CellMed

Hemorrhoids are vascular structures consisting of rectal veins located just above the anus, which become engorged.¹ In a normal state, they serve as cushions that aid defecation but can become pathological if they swell or become inflamed.² They typically occur due to continuous stimulation such as constipation and are classified into two types based on the signs and symptoms of hemorrhoids. Internal hemorrhoids often cause bright red rectal bleeding with painless defecation.³ In contrast, external hemorrhoids often cause pain and edema in the anal area. If bleeding occurs, it tends to be a little darker in color, but symptoms usually improve quickly after a few days. The exact cause of hemorrhoids is still unknown, but it is known that the risk increases with pressure applied to the abdomen.³ As early-stage hemorrhoids may not require any particular intervention, symptoms can improve with dietary fiber intake, hydration, rest, and anti-inflammatory medication prescriptions. There are often prescriptions with externals. However, there is an opinion that these are not very efficient. At least half of all populations experience hemorrhoids at some point in their lives. Hemorrhoids occur in both women and men and are particularly common in the 45-65 age group.⁴

However, it is not actually known how common hemorrhoids occur. This is largely because many patients with hemorrhoids do not seek medical treatment, even when they are symptomatic.^5,6 As previously mentioned, the exact cause of hemorrhoids is unknown. It is believed to originate from various factors such as irregular bowel habits (constipation or diarrhea), lack of exercise, diet, increased intra-abdominal pressure (long-term tension, ascites, intra-abdominal tumors, pregnancy), genetic factors and aging.^4,7 With the advent of modern society, lifestyles including excessive consumption of meat and instant foods leading to obesity, prolonged sitting postures, and worsening bowel movements due to spending a long time on the toilet have resulted in an increase in hemorrhoid cases.¹ It's important to avoid straining during bowel movement, eat a high-fiber diet, and drink sufficient water to prevent hemorrhoids.

The patient in this case is a working mother of two children in her early 40s. She has been showing symptoms of hemorrhoids for the past two years and recently complained of pain severe enough to disrupt her daily life. I would like to report the progress of applying nutrition therapy to such a patient with hemorrhoids.

1. Subject

One patient with hemorrhoids was studied.

1) Name: ㅇㅇㅇ (Female/40 years old)

2) Diagnosis: hemorrhoid

3) Onset date: July 2023

4) Treatment period: July 2023 – September 2023

5) Chief complaints: Anal pain and edema

6) Illness history: Gallbladder surgery

7) Social history: No drinking and smoking

8) Family history: None

9) Present illness history and medications: None

2. Method

The OCNT was applied in the following manner:

First phase of the OCNT:

Haepobooster (101, twice daily, one sachet per intake)

Hemoplex (202, twice daily, two capsules per intake)

Curcuplex (101, once daily, one sachet per intake)

Viva Circu (101, twice daily, one capsule per intake)

Viva Kan (101, twice daily, one capsule per intake)

Hwapyeongwon (101, twice daily, one sachet per intake)

Cyaplex X (101, twice daily, one sachet per intake)

Second phase of the OCNT:

Hemoplex (202, twice daily, two capsules per intake)

Viva Kan (101, twice daily, one sachet per intake)

Viva Circu (101, twice daily, one capsule per intake)

Cyaplex X (101, twice daily, one sachet per intake)

Hwapyeongwon (101, twice daily, one sachet per intake)

In addition, to improve the patient's quality of life, the following lifestyle corrections were requested:

• 1. Correction of a diet primarily consisting of protein

• 2. Analysis of causes and problems related to gallbladder removal surgery.

• 3. Removal of Mirena

• 4. Proper eating habits - composing a diet rich in dietary fiber.

• 5. Guiding on methods for reducing sleep medication and antidepressants.

The patient had been taking psychiatric medications for depression and anxiety disorders for seven years following traditional Korean weight loss treatments due to the postpartum obesity. In an attempt to control her drastically increased weight, she consumed protein drinks and chicken breasts while hardly having regular meals. Two years ago, she visited a pharmacy complaining of hemorrhoid symptoms, whereupon she was prescribed Notoplex to improve blood circulation. After gallbladder removal surgery, she complained of decreased stamina and indigestion. Therefore, Enzaplex and Heartberry Haedam were administered to supply probiotics, prebiotics, and organic acids. Recently, as the pain from hemorrhoids dramatically worsened, Notoplex, Cyaplex, and Hwapyeongwon were used to alleviate the pain and then nutrition therapy was fully implemented from July 28th. As a result, four weeks after starting the nutrition therapy, the pain had been reduced by approximately half compared with before treatment. Finally, on September 5th, both the pain and edema disappeared completely. She is currently maintaining her condition through continued nutrition therapy (Fig. 1).

