Firstly, your digestion and bowel function will greatly depend on your lifestyle, diet and exercise. A well balanced diet consisting of protein, healthy grains, fruits and vegetables is required for regular bowel function. These days many patients in the hope of losing weight go on high protein diets forgetting the necessity of the rest of the components. Natural fiber from fruits and vegetables help to keep bowel function regular besides the nutrition and antioxidants they provide. It is very important to drink at least 8 glasses of water per day if not more. Many patients tell me that they forget to drink water due to busy work schedules. I suggest to them that they fill a container with a gallon of water every day and bring it to work and keep it by their desk, making sure by the end of the day they have finished most of it. Exercise is another key factor that speeds up your metabolism and helps to regulate bowel function. When your metabolism is slow, you will go to the bathroom less frequently while exercise contributes to bowel motility and aids in elimination.

Another big cause of indigestion is when our body is unable to produce adequate digestive enzymes required to digest foods. Digestion is the chemical breakdown of large food molecules into smaller molecules that can be used by cells. The breakdown occurs when certain specific enzymes are mixed with food. Digestion begins as soon as we put food in our mouths. Teeth help to chew and break food into smaller particles. Saliva produced by salivary glands contains an enzyme that begins to digest the starch from food into smaller molecules. The next set of digestive glands is in the stomach lining. They produce stomach acid and an enzyme that digests protein. The stomach empties the food into small intestine where enzymes produced by the pancreas will help to digest proteins, fats and carbohydrates. The liver produces bile which is stored between meals in the gall bladder. At mealtime, bile is released from the gall bladder via bile ducts into the intestines to help in the digestion of fats. Please refer to the picture below that shows the digestive system and how the food passes down the mouth to the rectum. In the process, it shows what organs produce which enzymes and how it helps to digest food.

Now imagine if you are missing any one or more of these organs or enzyme systems is not working efficiently enough to produce the enzymes that it should be. The result is that you will have difficulty digesting the food you are eating which can cause symptoms of indigestion.

I would like to provide some examples here. When a patient has a bariatric surgery where part of the stomach is removed, they lose the ability to adequately digest proteins, because as mentioned earlier, proteins are largely digested in the stomach. Patients who have had their gall bladder removed have a lack of bile that helps digest fat, thus they usually have gas and bloating and pass stools that float because of undigested fats in it. Patients who have had parts of digestive tracts removed due to cancer or who suffer from chronic inflammatory diseases like Crohn’s will suffer from digestive issues as well.

At our clinic we have successfully treated a variety of digestive problems. In naturopathic medicine, we believe that many diseases can originate in the gastrointestinal tract. Thus in order to have an overall successful treatment outcome, we need to address the issues of the gut that a patient is having regardless of the disease they are being seen for. One common tool has been adding a digestive enzyme as a supplement to a patient’s treatment protocol when we suspect, based on their symptoms, that they may be lacking the production of certain enzymes. It has helped patients with conditions like external hemorrhoids, acid reflux, constipation, and eructations among other symptoms that can rise due an inability to properly digest foods. We are able to individualize treatments based upon the presenting symptoms and/or condition. Thus for a patient with a gall bladder removal, we use bile in supplement form to help digest ingested fats, while patients who lack production of stomach acid may need a supplement that replaces hydrochloric acid to help digest proteins.

All of us need to eat healthy diets and have optimal digestion in order to get our daily dose of nutrients, vitamins and minerals from the food we consume. If our body has lost the capacity to do that, maybe because of an inflammatory bowel condition resulting in parts of digestive tract having been removed, or if our organ systems don’t work well, you can benefit immensely from getting a Nutrient IV treatment at the clinic. These treatments are becoming very popular among many physicians, including the ones who practice in a more traditional manner. Commonly known as a Myer’s IV, we individualize treatments for every patient, mixing vitamins and minerals in a IV bag and administering it through a vein. One of my patients who has history of cancer and has 80% of her colon removed was surprised why she was not told that she will not be able to absorb nutrients from her foods for the rest of her life! When I first saw her, she was so fatigued, she could hardly function because whatever she was eating, went right through her system causing 6-8 watery bowel movements/day. Now she comes in weekly for her nutrient IVs and could not feel any better.

