Trouble Standing Up or Sitting Down? An In-Depth Look at BORRAGINOL®, Japan’s Best-Selling Hemorrhoid Medication!

Hemorrhoids can be a little embarrassing to talk about because of their location inside or around the anus, but they are nothing to be ashamed of. Everyone from office workers sitting behind a desk all day to pregnant women can come down with them. In fact, some data suggests that over half of Japan’s adult population has struggled with hemorrhoids. That’s why, in this article, we’ll be introducing BORRAGINOL®, the best-selling hemorrhoid medication in Japan. We’ll talk more about this medication as well as explain what exactly hemorrhoids are, their types and symptoms, and the characteristics of the different forms the medication can take – ointment, ointment in prefilled disposable applicator, suppository, etc. – so that you can discover what kind of BORRAGINOL® will give you the most relief.

*This article was sponsored by AMATO PHARMACEUTICAL PRODUCTS, LTD.
*All the ®︎ are superscripts. In the article, it is shown as BORRAGINOL®.
*Thumbnail: BORRAGINOL® A Ointment (Designated category 2 OTC medicine), BORRAGINOL® M Ointment (Category 2 OTC medicine), BORRAGINOL® A Ointment in Prefilled Disposable Applicators (Designated category 2 OTC medicine), BORRAGINOL® A Suppositories (Designated category 2 OTC medicine), BORRAGINOL® M Suppositories (Category 2 OTC medicine), BORRAGINOL® EP Oral (Category 2 OTC medicine)
*Consult a pharmacist or a registered salesperson and read the precautions carefully before using BORRAGINOL®

What Are Hemorrhoids?

In Japan, “hemorrhoids” is a general term that refers to all kinds of anus illnesses, which include what the Western world calls “hemorrhoids” or “piles” as well as anal fissures and anal fistulas. Here’s what all those terms mean.

Types of Hemorrhoids and Their Symptoms

Hemorrhoids (Piles)

Hemorrhoids (piles) are wart-shaped swellings in or around the anus. Data has shown that they account for over half of all hemorrhoid cases in Japan. The piles that form on the inside of the anus across the dentate line are called “internal hemorrhoids” and those that form on the outside are called “external hemorrhoids.” Internal hemorrhoids rarely cause pain, but are often associated with bleeding and may paint the toilet bowl red with blood during a bowel movement. If left untreated, internal hemorrhoids may come out of the anus and become inflamed, resulting in pain. External hemorrhoids are almost always painful. They can also become suddenly inflamed, leading to thrombi (blood clots), significant swelling, and severe pain. When the symptoms of internal and external hemorrhoids occur together, it results in what’s known as “incarcerated hemorrhoids.” Surgery may become necessary when a hemorrhoid is clearly swollen and has moved outside the anus, so professionals advise to act proactively and treat even minor symptoms of hemorrhoids such as discomfort or rectal bleeding.

Anal Fissures

Anal fissures are tears in the skin of the anal canal caused by the passage of hard stool due to constipation or by strong pressure during diarrhea. The main symptoms of anal fissures include severe pain and a small amount of rectal bleeding. Anal fissures often heal naturally and can be treated with ointments, but a doctor’s help should be sought if they become a chronic issue or do not heal for a long period of time, which can result in ulcers.

Anal Fistulas

An anal fistula is a bacterial infection of the anal tissues due to diarrhea or other causes, which results in inflammation, pus, and the formation of an abscess inside the anus. If left untreated, the anal abscess will form a tunnel connecting to the outside of the anal canal to drain the pus. The main symptoms of an anal fistula include swelling and throbbing pain around the anus, fever, and pus. Anal fistulas and the abscesses that precede them cannot be treated with OTC medication, so if you see pus around your anus, consult a doctor as soon as possible.

Causes of Hemorrhoids

The main causes of hemorrhoids, which trouble more than half the adult population of Japan, include constipation, diarrhea, strenuous bowel movements, and sitting for prolonged periods of time.

Hemorrhoids (piles) are mostly caused by excessive pushing during bowel movements, constipation, or sitting for long periods of time, all of which put pressure on the anus, restricting blood circulation around the anal canal and congesting blood in the capillaries of the venous plexus. In pregnant women, as the baby grows, the expanding uterus can also put additional pressure on the rectum and anus, congesting blood and resulting in hemorrhoids.
 
It is said that women are more likely to develop anal fissures due to limited food intake due to dieting and other reasons. Eating less food causes stool volume to decrease, leading to the intestinal tract not being stimulated sufficiently, which results in constipation. When hardened stool is forced through the anus, it can tear the anal canal, forming an anal fissure.
 
As mentioned earlier, anal fistulas are most commonly caused by bacteria (such as E. coli) infecting the tissue of the anus due to diarrhea and other means. If there are tears or cuts near the anus or if the body's immunity has been weakened, the anal canal can become infected and leak pus.

