Abascal K, Yarnell E. Botanical treatments for hemorrhoids. Altern Complement Med. 2005;11(6):285-289.

Almost one-half of all Americans have some discomfort from hemorrhoids by the time they reach age 50, but only 4% seek medical treatment.¹ The authors discuss the roles of butcher's broom (Ruscus aculeatus), horse chestnut (Aesculus hippocastanum), stoneroot (Collinsonia canadensis), witch hazel (Hamamelis virginiana), arnica (Arnica spp.), oak (Quercus spp.), chamomile (Matricaria recutita), gotu kola (Centella asiatica), calendula (Calendula officinalis), and psyllium (Plantago ovata seed) in the treatment of hemorrhoids.

Hemorrhoidal tissues, cushions of tissue within the anal canal that contain blood vessels and supporting tissue made up of muscle and elastic tissue, are present in all individuals.² Hemorrhoids occur when these cushions enlarge and cause negative symptoms, e.g., the passage of bright red blood. Two types of hemorrhoids can occur: internal hemorrhoids, which originate at the top of the anal canal, and external hemorrhoids, which originate at the lower end of the canal, near the anus. According to the authors, botanical treatments for hemorrhoids have been poorly researched.

Butcher's broom has a long history of clinical use as a treatment for hemorrhoids, and its use for treating this condition has been approved by the German Commission E.³ The authors cite an open-label multicenter study of 124 patients, in which 69% of those patients rated butcher's broom as having good or excellent efficacy. After taking 6 capsules per day of a product containing 150 mg of butcher's broom for 3 days and then reducing their dose to 4 capsules per day, the patients reported symptom (pain, local signs, overall severity) improvement.

Horse chestnut contains a mixture of triterpene saponins (referred to as escins), flavonoids, and tannins. The German Commission E has approved the use of a standardized horse chestnut extract (containing 16%-20% anhydrous escin) for treating chronic venous insufficiency. Although European publications from the late 1800s and early 1900s report that horse chestnut benefits patients who have hemorrhoids, there are no recent studies on its use as a hemorrhoid treatment. The authors cite a double-blinded placebo-controlled study of 80 patients suffering from acute symptomatic hemorrhoids. In 81% of those patients, symptoms were reduced, and bleeding and swelling were notably reduced. In that study, 40 mg of escin was administered 3 times daily for up to 2 months.

Stoneroot is used by many American herbalists, including the authors, as a treatment for symptomatic hemorrhoids. The only research on stoneroot is constituent studies showing that it contains flavonoids  and saponins.

Witch hazel has long been used to treat hemorrhoids. Both European and American herbalists use witch hazel both as an internal and topical remedy. It is prescribed as a decoction or as an alcohol-preserved decoction. In pharmacological studies, it has produced anti-inflammatory, astringent, and vasoconstrictive properties.⁴

Topical treatments can calm the inflammation and stop the bleeding and swelling associated with hemorrhoids. Rudolf Fritz Weiss, MD (a German phytotherapist) recommended using 1-2 teaspoons of arnica tincture per half-liter water as a wet compress. Alternatively, he recommended the use of an oak bark decoction or a chamomile infusion, and the use of a witch hazel ointment following the application of compresses.

The authors recommend combining several herbs in compresses, sitz baths, or ointments to provide a broader range of actions. For topical application, they suggest including herbs noted for their wound-healing properties (e.g., gotu kola, chamomile, or calendula), as well as those used internally (stoneroot, butcher's broom, horse chestnut, and witch hazel).

The authors note the importance of other issues in the treatment of hemorrhoids. They recommend an increased intake of fruits and vegetables, as well as increased water intake and exercise, for a long-term reduction of hemorrhoid symptoms. For those patients who are constipated, the authors recommend psyllium seed husks.

"A comprehensive treatment plan will work effectively on hemorrhoids in the early stages. More complicated and advanced hemorrhoids are likely to require allopathic intervention. Nonetheless, botanicals as an adjunct to ligation and surgery will be helpful for healing and preventing recurrences," conclude the authors.

—Shari Henson

References

¹Online document at: www.answers.com/main/ntquery?name=hemorrhoid. Accessed September 2005.

²Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 2004;126:1463-1473.

³Abascal K. Yarnell E. Butcher's broom: herb's potential too often swept under the rug. Alternative & Complementary Therapies. 2002;8:177-186.