The use of probiotics to prevent gas, diarrhea and cramping from use of antibiotics is becoming very common. Antibiotics will kill the beneficial bacteria along with disease causing bacteria in the gut. A decrease in beneficial bacteria will cause digestive problems because of  a flora imbalance. Thus using a good probiotic supplement can help restore healthy bacteria that prevent development of diseases and increases patient’s immunity or disease fighting capacity.

You may have noticed that you may not be able to digest the same food as well as someone else in your family while eating dinner together. Have you given a thought on what Blood Type you are? Consider that you need to eat right for your Blood Type and read the book written by Dr. Peter D’Adamo. You will find out why if you are Blood Type A you may do better by eating more vegetarian foods compared to Blood Type O who can tolerate more meats. We offer the Dietary Serotype Panel blood testing at our clinic and can provide you more of an individualized diet plan that can help reduce inflammation, digest foods better and thus cause weight loss.

In this article, I have tried to explain a few reasons of indigestion and provided a few tools to help correct it. I would recommend consulting with your health care provider to address your problems in detail. At our clinic we can help with ordering specialized testing and providing safe, effective and natural treatments for you and your family.

Affliction from hemorrhoids has been noted in the writings of various cultures throughout history such as Babylonian, Hindu, Greek, Egyptian, and Hebrew.  In the United States, as well as other industrialized countries, hemorrhoidal disease is extremely common. Estimates have indicated that 50% of persons over 50 years of age have symptomatic hemorrhoidal disease at one time or another and up to one-third of the total US population have hemorrhoids to some degree.

The causes of hemorrhoidal disease are similar to those of varicose veins. Like varicose veins, predisposition to development of hemorrhoids depends on genetic make up, excessive venous pressure, pregnancy, long periods of standing or sitting, straining at stool and heavy lifting are considered the major factors. Most patients have more than one predisposing factor.

Presenting symptoms are itching, burning, irritation with passage of stool, swelling of the anus and perianal region, blood on the toilet paper or in the bowl, and seepage of mucus. Most patients attribute all rectal symptoms to hemorrhoids, however, rarely are internal hemorrhoids painful or cause itching. Usually the hallmark of a hemorrhoid eruption is bleeding or protrusion which is noted following passage of stool. Pain from internal hemorrhoids occurs when they become strangulated from prolapse and with thrombosis. Any other pain associated with hemorrhoids is usually due to a coexisting lesion such as a fissure. Itching is rarely associated with internal hemorrhoids except where there is excess mucus discharge.

Internal hemorrhoids are classified according to symptomology and finding on examination. Stage I hemorrhoids bleed but do not protrude. Stage II hemorrhoids protrude following bowel movement, and then spontaneously reduce. Stage III hemorrhoids protrude with stool and must be manually reduced. Stage IV hemorrhoids protrude and are not reducible. Stages II, III, and IV may or may not bleed and a Stage IV hemorrhoid presents the possibility of strangulation resulting in decreased blood flow and eventual thrombosis.

In contrast to the United States and the United Kingdom, hemorrhoids are rarely seen in parts of the world where high-fiber, unrefined food diets are consumed. A low-fiber diet, high in refined foods, contributes greatly to the development of hemorrhoids. Individuals consuming a low-fiber diet tend to strain more during bowel movements, since their smaller and harder stools are more difficult to pass. This straining increases the pressure in the abdomen, which obstructs venous return. The increased pressure will increase pelvic congestion and may significantly weaken the veins, causing hemorrhoids to form.