In summary, whether a person develops hemorrhoids or not depends largely on their lifestyle, so particular care should be taken by those who sit for long periods of time, don’t exercise regularly, or do not have enough fiber in their diet. It’s also recommended to monitor any changes in your bowel habits, especially if you suffer from chronic diarrhea or constipation, or are pregnant, elderly, or don’t exercise regularly for any other reason.

BORRAGINOL® – Japan’s Favorite Hemorrhoid Medication!

BORRAGINOL® has long been Japan’s most popular over-the-counter hemorrhoid medication and currently has more than 50% of the domestic market share. First released over 100 years ago in 1921, it was originally an in-house prescription developed at Kyoto University Hospital due to the lack of any Western hemorrhoid treatments in Japan at the time. Kinzo Ohtsuki, founder of the Amato Pharmaceutical Research Institute (the predecessor of Amato Pharmaceutical Products, Ltd.), was a pharmacist at Kyoto University Hospital and an instrumental figure in the development of BORRAGINOL®. Since then, Amato Pharmaceutical has continued to focus their efforts on the research and development of hemorrhoid medications.

So Many Types Available! Which BORRAGINOL® Is Right for You?

By Symptoms and Ingredients

  BORRAGINOL® A Series
(Designated category 2 OTC medicine)
BORRAGINOL® M Series
(Category 2 OTC medicine)
Symptoms Pain, bleeding, swelling, and itching caused by hemmorhoids (piles) and anal fissures Pain and itching caused by hemmorhoids (piles) and anal fissures
Active Ingredients and Their Actions

Includes steroids

Prednisolone acetate: Suppresses inflammation to relieve bleeding, swelling, and itching.
Lidocaine: A local anesthetic that temporarily numbs the affected area to relieve pain and itching.
Allantoin: Acceleration of wound healing and repair of tissue.
Vitamin E acetate (Tocopherol acetate): Improvement of blood congestion by promoting peripheral blood circulation.

Doesn’t include steroids

Glycyrrhetinic acid: Non-steroidal, anti-inflammatory agent that helps relieve inflammation which can cause itching and pain.
Lidocaine: A local anesthetic that temporarily numbs the affected area to relieve pain and itching.
Allantoin: Acceleration of wound healing and repair of tissue.
Vitamin E acetate (Tocopherol acetate): Improvement of blood congestion by promoting peripheral blood circulation.

 

*The steroidal agents (prednisolone acetate) included in the BORRAGINOL® A series are a chemically synthesized version of adrenocortical hormones produced in the body.
They are classified as a weaker type of steroid external medicine, so there is no need for excessive concern if used properly.

By Form Factor (Type)

  BORRAGINOL® A Series
(Designated category 2 OTC medicine)
BORRAGINOL® M Series
(Category 2 OTC medicine)
Type of Hemorrhoid
Ointment

This little-irritant oil-based ointment protects damaged lesions.

Dosage and directions: Adults (15 years old and older): Apply directly to the affected area 1 – 3 times a day.

WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.

Safe to use while breastfeeding.

Price: 1,440 yen/20g

This little-irritant oil-based ointment protects damaged lesions.

Dosage and directions: Adults (15 years old and older): Apply directly to the affected area 1 – 3 times a day.

Safe to use while pregnant or breastfeeding.

Price: 1,170 yen/20g

It is intended to be applied directly to hemorrhoids outside or around the anus, so it is best for piles and fissures outside and around the anus area.
Ointment in Prefilled Disposable Applicators

This little-irritant oil-based ointment protects damaged lesions.

Dosage and directions: Adults (15 years old and older): Apply directly to the affected area 1 – 3 times a day.

WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.

Safe to use while breastfeeding.

Price: 1,440 yen/20g
Small, portable, individually-wrapped applicators. The nozzle can be inserted into the anus to apply the medication hygienically, without needing to touch the affected areas or medicine directly.

Dosage and directions: Adults (15 years old and older): For infusion into the anus, 1 – 2 times a day, using 1 applicator each time. If application on the affected area, apply the appropriate amount to the affected area 1 – 3 times a day.

For internal hemorrhoids, apply by inserting the nozzle into the anus. For external hemorrhoids and anal fissures, apply directly to the affected area.

WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.

Safe to use while breastfeeding.

Precautions: If inserting into the anus, use the entire amount at one time.
If applying directly, do not use any remaining ointment for insertion as the amount will be insufficient for treatment.

Price:
1,850 yen/10 x 2g
4,940 yen/30 x 2g

Not available It can be injected into the anus as well as applied directly to hemorrhoids outside or around the anus, making it suitable for piles and fissures inside, outside, and around the anus area.
Suppositories

Oil-based medication that melts rapidly at body temperature (rectal temperature which is approximately 37℃). Works directly on the affected area and helps smooth bowel movements.

Dosage and directions: Adults (15 years old and older): 1 or 2 times a day, with 1 suppository per use. Remove the aluminum container and insert the suppository into the anus. If the suppository is too soft, let it cool before use. If the suppository is too hard due to cold weather, warm it in your hands until its surface becomes smooth before use.

WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.

