fiber helps soften the stool.) Oatmeal is okay with about 3 to 6 grams of fiber per serving, half of which is soluble. If you take one-third of a cup of a leading high-fiber cereal, put some flaxseed powder on it, and add a few ounces of milk, that’s about 15 grams of fiber, most of it insoluble.
Take a soak
Sitting in a warm bath with Epsom salts (magnesium sulfate) and then applying a water-based ointment like K-Y jelly can make you feel better than many of the specialized hemorrhoid ointments from the store will. While sitz baths do not have much human research and don’t appear to improve recovery from hemorrhoids, I recommend them because they reduce stress and relieve tension when dealing with hemorrhoids, and they just feel good.
The less you weigh, the less pressure you put on the veins of your rectum and legs. If you’re exercising to manage your weight, stay hydrated. Pregnancy can exacerbate hemorrhoids, which tend to spontaneously improve after birth.
Find a cushy seat
Sit in a comfortable, padded chair or use a doughnut cushion. Cotton (or some other breathable fabric) underwear tends to be less irritating, too. I’m convinced seat warmers, which all the cars in Michigan have thanks to the harsh winters, can make hemorrhoids worse. I can’t back up this statement with research, but I have my own personal clinical trial of one (“Moyad”) that says it’s true.
Opt for acetaminophen
Aspirin, ibuprofen, and other NSAIDs (like naproxen) can thin the blood and make bleeding worse. Acetaminophen (Tylenol) is a better choice. Also, avoid alcohol if you have hemorrhoids because it is dehydrating, can thin the blood, and could delay recovery time.