Treatment

A high-fiber diet is perhaps the most important component in the prevention of hemorrhoids. A diet rich in vegetables, fruits, legumes, and grains promotes peristalsis because many fiber components attract water and form a gelatinous mass which keeps the feces soft, bulky, and easy to pass. The net effect of a high-fiber diet is significantly less straining during defecation.

Another important, but only recently recognized, dietary factor is breakfast. An age, sex and pregnancy matched case–control study carried out in an outpatient clinic found a remarkable 7.5-fold increase in the odds of suffering from hemorrhoids or anal fissures in matched subjects who did not eat breakfast!

Topical treatments for acute or chronic hemorrhoids involving the use of suppositories, ointments, and anorectal pads, in most circumstances, only provide temporary relief. Many over-the-counter products for hemorrhoids primarily contain natural ingredients, such as witch hazel (Hamamelis), cocoa butter, Peruvian balsam, zinc oxide, allantoin or homeopathic preparations, to name a few. Many patients will use hydrocortisone cream to help with itching that they associate with hemorrhoids. Prolonged use can often aggravate the pruritis ani setting up a cycle of continued use.

Surgical Treatment

Hemorrhoidectomy, or the surgical removal of redundant tissue is by far the most invasive of the hemorrhoid procedures. This procedure often requires an outpatient surgical setting and results in lost time from activities of daily living so healing can take place. Most patients seek alternative treatments in order to avoid surgery and its complications such as pain and rectal sphincter instability.

The Keesey Galvanic technique is a monopolar direct current treatment that is purely an in-office procedure. What makes the Keesey technique attractive is that the patient may be freely ambulant after completion of the procedure and can return to their normal activities of daily living. The hemorrhoid will disappear in 7 to 10 days after the treatment. Each separate hemorrhoid is treated in the same manner and larger hemorrhoids may need to be treated more than once.

Infra red coagulation (IRC) is effective with Stage I and II hemorrhoids but can be combined with the Keesey treatment for Stage III and IV. While the Keesey technique utilizes current, the infra red coagulator utilizes a burst of intense heat generated internally and shot through a blue anodized sapphire tip to the surface of the hemorrhoid. The IRC painlessly “coagulates” the redundant tissue to a depth that is a function of the amount of time of the light burst, usually 1 to 1.5 seconds.

External Hemorrhoids

External hemorrhoids occur when there is dilation of the external rectal plexus or thrombosis following an episode of constipation, diarrhea, heavy lifting or valsalva from sneezing, coughing or childbirth. The patient will notice an often-painful perianal lump and may have some bleeding associated with it. External hemorrhoids usually pose mild to little discomfort and will largely resolve on there own if homeostasis is restored. External anal skin tags found on examination are the remnants of previous external hemorrhoids.

If however the hemorrhoid becomes thrombosed, a cycle of acute edema and pain is set up which may lead to surgical intervention. As the lesion becomes increasingly distended, varying degrees of pain and swelling can be found which is often exacerbated by passage of stool or from prolonged sitting. The patient may report that there is bleeding after stool due to a disruption of the hemorrhoid.

Treatment

Unless the hemorrhoid has thrombosed and the patient is in excessive pain, the condition can usually be managed medically. Initial treatment should be to relieve the pressure and dissolve whatever thrombosis has formed. As this occurs, long term management in the form of patient education, dietary changes and enhancing vascular integrity should be undertaken to help prevent further episodes.

Initial treatment with the enzyme Protease 2400 mcu’s, two capsules between meals TID and two capsules at bed time will help to reduce the thrombosis and decrease pain. Alternating Sitz baths act to relieve pain and increase blood flow. A number of homeopathic medicines such as Aesculus, Aloe, Hamamelis, Muriatic acid, Ratanhia and Sepia are effective in relieving pain and speeding the course of healing.

In patients who are experiencing an acute episode of a thrombosed external hemorrhoid, prompt surgical excision or incision are in order. Because the external skin is innervated by somatic nerves, administration of anesthesia prior to evacuation of the clot will be needed. Excision, leaves a wound that should not be sutured but allowed to heal by second intention, but leads to increased postoperative pain. Incision and debridement of the clot allows for less pain, but may close too early and lead to reformation of the thrombus. A minor or rectal and colon surgical text should be consulted as to proper surgical technique.
References upon request.

