Hemorrhoids are a common condition, in which the veins in the soft tissues around the anus or inside the lower rectum become swollen and inflamed. External hemorrhoids refers to swelling under the skin around the anus. Internal hemorrhoids refers to swelling inside the anus. A prolapsing hemorrhoid occurs when an internal hemorrhoid protrudes outside the anus. Hemorrhoids usually are not a serious condition and symptoms commonly resolve within a few days.
Hemorrhoids are often associated with a low-fiber Western diet. These high fat, low-fiber diets often cause individuals to suffer from constipation. Constipation causes straining during bowel movements, and because the smaller and harder stools are, the more difficult they are to pass. Hemorrhoids can form when intra-abdominal pressure increases from straining during defecation or from lack of fecal bulk. Hemorrhoids are also common during periods of hormonal stress and pregnancy in women. Other factors that may cause hemorrhoids include; obesity, aging, diarrhea, long periods of standing or sitting, heavy lifting, and anal intercourse. [1-3]
According to the National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health :
- Hemorrhoids are very common in men and women.
- Hemorrhoids are common among pregnant women.
- About half of all people over the age of 50 have hemorrhoids
Hemorrhoid symptoms commonly occur following constipation. Signs of a developing/existing hemorrhoid include;
- Red blood on toilet paper or covering the stool after a bowel movement
- Swellings around the anus
- Mucus discharge from the anus with or without itching
- Discomfort and tenderness on defecation
- Soft tissue protrudes through the anus with defecation and then retracts, with a prolapsing hemorrhoid.
Severe cases may include painful swelling or a hard lump around the anus from a blood clot (thrombus).
Bleeding from the anus may indicate colorectal cancer and requires immediate medical care.
A high-fiber diet is the most important component in the treatment and prevention of hemorrhoids. A sitz bath and stool softeners may also help to ease specific symptoms. Topical corticosteroids, corticosteroid suppositories, and anesthetic sprays may be prescribed to treat swelling, itching, and pain. Internal hemorrhoids may be treated with sclerotherapy (the area is injected with a solution causing the veins to shrink) or by rubber band ligation (cutting off circulation to the hemorrhoid causing it to shrink). Persistent, painful hemorrhoids may be removed surgically or by laser or infrared heat treatment. A colonoscopy may also be performed to rule out serious underlying disease.
Psyllium and Pectin Fiber
A high-fiber diet including the use of natural plant fibers such as pectin (fruit fiber) and psyllium, may be an effective treatment and prevention of hemorrhoids. Pectin and psyllium have been traditionally used as bulking agents to improve stool consistency, promote peristalsis, and reduce straining during defecation. [4-6]
Citrus bioflavonoids, such as rutin and hydroxyethylrutosides (HER), provide many health-promoting benefits including hemorrhoidal relief. Rutin and HER have been shown to improve venous strength and function. Numerous studies in patients with hemorrhoids, including pregnant women, have found that HER supplementation significantly improved hemorrhoidal symptoms. [7-16]
In one particular double-blind study, 40 patients with hemorrhoids were administered an oral treatment of either 4 grams of HER or a placebo daily. The patients treated with HER showed a significant improvement in HER symptoms, including reduction of bleeding and pain, as compared with the patients taking the placebo. 
Glycosaminoglycans (GAGs), naturally present in the blood vessels, protect and maintain venous strength and function. In two double-blind studies, GAGs have been found to be even more effective in treating the symptoms of hemorrhoids than HER or bilberry extract. 
Bilberry extract, or Vaccinium myrtillus, is a potent flavonoid that protects and maintains venous strength and function. Bilberry extract may be helpful in the treatment of hemorrhoids. 
Gotu kola extract, or Centella asiatica, contains triterpenic acids that enhance connective tissue structure and improve blood flow. Gotu kola has been traditionally used to improve and support venous function, and may be helpful in the overall treatment of hemorrhoids. [19-20]
Butcher’s broom extract, or Ruscus aculeatus, contains ruscogenins that have anti-inflammatory and vasoconstrictor effects. In study, butcher’s broom has been used to treat venous problems, including those associated with hemorrhoids and varicose veins. 
1. National Institute of Diabetes and Digestive and Kidney Diseases:
2. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 507-511.
3. Stoppard M. Family Health Guide, New York: DK Publishing, 2002: 370.
4. Burkitt DP. A deficiency of dietary fiber may be one cause of certain colonic and venous disorders. Am J Dig Dis. Feb1976;21(2):104-8.
5. Perez-Miranda M. Effect of fiber supplements on internal bleeding hemorrhoids. Hepatogastroenterology. Nov1996;43(12):1504-7.
6. Webster DJ et al. The use of bulk evacuation in patients with hemorrhoids. Br J Surg 1978 (65): 291-92.
7. Misra MC, Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg. Jul2000;87(7):868-72.
8. Wadworth AN, et al. Hydroxyethylrutosides: a review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs 1992 (44):1013-32
9. Poynard T et al. Meta-analysis of hydroxyethylrutosides in the treatment of chrnoic venous insufficiency. Vasa 1994 (23): 244-50.
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11. Neumann HA et al. A comparative clinical trial of graduated compression stockings and O-(beta-hydroxyethyl)-rutosides (HR) in the treatment of patients with chronic venous insufficiency. Z Lymphol 1995 (19): 8-11.
12. Benton S et al. The effect of hydroxyethylrutosides on capillary filtration in moderate venous hypertension: a double blind study. Int Angiol 1994 (13): 259-62.
13. MacLennan WJ et al. Hydroxyethylrutosides in elderly patients with chronic venous insufficiency: its efficacy and tolerability. Gerontology 1994 (40): 45-52.
14. Bergstein NAM. Clinical study on the efficacy of o-(beta-hydroxyethyl)-rutosides in varicosis of pregnancy. J Int Med Res 1975 (3): 189-93.
15. Wijayanegara H et al. A clinical trial of hydroxyethylrutosides in the treatment of pregnancy. J Int Med Res 1992 (20): 54-60.
16. Annoni F et al. Treatment of acute symptoms of hemorrhoidal disease with high dose
O-(beta-hydroxyethyl)-rutoside. Minerva Medica 1986 (77): 1663-68.
17. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 510.
18. 1. Murray MT. Encyclopedia of Nutritional Supplements, NY: Three Rivers Press, 1996: 326.
19. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 828.
20. MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. Apr2001;6(2):126-40.
21. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 829.