emorrhoid, commonly known as piles, is a painful condition that occurs due to swelling of the veins in the anus and lower rectum. It is believed that almost 50% of the adult population above the age of 50 suffers from hemorrhoids.  It is one of the most common causes of painful bowel movement in both men and women. Despite the painful symptoms and risk of rectal bleeding, hemorrhoids are rarely serious. In most cases, they can be easily relieved with the help of conventional topical medications and home remedies.
Pathogenesis of hemorrhoids is poorly understood. Earlier it was believed that it was similar to the development of varicose veins. However, recent studies have revealed that the two conditions are not related. Latest researches suggest that hemorrhoids develop due to disintegration or deterioration of the supporting tissues of the canal lining. This leads to abnormal downward displacement of the canal cushion. The pathological change dilates the veins in the area. In addition, the severe inflammatory reaction is triggered by the pathological changes that affect the walls of the blood vessels and the connective tissues in the area leading to local thrombosis, ischemia, and mucosal ulceration. 
Hemorrhoids could be external or internal. External hemorrhoids, owing to their location under the skin where most of the pain-sensing nerves are located, are more painful than internal hemorrhoids. Internal hemorrhoids tend to be less painful because fewer pain-sensing nerves are present inside the rectum where they are located. Unlike external hemorrhoids that you can easily feel or see, internal hemorrhoids unless they are prolapsed cannot be felt or seen. Internal hemorrhoids that are not prolapsed are not painful, though they are known to cause rectal bleeding. 
Symptoms of Hemorrhoids
Painless rectal bleeding during bowel movement is the most common symptom of hemorrhoids. The small amount of bright red blood is usually seen dripping in the toilet bowl. Irritation, itching, pain and discomfort in the anal region are other common symptoms. The area around the anus is usually swollen. You may feel a lump near the anus, which could be painful and sensitive. 
However, the exact symptoms depend upon the location of the hemorrhoids. Anal itching, the presence of one or more tender hard lumps in the anal area and anal pain, that is usually experienced while sitting, are the common symptoms of external hemorrhoids. Symptoms tend to worsen by excessive straining during bowel movements and cleaning and rubbing the anal area.
In the case of internal hemorrhoids, rectal bleeding while straining the affected area to pass stool is a common symptom. Straining or irritation associated with bowel movement damages the surface of hemorrhoid that makes it bleed. Excessive straining during defecation could push the internal hemorrhoids downwards. Internal hemorrhoid protruding through the anal opening is known as a prolapsed hemorrhoid. Pain and irritation are associated with the prolapsed internal hemorrhoid. 
In some cases, blood clots in the affected vein, leading to the thrombosed hemorrhoid. It is more common in external hemorrhoids. Thrombosed hemorrhoids are associated with swelling, inflammation and severe pain. You can also feel and see a hard lump near the anal region.
Causes and Risk Factors of Hemorrhoids
The veins in the anal region tend to swell when excess pressure is applied to the area. Persistent pressure stretches the veins that become inflamed. It usually occurs by straining while passing a bowel. It is common in people who are constipated. Chronic diarrhea is also known to increase pressure on the veins in the anal area. A low-fiber diet increases the risk of constipation and hemorrhoids. As the connective tissues that support the veins in the rectum and anus weaken with age, the risk of developing hemorrhoids is higher in older adults. Risk of developing hemorrhoids is higher in pregnant women and obese individuals. During pregnancy, the baby weight increases pressure on the anal area that weakens and stretches the tissues in the area, leading to hemorrhoids. 
How to Get Rid of Hemorrhoids Naturally
Home remedies are usually found to be effective in alleviating the symptoms of hemorrhoids and speeding up the healing process.
1. Hot Sitz Bath
Fill a bathtub with warm water. The temperature of the water should be from 40 to 42 degree Celsius. Sit in the stiz bath for 3 minutes. Avoid longer size bath as it increases the risk of hemorrhoid congestion or prolapsed hemorrhoid. The warm water cleans the anus and boosts blood circulation in the affected area that helps in reducing edema and congestion. The warmth of the water helps to alleviate pain. 
2. Ice Packs
The swelling of the anal area could be reduced with the help of ice packs. Wrap ice in a cloth and apply the ice pack to the affected area for 15 to 20 minutes. Ice packs are usually used for reducing swelling associated with thrombosed external hemorrhoids. 
3. Witch Hazel
Topical witch hazel alcohol tincture helps in improving the tone of the veins. However, this property is missing in witch hazel tea and steam processed witch hazel water. You will, therefore, find witch hazel tincture in the ingredients list of a number of over-the-counter topical products for relieving hemorrhoids. Witch hazel poultice is traditionally used as a remedy for the bleeding and weeping external hemorrhoids.  Take a small amount of witch hazel on a cotton ball and dab it on external hemorrhoid. For better result, chill the witch hazel tincture before applying it. Cold witch hazel helps provide fast relief from pain. 
4. Horse Chestnut
Traditionally witch hazel is combined with horse chestnut in commercial preparations that are sold over the counter for hemorrhoids. Horse chestnut seeds contain an active constituent called aescin that possesses anti-inflammatory and astringent properties that could help in tightening and toning the swollen veins. Horse chestnut tea, prepared by simmering a teaspoon of the dried seeds in a cup of water, can be used for applying a topical compress. Allow the tea to cool before application. Alternatively, combine 80 ml distilled witch hazel with 10 ml horse chestnut. If needed, dilute the mixture to minimize the risk of irritating the skin. Dab a small amount of the mixture to the anal area. 
5. Aloe Vera
The soothing and cooling effect of the gel extracted from the leaves of the aloe vera plant can help in reducing the pain and swelling associated with external hemorrhoids. Aloe vera gel can be applied directly to the affected area or it can be added to cold compresses. Furthermore, to ease bowel movement, aloe vera latex can be taken to relieve constipation. It is known to make stool soft and relieve irritation caused by hemorrhoids. 
