Hemorrhoids and Varicose Veins: A Review of Treatment Options
Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often leads a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.
(Altern Med Rev 2001;6(2):126-140)
Every general practitioner sees a large number of patients who suffer from problems associated with venous insufficiency. Two of the most common manifestations of venous insufficiency are varicose veins and hemorrhoids. The prevalence of these two conditions is astonishing. In population studies the prevalence of varicose veins has been reported to be 10-15 percent for men and 20-25 percent for women. In a recent cross-sectional study, the age-adjusted prevalence of varicose veins was 58 percent for men and 48 percent for women. Over three-quarters of individuals in the United States have hemorrhoids at some point in their lives, and about half of the population over age 50 requires treatment.
The Merck Manual defines hemorrhoids as "Varicosities of the veins of the hemorrhoidal plexus, often complicated by inflammation, thrombosis, and bleeding." It has been suggested this is an oversimplification of the nature of hemorrhoids. A more recent definition is, "Vascular cushions, consisting of thick submucosa containing both venous and arterial blood vessels, smooth muscle, and elastic connective tissue." While everyone has this tissue, it is the enlargement, bleeding and protrusion that create pathology. The crossroads to the development of varicose veins and hemorrhoids is the loss of vascular integrity. Considering the combined prevalence of varicose veins and hemorrhoids, venous insufficiency and its manifestations are an extremely common medical problem that every physician should be prepared to treat.
Historical Perspective on Hemorrhoids
Hemorrhoids are mentioned in ancient medical writings of every culture, including Babylonian, Hindu, Greek, Egyptian, and Hebrew. The word "hemorrhoid" is derived from the Greek "haema" = blood, and...