Safe to use while breastfeeding.

Precautions:
Store at temperatures between 1℃ and 30℃. Keep away from direct sunlight. Avoid storing in places 0℃ and under. Do not store in the freezer.
Store in the box with the tips of the suppositories pointing down and the arrow on the packaging pointing up.
Avoid strenuous exercise immediately after insertion to prevent the suppository from slipping out.

Price:
1,550 yen/10 suppositories
2,900 yen/20 suppositories
4,150 yen/30 suppositories

Oil-based medication that melts rapidly at body temperature (rectal temperature which is approximately 37℃). Works directly on the affected area and helps smooth bowel movements.

Dosage and directions: Adults (15 years old and older): 1 or 2 times a day, with 1 suppository per use. Remove the aluminum container and insert the suppository into the anus. If the suppository is too soft, let it cool before use. If the suppository is too hard due to cold weather, warm it in your hands until its surface becomes smooth before use.

WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.

Safe to use while breastfeeding.

Precautions:
Store at temperatures between 1℃ and 30℃. Keep away from direct sunlight. Avoid storing in places 0℃ and under. Do not store in the freezer.
Store in the box with the tips of the suppositories pointing down and the arrow on the packaging pointing up.
Avoid strenuous exercise immediately after insertion to prevent the suppository from slipping out.

Price:
1,270 yen/10 suppositories
3,180 yen/30 suppositories

It is intended to be inserted into the nus, making it most suitable for piles and anal fissures inside the anus.

 

*BORRAGINOL® A and M Series are intended for people 15 years old and older. If there is no improvement after 10 days, stop usage and consult a physician, pharmacist, or registered salesperson.

BORRAGINOL® Also Comes in Oral (Pill) Form

BORRAGINOL® EP Oral (Category 2 OTC medicine)

Hemorrhoids (piles) and anal fissures are often accompanied by pain, bleeding, swelling, and itchiness. The active ingredients in BORRAGINOL® EP Oral include three kinds of herbal drug extracts (Moutan cortex, Rosskastanien, and Lithospermi radix) and vitamin E acetate, which promote blood circulation around the rectum and anus, suppressing inflammation and alleviating some of these symptoms.

Dosage and directions: Adults (15 years old and older): 1 packet 2 times a day.
WARNING: Consult a physician, pharmacist, or registered salesperson before use if pregnant.
Safe to use while breastfeeding.

Price: 2,700 yen/16 packets

*BORRAGINOL® EP Oral is intended for people 15 years old and older. If there is no improvement after 1 month, stop usage and consult a physician, pharmacist, or registered salesperson.

Where to Buy BORRAGINOL®

As the best-selling hemorrhoid medication in Japan, BORRAGINOL® is available at major drugstores throughout the country such as Matsumoto Kiyoshi, Sundrug, Daikoku Drug, Welcia, and TSURUHA Drug, as well as at major supermarkets such as AEON Mall and Ito Yokado. However, availability may vary from store to store, with larger locations being more likely to have the full lineup of BORRAGINOL® products.

Daily Care and Prevention for Those Suffering from Hemorrhoids

Besides medication or visits to the doctor, hemorrhoids can also be treated with simple lifestyle changes.

Take in more fiber and water: Add plenty of fruit and vegetables to your diet to increase your fiber intake and boost your intestinal flora. Adults are also advised to drink 2 liters of water daily to avoid hardened stools.

Take the time to soak in a bath: Bathing is an effective way of preventing hemorrhoids. Not only does it keep the anal area clean, but warming up the bottom additionally improves blood circulation around the anus. That’s why long soaks in the bath, even if only half your body is submerged, are preferrable to showers. Also, it’s best not to make the water too hot.

Exercise: A moderate amount of exercise is good for your health as it strengthens your cardiopulmonary system and improves blood circulation, including around the anus. This prevents blood congestion, one of the leading causes of hemorrhoids. If you have a desk job where you sit for prolonged periods of time, be sure to take the occasional break to stretch or do something else that requires physical movement. However, if you already have a hemorrhoid, avoid strenuous exercise as it might aggravate your condition.

Keep your anus clean: If the area around the anus is not sufficiently clean, it can lead to bacterial growth, itching, inflammation, and a worsening of hemorrhoids. Make it a practice to thoroughly wipe your bottom after a bowel movement to make sure there is no stool left around the anus. Be sure not to rub, but rather wipe it gently with toilet paper.

Summary

Hopefully this article has helped you better understand the importance of rectal health. The busy lives of many people today make them prone to hemorrhoids, so be sure to exercise regularly and eat a healthy diet, and, at the first sign of trouble with your bottom, try BORRAGINOL®.


For more information on BORRAGINOL®, visit the official website.

Japanese: https://www.borraginol.com/
English: https://www.borraginol.com/en/

The information in this article is accurate at the time of publication.

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About the author

Ying
Ying Lu
From Taiwan, but now living in Tokyo. Deep into various subcultures, including all things 2D and live gigs. Often frequents Ikebukuro.
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