Anal fissure is a common finding in patient’s presenting with rectal pain and often associated with internal hemorrhoids. While there are only a few allopathic treatments for anal fissure, this condition is quite responsive to treatment with a variety of natural medicines.

Anal fissure is a slit like separation of the anal mucosa that lies below the dentate line, similar to having a cracked lip. The majority of fissures are usually found in the posterior midline region (70% to 80%) while anterior midline lesions (10% to 20%) are more commonly seen in women. Anal fissure in children is not all that uncommon as well, often being associated with chronic diarrhea or hard stool.

Anal fissures are very painful because of their somatic innervation resulting from spasm of the anal sphincter in response to stretching and tearing during the passage of stool. The presence of an anal fissure will trigger a vicious cycle of pain causing sphincter spasm, which contributes to a tightening of the sphincter and increased pain with passage of stool. Patients usually have severe pain during and for some time after defecation and bleeding is not uncommon. As the lesion becomes larger it may ulcerate and become infected.

Patients will often relate a history of periodic episodes of rectal pain followed by periods of remission for some months when they are pain free. Some triggering event will cause the cycle to begin again with eventually the episodes becoming more frequent and severe. Often by the time they have made it to your office they are in severe pain and spasm and quite anxious for relief.

Anal fissure can be caused by passage of large, hard stools, trauma from child birth, chronic diarrhea, trauma from insertion of foreign objects, food allergy, or prolonged straining to pass stool. Infants and young children who consume large amounts of cow’s milk are more likely to develop anal fissure and chronic constipation, especially if they were breast-fed for a shorter period of time. Many of the patients who develop anal fissure display intense, compulsive personalities that may contribute to their formation as well as the ability to heal. A previous anal or rectal operation, Syphilis, or Crohn’s disease also predisposes the patient to fissure development.

Clinicians should consider the presence of Crohn’s disease, especially if the patient is younger, there is a history of periodic or chronic diarrhea, and the fissure lies in the anterioposterior vertical axis. In my experience, patients who present with chronic fissure almost always have some symptomology of irritable bowel disease or chronic mal-digestion. Squamous cell carcinoma, syphilitic ulcers and rarely tuberculosis should be considered as part of the differential diagnosis. Spasm of the levator ani muscle may also make one think of anal fissure, but no lesion will be present.

Examination of a patient with an active fissure may be difficult because of the pain and spasm, and anoscopic exam is often out of the question unless anesthesia is used. A localized injection of 1% or 2% lidocaine into the rectal sphincter at 3 o’clock and 9 o’clock can help relax it enough for an examination to occur. Anal fissures can often be seen without using an anoscope simply by pulling back on the anal skin and examining the tissue. Presence of a sentinel pile or enlarged papilli suggest chronic anal fissure and are the result of inflammation and the bodies attempt to protect the inflamed area. Anal spasm may be marked making it difficult to perform an examination and anal stenosis and fibrosis may be present if the condition has been chronic.

Treatment of anal fissure can prove to be one of the more difficult courses of therapy for both the patient as well as the clinician. While surgical intervention will remove the lesion and alleviate the pain, invariably the lesion will return because the underlying cause has not been addressed. Additionally, surgical intervention often predisposes to fecal incontinence later in life. Therefore medical management both in the short and long terms is necessary for complete resolution. Patients must be cautioned that the healing of a rectal fissure will have its periods of exacerbation and remission and that continuing on the treatment protocol is important despite the periodic set backs that are often encountered. Educating the patient on this point upon initiation of therapy is essential to its success.

Conventional medical treatment consists of rectal dilation which can be very painful, internal sphincterotomy which will weaken the anal sphincter and can lead to fecal incontinence, and electrodessication or surgical excision.

