This is a guest post by Eilaf Meenai.
Hemorrhoids are swollen veins that form around the anus. They can be uncomfortable, painful, and debilitating to live with. And some claim that these swellings are the result of inactivity, which many of us are guilty of nowadays.
But are hemorrhoids a modern problem?
The answer is no. In fact, they were first described in the 4,000-year-old Babylon Code of Hammurabi, meaning they’ve been around for millennia. This begs the question: how did ancient people treat hemorrhoids?
Let’s find out.
Early recognition of hemorrhoids
Hemorrhoids have been plaguing human civilization for at least 4,000 years, according to surviving texts. For instance, a condition that cannot be anything other than hemorrhoids is mentioned in both the Edwin Smith Papyrus (1700 BC), the Ebers Papyrus (1500 BC), and the Chester Beatty Papyrus (1200 BC).
But it wasn’t until 460 BC that Hippocrates coined the term “hemorrhoid” — a combination of the Greek haema (blood) and rhoos (flowing) — for these debilitating anal swellings. He also outlined the clinical symptoms and treatment for this condition.
Four hundred years later, Celsus described hemorrhoids, along with their surgical treatments and post-operative complications. This suggests that our ancestors weren’t unaware of this condition and did everything they could to ease the pain people were experiencing.
Treatment in ancient times
Now that we’ve established that hemorrhoids have been affecting humans for millennia, let’s talk about treatments ancient civilizations prescribed for them:
1. Ancient Egyptians (1700 to 1200 BC)
While the ancient Edwin Smith Papyrus doesn’t explicitly mention that “here’s the cure for hemorrhoids,” it does state that if “you inspect a man in his anus, whether standing or sitting, suffering very greatly with seizures in both his legs,” you should:
- Make an “ointment of great protection” from “acacia leaves, ground, triturated, and cooked.”
- Smear the paste on a linen strip.
- Place the strip in the anus to ensure the man recovers quickly.
It’s likely that the ancient Egyptians used acacia (an astringent) to draw water out of tissues and help them shrink.
However, aside from acacia leaves, the Egyptians also used potions made from sweet beer, ibex fat, flour, myrrh, and honey to treat hemorrhoids, according to the Chester Beatty Papyrus.
2. Ancient Greeks (460 to 377 BC)
Hippocrates, considered the father of modern medicine, gave a name to these painful swellings and wrote about them in the Hippocratic Treatises. He described the appearance of hemorrhoids as follows:
“You will recognize the hemorrhoids without difficulty, for they project on the inside of the gut like dark-colored grapes, and when the anus is forced out, they spurt blood.”
He suggested using hot irons to cauterize the area when the case was severe but actually favored ligating the hemorrhoid using a needle and thick woolen thread because it made the cure more certain.
Moreover, in On Hemorrhoids, Hippocrates also talked about hemorrhoidal excision and mentioned the use of a rectal speculum similar to the Eisenhammer retractor we use today.
3. Roman Eras (25 BC to AD 201)
Unlike the ancient Greeks, the Romans didn’t add much to what was already known about hemorrhoids. However, Celsus talked about the ligature-excision and ligation techniques in De Medicina. He also mentioned that these operations could lead to urinary retention.
150 years later, Galen described the hemorrhoidal disease and proposed the use of ointments, leeches, and laxatives for its management. He suggested ligation as the only surgical option, however.
4. Ancient Indian Ayurveda (400 BC to AD 500)
The Susruta Samhita, an ancient Sanskrit medical text, mentions a condition with all the symptoms of hemorrhoids, which it calls “arsha.” The book mentions that these mamsa ankura (growths) are experienced by people who don’t control their eating habits or exercise.
It also classified these arsha into several categories, similar to how we grade hemorrhoids today:
- Vataja – These are tubular masses that cause excruciating pain without bleeding.
- Pittaja – These are small, bright red masses that may move in and out of the rectum upon movement.
- Kaphaja – These are hard, whitish masses that protrude out of the rectum.
- Rakataj – These are red coral-like masses that stick out during the passing of stool. They may actually be anorectal polyps or papules.
- Sannipataj – These are brilliant red hard masses that cause bleeding and extreme discomfort.
The Susruta Samhita recommended treating these arshas at onset through dietary changes. But if that wasn’t possible, it advised using ligation to treat rough, cutaneous hemorrhoids.
However, if the hemorrhoidal masses began to bleed, had narrow bases, and were large, it recommended the use of shastra karma (an ancient form of hemorrhoidectomy) as a treatment.
Middle ages to the renaissance
The Middle Ages and the Renaissance were opposites: one was a time of enlightenment, while the other was a dark chapter in the history of science.
Let’s understand how this affected hemorrhoid treatments:
1. Middle ages
While the Middle Ages in Europe saw the rise of master surgeons like John of Ardene, Henri de Mondeville, and Guy de Chauliac, little attention was paid to the management and treatment of hemorrhoids.