Figure 1. Indicator of patient's perceived symptoms after the implementation of nutritional therapy. The scale ranges from 0 to 10, with 10 indicating severe symptoms.

Approximately 40% of hemorrhoid patients do not show any specific symptoms.³ Therefore, many people find it difficult to receive early treatment as they often seek medical attention only after experiencing significant discomfort. Hemorrhoids can manifest not only as either of internal or external types but also in a complex combination of both. Bleeding severe enough to cause anemia is rare, and life-threatening bleeding is even rarer. Treatment for hemorrhoids generally involves taking anti-inflammatory medications and consuming dietary fiber, though some patients undergo surgical procedures. However, because the nerves supplying the rectum and bladder with blood are close by, complications such as bleeding, infection, anal stenosis, and urinary retention can occur to some extent. Therefore, if symptoms are not severe, sitz baths are considered the best treatment. Doctors often advise hemorrhoid patients to limit alcohol consumption, as drinking can cause blood vessels to dilate and the affected area to enlarge. Additionally, hemorrhoids can be worse due to poor health under excessive stress, or in the cold winter season. Hemorrhoids can be completely cured with appropriate treatment methods. The method of treatment varies depending on symptoms and severity. Mild hemorrhoids can be alleviated through conservative treatments or non-surgical therapies. Taking sufficient rest, eating sufficient fibers to prevent constipation or diarrhea, and promoting blood circulation through warm sitz baths are all viable treatment options. If conservative treatment or symptomatic treatment is ineffective and the hemorrhoids have progressed to a severe prolapse that requires manual reinsertion, surgical intervention is necessary. The patient in this case complained of discomfort in daily life due to anal edema and pain. Therefore, it was thought that as time passed, congestion occurred in the vascular tissue inside the anal canal, causing surrounding tissues to stretch and inflammation to accompany pain. Curcumin contained in Curcuplex is known to activate Peroxisome Proliferator Activated Receptor-gamma (PPAR-gamma), which blocks mediators causing inflammation, thereby exerting anti-inflammatory, antioxidant, and antimicrobial effects.⁸ The Asiatic Pennywort leaf extract contained in Viva Circu can promote blood circulation in chronic venous insufficiency, relax the sphincter muscle to reduce pain, and aid in wound healing.⁹ The bamboo leaves contained in Hwapyeongwon are known to alleviate pain and edema. This is due to the matter of fact that tricin, contained in bamboo leaves, is known to inhibit the production of Nitric Oxide (NO), an inflammatory factor. It helps alleviate pain and edema and is also reported to play a significant role in vasodilation and regulation of blood flow.^10,11 Therefore, bamboo leaves can help improve blood circulation in the vascular tissue of the anal canal and alleviate symptoms of pain and inflammation. Also, anthocyanin contained in Cyaplex X can increase blood flow and peripheral blood flow, which can help improve blood circulation in patients with congestion due to venous insufficiency.¹² Selenium contained in Viva Kan is a component of glutathione peroxidases. It has been reported that this enzyme reduces the generation of hydrogen peroxide and lipid peroxides and prevents the generation of reactive oxygen species, thus exhibiting antioxidant and anti-inflammatory functions.¹³ Heme iron contained in Hemoplex can promote the binding of NO and hemoglobin. The S-nitrosohemoglobin generated in this process has been reported to constrict blood vessels or improve blood flow, which may help improve reduced blood flow due to venous insufficiency like hemorrhoids.¹⁴ Taurine, contained in Haepobooster, is found at high concentrations in smooth muscle and heart muscle. Taurine contracts the vessels and maintains blood pressure when vascular tension is excessively low.¹⁵

This is a single case and cannot be generalized to all patients with hemorrhoids, presenting limitations in interpreting the results. However, it is believed that nutrition therapy and lifestyle corrections helped alleviate anal pain and edema in this patient with hemorrhoids. I report this case with the patient's consent.