After a long work out session that included an increase in weights from the previous week I noticed a small painful bump on the outer edge of my anus. It’s really tender and red but doesn’t appear to be bleeding. I’m wondering if lifting heavy weights can give me haemorrhoids?

Answer: Interestingly enough a lot of weightlifters complain of having haemorrhoids. It’s probably due to the fact that you’re straining so much when lifting the heavy weights causing an increase in pressure in your rectal veins. Your rectal veins naturally dilate every time you have a bowel movement causing blood to rush to that area and straining when going number 2 can cause a flare up. However, according to BMJ Clinical evidence, “The cause of haemorrhoids remains unknown, but the downward slide of the anal blood cushions is considered the most likely explanation.” It seems to me that you have what it’s called an external haemorrhoid. Haemorrhoids can occur internally, externally, or a combination of both.

Solution: Incorporate fibre into your diet. This will make it easier for you to go to the bathroom and reduce the risk of having a flare up. Keep your anal area clean. Use baby wipes instead of sandpaper grade toilette paper. Take a warm bath as often as possible. This can soothe the area and cause the inflammation to go down. Consult your doctor if you’re planning on using any medication to treat this. Haemorrhoid cream can help reduce the itchiness and pain associated with the haemorrhoid.

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Nitrates act as a source of nitric oxide. Venodilatation is their most prominent effect but certain arteriolar beds (eg coronary) are also dilated. They have been used for many years to treat angina pectoris but more recently have found a place in treating unstable angina and heart failure. Topical glyceryl trinitrate is an effective treatment for Raynaud’s phenomenon, and has been used in strengths up to 2%; however, adverse effects, especially headaches, which are often refractory to treatment and require cessation of therapy, limit its use for this indication.

Glyceryl trinitrate is the most commonly used nitrate. It has a half-life of only a few minutes. Extensive removal by the liver makes oral administration ineffective. It is therefore given sublingually, intravenously or for prolonged action due to continued absorption, transdermally. Glyceryl trinitrate tablets deteriorate on storage and it is recommended that tablets should be kept in their original bottle and kept for no more than 3 months after opening. This problem does not occur with the isosorbide nitrates or the glyceryl trinitrate sublingual spray.

Isosorbide mononitrate is 100% bioavailable after oral administration and has a half-life of about 5 hours. Sustained-release formulations permit once-daily dosing.

Isosorbide dinitrate has low bioavailability of about 25% given orally but sublingual absorption is satisfactory. It has a half-life of about 45 minutes. Many of isosorbide dinitrate’s effects are due to the presence of isosorbide mononitrate, one of its active metabolites.

Precautions and adverse effects: Tolerance to nitrates occurs with frequent or continuous exposure and may develop within 24 hours. Whatever the agent or route of administration it is important to ensure a nitrate-free interval of 10 to 12 hours each day. Patients should be advised to apply or take their nitrate at the time of the day when angina is most frequent (eg at night for nocturnal angina or in the morning for diurnal angina). Major dose-related adverse effects of nitrates include headache and hypotension.

Interactions: Phosphodiesterase type 5 inhibitors—sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra)—must not be used concomitantly with nitrates because they potentiate the vasodilatory effect of circulating nitric oxide, resulting in significant hypotension. Nitrates should not be administered within 3 to 5 days of tadalafil, and within 24 hours of sildenafil or vardenafil.

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Species (Family)
Black Horehound, Ballota nigra L. (Labiatae)

Constituents
Limited chemical information is available for black horehound. Documented constituents include diterpenes (e.g. ballotenol, ballotinone, preleosibirin), flavonoids, and volatile oil.

Food Use
Black horehound is listed by the Council of Europe as a natural source of food flavouring (category N3). This category indicates that black horehound can be added to foodstuffs in the traditionally accepted manner, although insufficient information is available for an adequate assessment of potential toxicity.

Herbal Use
Black horehound is stated to possess anti–emetic, sedative and mild astringent properties. Traditionally, it has been used for nausea, vomiting, nervous dyspepsia, and specifically for vomiting of central origin.

Contra–Indications and Warnings
None documented.

Pregnancy and lactation
Black horehound is reputed to affect the menstrual cycle. In view of the lack of phytochemical, pharmacological and toxicity data, the use of black horehound during pregnancy and lactation should be avoided.

Pharmaceutical Comment
Limited phytochemical or pharmacological information is available for black horehound to justify its use as a herbal remedy. In view of the lack of toxicity data, excessive use should be avoided.

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