Initial treatment should be to alleviate the pain and spasm, as often this is what has brought them to your office. Homeopathic medicines are excellent for this as they provide prompt relief if the simillimum is found and will aid the healing process. While most homeopathic medicines have some degree of symptomology associated with the anal-rectal area, a few are found to be indicated much more often than others. Therefore, knowledge of their materia medica with regard to presenting and keynote symptoms will often streamline the intake process allowing you to prescribe more quickly.

Some of the more often indicated medicines are Chamomilla, Graphites, Nitric acid, Ratanhia, Sepia, Silicea and Thuja. Frequent dosing and the use of high potencies such as 200C or 1M is generally the rule. While a number of these homeopathic medicines are considered “constitutional” prescriptions, smaller and lesser utilized medicines such as Aesculus, Paeonia, and Ratanhia will be indicated if keynote symptoms are present. It has been my experience that homeopathic medicines often work faster and provide greater pain relief than analgesics and narcotics.

A preparation of 0.2% glyceral trinitrite can be used topically to relieve rectal spasm as well as 5% Lidocaine cream for localized pain. Glyceral trinitrite has been shown in a number of studies to be effective in relieving rectal spasm as well as increasing blood flow to the anal sphincter. Additionally, protease 315 mg two capsules TID between meals and before bed will sometimes help to alleviate pain as well.

In order to facilitate healing of the fissure, I compound a topical cream consisting of Vitamin’s A and E, panthenol, calendula, goldenseal and Emu oil. This formula considerably enhances the healing process by providing nutrients essential for healing by second intention. Some of the commercial preparations also contain boric acid, which acts as a styptic. The cream should be applied topically after every bowel movement and at bedtime initially. As healing occurs, twice-daily use usually suffices until the lesion has resolved.

Iontophoresis using a zinc or copper electrode and applying a positive current will help to facilitate healing by hardening the underlying fissure, decreasing bleeding and affording pain relief. The patient lies on the negative dispersing pad and current is applied for 10 minutes at anywhere from 1 to10 milliamps.

Often patients have developed poor defecation technique and are in need of instruction. The patient should be instructed to not strain during passage of stool and to use cotton balls that have been moistened with water rather than toilet paper, chemical or alcohol wipes. Over-the-counter wipes that contain chemicals and alcohol break down the skins protective barrier making healing more difficult and infection more likely. Some patients are excessive cleaners and they should be instructed that it is unnecessary to wipe deep into the anal canal, as this will make the condition worse. Additionally, leaning forward with passage of stool allows for a change in the rectal angle and easier passage.

Sitz baths also aid in the healing process by providing increased blood flow to the area. If doing a sitz bath isn’t possible, alternately spraying hot and cold water on the perineal area will achieve the same result.
Increasing dietary fiber is necessary if the condition is due to chronic constipation while chronic diarrhea can be managed through a variety of therapeutic approaches once the cause is found. Occasionally you will be presented with a patient whose dietary fiber intake is excessive. This can also lead to exacerbation of an anal fissure but more likely results in a chronic proctitis. Diet changes are a must, especially if the anal fissure is associated with irritable bowel or Crohn’s disease. Higher rates of hemorrhoids and Crohn’s disease are seen in blood group O individuals and are felt to be due to food intolerance. I have found that placing a patient on a diet based upon their blood type is effective in preventing recurrence of fissures. I have had some cases where patients needed to follow it religiously otherwise symptoms would return quickly. Foods most often associated with these cases were wheat, corn, and peanuts.

The clinical course varies from patient to patient and seems to be partially dependent upon how well they follow the treatment plan. Patients will often stop the treatment once their pain level has decreased but before complete healing has occurred. Patient education as to the healing process and what can be expected during its course is very important for successful treatment. I have found that frequent follow up is needed to assess the healing process and reassure the patient. Once healing has occurred, maintaining proper bowel function and good dietary and bowel habits are necessary for prevention of further episodes.