Alternative Treatments for Anal Fissures and Hemorrhoids

Anal fissures and hemorrhoids are common yet often unspoken health concerns, causing discomfort and distress to many.

In the following sections, we will guide you through the world of alternative treatments, providing insight into gentle yet effective ways to soothe and heal the body from these conditions, emphasizing the importance of holistic health and well-being.

Common Causes

Anal Fissures

An anal fissure is essentially a small tear or cut in the mucosa (the moist tissue lining) of the anus, the opening through which stool exits the body.

This condition can be excruciating, often characterized by a sharp pain during bowel movements.

Hemorrhoids are common in both men and women, affecting about 1 in 20 Americans, with about half of adults over the age of 50 experiencing them.

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Anal fissures are commonly caused by passing hard or large stools, but they can also result from chronic (long-lasting) diarrhea, childbirth, or diseases that affect bowel movements.

Hemorrhoids

Hemorrhoids are swollen blood vessels located in the lower part of the rectum and the anus. They are somewhat akin to varicose veins but located in the rectal area.

These swollen vessels can develop internally (inside the rectum) or externally (around the anal opening) and are primarily caused by increased pressure in the lower rectum. This pressure can stem from straining during bowel movements, obesity, pregnancy, or prolonged sitting.

Symptoms

Anal Fissures

The hallmark symptom of an anal fissure is a sharp pain during bowel movements, often accompanied by bright red bleeding. Sufferers might also experience a burning or itching sensation near the anal area.

Hemorrhoids

Symptoms of hemorrhoids include discomfort, itching, or pain around the anal area, especially during bowel movements.

Bleeding, which will be bright red, is also a common symptom, occurring during or after bowel movements. In some cases, if the hemorrhoids are external, a person might feel or see a lump near the anus.

A Statistical Glimpse

Anal fissures and hemorrhoids, while often not discussed openly, are conditions that affect a significant portion of the population. In this exploration, we delve into the statistics that reveal the widespread nature of these conditions, supported by scientific studies and research data.

Anal Fissures: A Common Yet Overlooked Condition

• Anal fissures, characterized by a small tear in the lining of the anus, are more common than one might expect.
• A study[1] published in the Official journal of the American College of Gastroenterology suggests that the incidence of Chronic Anal Fissure (CAF) markedly decreased with age, from 7% in the 20-50 age group to just 1.5% in individuals aged 60-90. Additionally, patients with Crohn’s disease were found to be twice as likely to develop CAF compared to those suffering from ulcerative colitis.
• Interestingly, a gender disparity is evident in anal fissure cases. Research indicates that women are slightly more prone to developing anal fissures compared to men. This disparity is attributed to factors such as childbirth and anatomical differences.

Hemorrhoids: A Widespread Concern

• Hemorrhoids, or swollen veins in the rectal area, are even more prevalent. According to a study[2] in the Annals of African Medicine, hemorrhoids affect approximately 50% of the population by the age of 50. This condition is almost equally common in men and women.
• The prevalence of hemorrhoids is linked to lifestyle factors, including diet, physical activity, and bowel habits. The increasing incidence of obesity and sedentary lifestyles has been correlated with a rise in hemorrhoid cases, as per research findings published in the International Journal of Colorectal Disease.

The prevalence of fissures was slightly higher in males (19.41%) than in females (14.14%), and it was more common in patients aged 18 to 40 years than in those aged 41 to 60 years.

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Anal Fissures and Hemorrhoids in the Postpartum Period

A study[3] on the incidence of thrombosed external hemorrhoids and anal fissures during pregnancy and after delivery in a Dutch hospital setting found that 9.1% of females had anal lesions (13 thrombosed external hemorrhoids and 2 anal fissures) during pregnancy.

Postpartum, the incidence rose significantly to 35.2%, with 33 cases of thrombosed external hemorrhoids and 25 cases of anal fissures observed. The study identified dyschezia (difficulty in defecating) and late delivery as two independent risk factors for these conditions.

Notably, most thrombosed external hemorrhoids were observed immediately after delivery, suggesting a significant impact of childbirth on these conditions​​.

Risk Factors and Prevention

• Both conditions are influenced by dietary habits, with a low-fiber diet being a significant risk factor. Chronic constipation and straining during bowel movements increase the risk for both anal fissures and hemorrhoids.
• Preventive measures, as highlighted in studies[4] include dietary modifications to include more fiber, adequate hydration, and regular physical activity. These lifestyle changes have been shown to significantly reduce the incidence of both conditions.

Conventional treatments

Anal fissures and hemorrhoids are common conditions that cause significant discomfort. While they share some similarities, their treatments can differ. Let’s explore the conventional treatment methods for each of these conditions.

Anal Fissures: Healing the Tear

Anal fissures are small tears in the lining of the anus, causing pain and bleeding during bowel movements. The primary aim of treatment is to relax the anal sphincter (the muscle around the opening of the anus) and promote healing.

Topical Treatments:

• Nitroglycerin Ointment: This ointment helps to relax the anal sphincter, reducing pain and facilitating healing. It’s applied externally around the anus.
• Topical Anesthetics: Creams or ointments containing lidocaine can provide temporary relief from the pain associated with anal fissures.

Stool Softeners

Medications like docusate sodium help soften stools, making bowel movements less painful.

Botox Injections

In some cases, Botulinum toxin injections are used to temporarily paralyze the anal sphincter muscle, relieving spasms and allowing the fissure to heal.

Hemorrhoids: Reducing Swelling and Discomfort

Hemorrhoids are swollen veins in the lower rectum or around the anus. Treatment focuses on reducing swelling and easing symptoms.

