A Pain in the Backside: Ancient Remedies for Haemorrhoids

By Glyn Muitjens

Although haemorrhoids are not often talked about, as many seem to consider them a source of embarrassment, they are anything but a rare condition. In fact, the Association of Coloproctology of Great Britain and Ireland suspects one in three people in Britain suffers from them sometime in life. Haemorrhoids seem to have been a common problem in Greek antiquity as well, and this inspired at least one medical author from the 5th century BCE to dedicate a treatise to them and their treatments – recipes included!

            Haemorrhoids (Greek haimorrhois, a contraction of haima, ‘blood’, and rhoia, ‘flux’) form due to prolonged pressure on the anal veins, which swell up and may in some cases lead to lumps appearing on the outside of the anus. The author of the treatise Haemorrhoids, which is part of the Hippocratic Corpus, describes their formation as follows:

Nineteenth-century representation of the excision of haemorrhoidal tumours. Source: Wellcome Images

When bile or phlegm becomes fixed in the vessels of the anus, it heats the blood in them so that, being heated, they attract blood from their nearest neighbours. As the vessels fill up, the interior of the anus becomes prominent and the heads of the vessels are raised above its surface, where they are partly abraded by the faeces passing out, and partly overcome by the blood collected inside them, and so spurt out blood, usually during defecation, but occasionally at other times as well. (Hippocrates, Haemorrhoids 1)

For this author humoral clogging, heat and the ensuing attraction of ‘like to like’ – staples of Hippocratic pathology – are to blame for the formation of haemorrhoids. Another Hippocratic claims that men from cities exposed to hot winds have heads filled with phlegm, often suffering from haemorrhoids “in the anus” (Airs Waters Places 3). The Greek word haimorrhois can be used to denote any vein that discharges blood, so some topographical precision is necessary to speak of haemorrhoids in our sense of the term.

            The Hippocratic author mentions several possible ways of treating haemorrhoids. Some of these are rather invasive: cauterization with heated irons, for example – a treatment not always welcomed with enthusiasm (“Let assistants hold the patient down by his head and arms while he is being cauterized so that he does not move – but let him shout during the cautery, for that makes the anus stick out more.” Haemorrhoids 2). The cautery wound is then covered with a plaster of boiled lentils and chickpeas for 5 or 6 days, after which an assemblage of different fabrics covered in honey is inserted in the anus and kept in place by a bandage tied around the body.

A tool to remove haemorrhoids: the Chassignae-type écraseur, London, England, 1880-1902. Source: Wellcome Images

            This final treatment points to an interesting aspect of treating haemorrhoids ‘of the anal variety’, namely that the backside is a difficult place to reach both for diagnosis – the author warns that using a device to dilate the anus for closer inspection might obscure the haemorrhoid – and for treatment, which elicits some creative responses. For example, having removed a “knobbiness” or kondulôma next to a blood vessel by hand, the author suggests to dry out the blood vessel by inserting a tube into the anus, and shove a heated iron into the tube, so as not to expose the patient to the burning directly.

            Haemorrhoids could also be removed purely with medications, for which the author provides several recipes, both for direct application and as suppositories. For example, after moistening the anus:

Grind myrrh and oak galls into a smooth paste, and add one and a half times as much burnt Egyptian alum and an equal amount of black pigment: apply this medication dry. (Haemorrhoids 8)

Recipes for this purpose were also provided by the 1st century CE pharmacological writer Dioscorides: bramble, and several kinds of frankincense when applied as a plaster could be used to treat condylomas and haemorrhoids (De Materia Medica 3.74.2; 4.37.1).

Frankincense, represented in the ‘Vienna Dioscorides’ manuscript, 512 CE

            At the end of the treatise, our Hippocratic author speaks of what he calls haemorrhoids “as pertaining to women.” The treatment is as follows:

Moisten with copious warm water in which sweet smelling substances have been boiled; grind tamarisk, burnt litharge, and oak gall, add white wine, olive oil, and goose grease, pound these all smooth, and after she has been moistened give this to be anointed. Also foment the anus after forcing it out as far as possible. (Haemorrhoids 9)

What does the author mean with “as pertaining to women”? The moistening treatment (the Greek verb used appears only a handful of times in the Corpus) is very reminiscent of those found in the Hippocratic gynaecological treatise Nature of Women, in which they pertain to the womb. Are we to imagine that these haemorrhoids are located in the uterus? The final sentence, “also foment the anus”, might be taken to point in this direction, as if the backside is not the primary concern.

            I hope to have broken some of the embarrassed silence surrounding haemorrhoids, putting them in historical perspective. Although haemorrhoids nowadays can be a nuisance, we should remember they are a common condition and rarely pose a serious threat to health. At worst, they have to be treated through minor surgery. Let’s thank the stars we’re not ancient Greeks.

All of the Greek translations, sometimes slightly adapted by me, are from Paul Potter, Hippocrates Volume VIII (Cambridge MA, London: Harvard University Press, 1995)

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