In fact, Henri de Mondeville only talked about hemorrhoids to warn people from operating on them, while other surgeons largely advocated using natural means to treat these painful swellings.
2. 17th century
The trend of ignoring hemorrhoids was continued by barber surgeons well into the 17th century, who typically ignored hemorrhoids or excised them to disastrous effects.
For instance, after a hemorrhoid operation, a battle hero named Don Juan of Austria bled uncontrollably for four hours until his death in 1578.
Due to these poor surgical outcomes, treatments for hemorrhoids became less common — until they were finally ignored — or substituted with invocation and prayer.
3. 18th century
The 18th century saw the end of the 350-year reign of barber surgeons and put science back into medicine. For instance, Hugues Ravaton broke from the Hippocratic tradition and said that “the methods of the ancients [were] too cruel” in Chirurgie.
Similarly, Ernest Stahl Giovanni Morgagni suggested that hemorrhoids were a hereditary condition, perhaps caused by a missing valve in the rectal veins.
19th century advancements
While the 18th century broke from the mold of the Hippocratic tradition, it wasn’t until the 19th century that surgical treatments for hemorrhoids actually began to pop up, mostly because of the use of anesthesia in medicine.
1. Anal stretching
In 1835, Frederick Salmon suggested the use of anal stretching to treat hemorrhoids and created an excision-ligation technique that laid the basis for the 20th-century open hemorrhoidectomy.
2. Sclerotherapy
James Morgan used sclerotherapy based on iron sulfate to treat people with hemorrhoids in 1869. Andrew Edmunds continued this practice by using carbolic acid and olive oil to treat 3,000 people, 50% of whom experienced relief.
3. Excision
In 1882, Walter Whitehead proposed the removal of the entire hemorrhoidal cushions, publishing research on 300 successful cases five years later. This technique soon became popular because of the relief it offered. However, reports of severe complications like a loss of urinary control led to its downfall.
20th century: modern medical interventions
Now that scientists knew that surgical options could provide relief to people with hemorrhoids, they began to work on improving 19th-century surgical techniques, ending up with the following:
1. Rubber band ligation
In 1963, James Barron came up with the idea of rubber band ligation, a technique in which surgeons used rubber bands to tie hemorrhoids. He reported only four cases of minor bleeding out of 200.
2. Sclerotherapy
While sclerotherapy provided relief to many people with hemorrhoids in the 1880s, it also caused painful complications due to the use of dangerous substances.
However, by the 1920s, 5% phenol oil injections — sometimes combined with quinone, alum, iodine, or urethane — became a common solution for shrinking hemorrhoids.
3. Hemorrhoidectomy
James Ferguson suggested the closed hemorrhoidectomy, the most popular hemorrhoid surgery in the US, in 1955.
The technique preserved the area around the hemorrhoids, reduced postoperative pain, encouraged faster wound healing, and had a lower risk of postoperative bleeding.
4. Stapled hemorrhoidopexy
While modifying older hemorrhoidectomy techniques, Antonio Longo ended up creating the stapled hemorrhoidectomy, a less painful technique for treating prolapsed hemorrhoids. It has excellent results and less risk of serious complications.
21st century: emerging and latest treatments
While traditional techniques have been modified to improve outcomes, the 21st century has encouraged the rise of minimally invasive treatments that reduce injuries to anal canal structures and cause even lower postoperative pain.
Let’s discuss these techniques below.
1. Hemorrhoids laser procedure (HeLP)
First described in 2011, HeLP is a minimally invasive laser therapy that shrinks hemorrhoids. It cuts off the blood supply to hemorrhoids, causing them to shrivel without damaging the anal canal.
The technique is safe, has a short operative time compared to surgical hemorrhoidectomy, and enables quick recovery.
Moreover, a 2022 study analyzing the consecutive use of HeLP found that 94% of patients didn’t experience pain after surgery, over 60% were “cured,” and about 90% experienced significant improvement in hemorrhoidal symptoms.
2. Emborrhoid
Emborrhoid is a radiological treatment for people who don’t respond to conservative therapy, have life-threatening bleeding, or aren’t fit for surgery. It blocks the veins that supply blood to hemorrhoids.
The procedure is typically successful, with 63% to 94% of patients experiencing no major complications.
3. Sclerobanding
Sclerobanding is a new hemorrhoid treatment that combines rubber band ligation and sclerotherapy, both of which have been shown to be effective at treating hemorrhoids.
This technique can potentially improve the outcomes of rubber band ligation and sclerotherapy, as well as decrease the risks associated with them.
A Historical Perspective on Ancient Remedies for Hemorrhoids
Hemorrhoids have been a common thread in most of written history. But we’ve come a long way from ancient herbal potions and excruciating cauterization to hemorrhoidectomies and HeLP.
Treatments for hemorrhoids are now safe, less painful, and more effective. However, there’s still room for improvement. And with high-energy devices already being tested in surgical procedures, we probably don’t have long to wait.