Over-the-Counter Remedies

Hemorrhoid Creams and Suppositories contain ingredients like hydrocortisone or witch hazel, which can reduce swelling and relieve pain and itching.

Astringents

Substances like witch hazel can be applied to the hemorrhoidal tissue to help shrink them and relieve irritation.

Sitz Baths

Sitting in warm water for 10 to 15 minutes several times a day can help relieve hemorrhoid symptoms.

Oral Pain Relievers

Over-the-counter pain medications like acetaminophen or ibuprofen can provide temporary relief from hemorrhoid discomfort.

Surgical and Minimally Invasive Options

When conservative treatments don’t work, more invasive procedures may be considered.

For Anal Fissures

Lateral Internal Sphincterotomy is a surgical procedure involves making a small incision in the anal sphincter to reduce muscle tension and promote healing.

For Hemorrhoids

• Rubber Band Ligation: A small rubber band is placed around the base of a hemorrhoid to cut off its blood supply, causing it to wither and fall off.
• Sclerotherapy: A chemical solution is injected into the hemorrhoidal tissue, causing it to shrink.
• Hemorrhoidectomy This surgical procedure involves the removal of excessive hemorrhoidal tissue.

Nutritional and Herbal Support

The prevalence of hemorrhoids is highest in Australia (38.93%), followed by Israel (16%) and Korea (14.4%).

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These natural remedies, backed by scientific studies, offer a holistic approach to healing. Let’s explore some of the most promising herbs and their active components for treating and preventing anal fissures and hemorrhoids.

Fiber Supplements: The Cornerstone of Treatment

Psyllium Husk

• Psyllium husk, derived from the seeds of Plantago ovata, is rich in soluble fiber. It helps in softening stools and ensuring smooth bowel movements, crucial in both preventing and managing anal fissures and hemorrhoids.
• A study[5] published in the “Alimentary pharmacology & therapeutics” demonstrated that psyllium husk effectively alleviates constipation, a key factor in hemorrhoid and fissure formation.

Methylcellulose

• Methylcellulose is a synthetic form of fiber that aids in bowel regularity. Like psyllium, it helps soften the stool and is commonly used as a laxative.
• The “Scientia Pharmaceutica” has reported[6] on its benefits in improving symptoms related to anal fissures.

Flavonoid Supplements: Reducing Inflammation and Pain

• Diosmin and hesperidin, bioflavonoids found in various citrus fruits, have been shown to improve vein health and reduce inflammation.
• A study[7] in the “World J Gastroenterol” journal highlighted that a combination of diosmin and hesperidin significantly reduced hemorrhoid symptoms, including pain, bleeding, and swelling.

Herbal Extracts

Witch Hazel (Hamamelis virginiana)

• Witch Hazel is renowned for its astringent properties, thanks to its active components like tannins and flavonoids. These compounds help reduce inflammation and swelling in hemorrhoidal tissues.
• A study[8] published in the “Alternative & Complementary Therapies” highlighted Witch Hazel’s efficacy in reducing hemorrhoid symptoms.

Horse Chestnut (Aesculus hippocastanum)

• Horse Chestnut is another herb widely used for hemorrhoids. Its active component, aescin, has been shown to strengthen vein walls, improving circulation and reducing swelling.
• The “Turkish Journal of Colorectal Disease” published a study[9] demonstrating its effectiveness in reducing hemorrhoid symptoms.

Aloe Vera (Aloe barbadensis)

• Aloe Vera is well-known for its soothing and healing properties, primarily due to its active compounds like aloin and barbaloin. It can help in the healing of anal fissures and reducing irritation caused by hemorrhoids.
• A study in “The Journal of Alternative and Complementary Medicine” found[10] that topical application of aloe vera gel significantly reduced symptoms of hemorrhoids.

Butcher’s Broom (Ruscus aculeatus)

• Butcher’s Broom contains active compounds like ruscogenin, which helps to reduce inflammation and tone veins, making it beneficial for hemorrhoid treatment.
• The “International Journal of Biological Chemistry” published a study[11] which reported that butcher’s broom effectively reduced hemorrhoid symptoms.

Comfrey (Symphytum officinale)

• Comfrey, with its active component allantoin, promotes cell regeneration and healing. This makes it potentially useful for anal fissures. However, due to its potential toxicity, it should only be used topically and for a short duration.
• The “Skin Pharmacology and Physiology” has documented[12] its healing properties in skin tissue.

Calendula (Calendula officinalis)

• Calendula is known for its anti-inflammatory properties, thanks to its flavonoid content. It can help soothe the discomfort caused by both hemorrhoids and anal fissures.
• The “Journal of Ethnopharmacology” highlighted [13]calendula’s efficacy in reducing inflammation.

Chamomile (Matricaria recutita)

• Chamomile, rich in flavonoids and terpenoids, is known for its soothing and anti-inflammatory properties. It can provide relief from the itching and discomfort associated with hemorrhoids.
• A study[14], Available at SSRN, tested a herbal cream, formulated with the essential oil of common myrtle and ethanolic extracts of chamomile, wild leek, and Russian olive, was compared to a conventional cream for treating hemorrhoids.
  The study findings suggest that this herbal cream can effectively reduce key symptoms of hemorrhoids, such as anal bleeding, anal pain, and difficulty during bowel movements.

Bilberry

• Bilberry, rich in anthocyanins, has been studied for its potential in strengthening blood vessels and reducing inflammation.
• Research in the “Journal of the International Society of Sports Nutrition (JISSN)” suggests[15] that bilberry extract may offer benefits in managing hemorrhoidal symptoms.

Both genders report the peak incidence of hemorrhoids between the ages of 45 and 65 years, with Caucasians being more frequently affected than African Americans.

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Bibliography