6. Essential Oils
Essential oils with analgesic and anti-inflammatory properties are used topically to relieve the hemorrhoid symptoms. Essential oils that are commonly used in natural hemorrhoid remedies include geranium, lavender, cypress, patchouli, immortelle, niaouli, helichrysum, and frankincense. Multiple essential oils are combined in various proportions and the resulting oil blend is mixed with a carrier oil or aloe vera gel and applied to the anal area. Some of the effective essential oil blends for relieving hemorrhoids include two drops each of geranium, cypress and patchouli oil and four drops of immortelle essential oil; three drops of cypress oil and two drops of geranium oil; three drops of lavender and two drops of immortelle; and three drops each of lavender and helichrysum oil. Add one tablespoon of your chosen essential oil blend to a ½ oz carrier oil or aloe vera gel. Apply a small amount to the affected area. 
7. Tea Tree Oil
Tea tree oil is believed to reduce the irritation and discomfort caused by hemorrhoids. You can apply several drops of tea tree oil to the anal area or add about 10 drops of tea tree oil to the sitz bath. Tea tree oil can also be combined with comfrey salve or witch hazel. Mix ten drops of tea tree oil with comfrey salve and then apply the salve to the anal area. For a cold compress, mix one tablespoon of tea tree oil with two ounces of witch hazel and apply the compress for about ten minutes. 
8. Black Tea
Tannin in the tea leaves can help in reducing swelling, pain, and bleeding. Apply cool compress with the wet tea bag for several minutes. 
9. Flavonoid Supplements
Supplementation with flavonoid-rich plant extracts can help in alleviating the symptoms of hemorrhoids. In a clinical trial, sweet orange, an excellent source of flavonoids, was found to help in relieving the acute and chronic hemorrhoid symptoms. The study revealed that regular intake of 500 mg of sweet orange extract for two months helped in reducing acute and chronic symptoms. The effectiveness of sweet orange extract persisted for a long time and helped decrease frequent acute hemorrhoid episodes. Furthermore, long-term sweet orange extract intake is considered safe for health. Therefore, individuals susceptible to hemorrhoids can continue taking sweet orange extract for a long time.
Unlike most of the home remedies that work primarily on external hemorrhoids, flavonoid supplements work on both external and internal hemorrhoids. Researchers had found in a study that supplementation with purified flavonoid fraction comprising of 50 mg of hesperidin and 450 mg of diosmin twice a day caused significant improvement in the hemorrhoid symptoms. 
To get rid of the hemorrhoid symptoms you can also take 1000 to 2000 mg of flavonoid supplement called hydroxyethylrutoside (HER). 3000 to 6000 mg of citrus bioflavonoids containing a mixture of rutin and hesperidin can also be taken daily. These flavonoid supplements help in strengthening the rectal blood vessels. Grapeseed and pine bark extracts are rich in flavonoids called proanthocyanidins that can help reduce the hemorrhoid symptoms by enhancing the strength and flexibility of the blood vessels. You can take 100 mg of any of the two supplements daily. 
Flavonoids found in the dark-colored berries are also known for their beneficial effect on hemorrhoids. Studies have shown that supplementation with flavonoids could stop rectal bleeding within a few days. Long-term flavonoid supplement intake helps in reducing the risk of relapse.  Bilberry extract, due to its high flavonoid content, is known to be an effective remedy for hemorrhoids. According to a study, bilberry extract when taken daily helped in reducing pain, itching, and burning caused by hemorrhoids in pregnant women. Bilberry is known to improve blood circulation. By strengthening the capillary walls, it could reduce the accumulation of fluid in the tissues surrounding the blood vessels.  About 150 to 600 mg of bilberry extract standardized to contain 25% anthocyanosides can be taken between meals. Instead of taking one large dose, divide it into two to three smaller doses. Discomfort, itching, and bleeding caused by hemorrhoids can also be reduced by taking 600 to 4000 mg of quercetin daily. 
10. Fiber Supplement
Increasing dietary fiber intake is known to reduce hemorrhoid symptoms. Fiber assists in the formation of soft bulky stools that make bowel movement less painful in people with hemorrhoids. Supplements containing psyllium, unprocessed bran or sterculia are known to reduce pain, itching and rectal bleeding. Regular intake of fiber supplements is believed to reduce the risk of prolapsed hemorrhoid. To improve colon cleansing, you can take a teaspoon of psyllium husk mixed with a glass of water. Flaxseed supplement is another excellent source of dietary fiber. Regular intake of 20 to 30 grams of fiber is known to cause significant improvement in bowel movement. However, limit your daily fiber intake from supplements to 15 grams. To boost the effectiveness of fiber supplement and reduce side effects such as bloating and flatulence, it should be taken with plenty of water. 
11. Apple Cider Vinegar
Apple cider vinegar is known for its anti-inflammatory and astringent properties that can help in reducing swelling and pain associated with hemorrhoids. To get rid of the throbbing pain, hold a clean cotton ball soaked in apple cider vinegar against the affected area for about 10 minutes. 
Dietary modifications are essential for alleviating the symptoms of hemorrhoids and speeding up the healing process. A high fiber diet is most important for minimizing the risk of developing hemorrhoids. Fresh fruits, almost all vegetables, wheat bran, oat bran, whole grains, nuts, and seeds are excellent sources of dietary fibers.
Foods rich in vitamin K such as dark green vegetables, alfalfa, and blackstrap molasses could help in reducing rectal bleeding. Water is a natural stool softener. Therefore, remember to drink plenty of water. Limit consumption of high protein animal foods and avoid animal fats, alcohol, coffee, and hot spices.