Systematic review and meta-analysis: Foods, drinks and diets and their effect on chronic constipation in adults.
Fruits and rye bread may improve certain constipation-related outcomes.PubMed 37905980 ↗
Open Source Apothecary At Home / Digestion
Hemorrhoids
The treatment is stool consistency and time. The soothing preparation is the part people enjoy.
remedyHemorrhoids are engorged vascular cushions at the anal margin, and the reason they bleed and hurt is mechanical: hard stool, straining, and prolonged sitting on the toilet. The interventions that work follow directly from that.
Soft stool is the treatment. Fibre, with adequate fluid, has randomised trial evidence for hemorrhoid symptoms and reduces bleeding. Psyllium is the fibre with the trials. This is unglamorous and it is the main intervention.
Topical soothing. A warm sitz bath for 10-15 minutes reduces pain. A demulcent — slippery elm, marshmallow or a plain oatmeal preparation — soothes. Commercially available astringent pads containing witch hazel are traditional and harmless; the astringent action on intact skin is small. Horse chestnut, whose active is aescin, has trial evidence in chronic venous insufficiency and is used for hemorrhoids; the evidence is better for the leg veins than for the anal ones.
What to avoid. Prolonged sitting on the toilet with a phone, straining, and the cycle of avoiding a bowel movement because it hurts — which makes the stool harder and the next one worse. Long-term topical steroid creams thin the skin and should not be used beyond the labelled period. And a topical anesthetic can sensitise the skin with repeated use.
The red flag that matters most. Rectal bleeding in an adult is assumed to be hemorrhoids by the person who has it, and that assumption delays the diagnosis of colorectal cancer. Any bleeding should be assessed, and it should be assessed sooner over 45, with weight loss, a change in bowel habit, anaemia, or a family history.
What the studies found
The Effect of Fiber Supplementation on Chronic Constipation in Adults: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Particularly, psyllium, doses >10 g/d and treatment durations of at least 4 weeks appear optimal, though caution is needed when interpreting the results due to considerable heterogeneity.PubMed 35816465 ↗
Management of faecal incontinence and constipation in adults with central neurological diseases.
There is still remarkably little research on this common and, to patients, very significant issue of bowel management.PubMed 24420006 ↗
Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis.
Optimal dosages, routes of administration, and PEG regimens should be determined in future randomized controlled studies and meta-analyses.PubMed 25310742 ↗
Preparation
Sitz bath
- Warm water (not hot), 10-15 minutes, two to three times a day and after a bowel movement
- A plain bath, or a sitz pan over the toilet
- Add nothing caustic. Epsom salts are pleasant and not required.
Demulcent compress
- Cold infusion of marshmallow root or slippery elm, applied on a soft cloth for 10 minutes
- Cold compresses reduce swelling and pain
Psyllium
- 1 teaspoon in a large glass of water daily, with a further glass of water
- The actual treatment; give it 4 weeks
Witch hazel
- A pad or a dilute decoction applied after a bowel movement
- Astringent and soothing; do not put strong alcohol-based witch hazel on broken skin
Horse chestnut
- Standardised extract (aescin 50 mg twice daily in the trials) — only with a clinician's advice, because of the interaction profile
- Better evidence for leg veins than for hemorrhoids
Cautions and interactions
- Do not use topical steroid creams beyond the labelled period. Skin thinning and worsening follow.
- Horse chestnut interacts with antiplatelets and anticoagulants and can cause bleeding. Check before using it.
- Topical anaesthetics can sensitise the perianal skin with repeated use.
- Do not apply essential oils or strong astringents to the anal skin. It is delicate and burns easily.
When this is not a self-care problem — get help
- Any rectal bleeding should be assessed. Over 45, or with weight loss, a change in bowel habit, anaemia, or a family history of bowel cancer, it needs prompt investigation.
- A painful lump that will not reduce, a fever, or severe pain with a perianal swelling — possible thrombosed hemorrhoid or abscess, needs assessment.
Related
Sources
- Systematic review and meta-analysis: Foods, drinks and diets and their effect on chronic constipation in adults. Alimentary pharmacology & therapeutics 2024; doi:10.1111/apt.17782 PubMed 37905980
- The Effect of Fiber Supplementation on Chronic Constipation in Adults: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American journal of clinical nutrition 2022; doi:10.1093/ajcn/nqac184 PubMed 35816465
- Management of faecal incontinence and constipation in adults with central neurological diseases. The Cochrane database of systematic reviews 2014; doi:10.1002/14651858.CD002115.pub3 PubMed 24420006
- Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis. Medicine 2014; doi:10.1097/MD.0000000000000065 PubMed 25310742