Hemorrhoids are one of those health problems you may try to treat quietly at home with a bathroom drawer full of drugstore creams, wipes, and home remedies that may or may not help.
Even though 1 out of every 2 people will have problems with hemorrhoids by the time they’re 50 years old, many of us don’t have a clue about how to avoid getting them, how to treat them, and when to bring up this issue with our healthcare provider.
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New guidance from the American Gastroenterological Association looks at the evidence around hemorrhoid treatment and identifies those with the most evidence of success — and those with weak proof.
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Here’s what to know about this common condition, including which treatments are best and which ones don’t really work at all, and when it’s time to seek medical help.
How Do You Know if You Have a Hemorrhoid?
Hemorrhoids are a collection of blood vessels inside the anus. “They are normal anatomic structures — everybody has them,” says Nicholas Ahn, MD, a colon and rectal surgeon at Stony Brook Medicine in New York, who didn’t work on the guidelines.
This feature of our anatomy usually exists unnoticed. But if hemorrhoids become swollen and enlarged, they cause issues like bleeding, protruding, or pain with bowel movements.
There are two types of hemorrhoids: internal and external. Internal hemorrhoids are located higher inside the anal canal. These are more likely to cause painless rectal bleeding or tissue that protrudes during a bowel movement.
External hemorrhoids are closer to the anal opening and may cause itching, swelling, bleeding, or severe pain if a blood clot forms.
It’s possible to have inflammation of both internal and external hemorrhoids.
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Inflamed hemorrhoids affect people of all ages, races, and ethnicities, but they are more common in older adults and pregnant women.
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What Actually Works to Relieve Hemorrhoids
The new guidelines keep it simple when it comes to prevention and treatment: First-line therapy should start with a fiber-rich diet and good bathroom habits.
In one clinical study of adults with symptomatic hemorrhoids, people who adopted these changes experienced less bleeding and improved prolapse (when a hemorrhoid is pushed outside the anus).
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Getting More Fiber
“Very mild hemorrhoid symptoms will respond to increasing fiber in your diet, along with taking stool softeners and not sitting on the toilet too long straining,” says guidelines coauthor Waqar Qureshi, MD, a gastroenterologist at Baylor College of Medicine in Houston.
Getting enough fiber can help soften stool and reduce straining, says Dr. Ahn. Staying hydrated is important too, he adds.
Dietary guidelines recommend adults eat 14 grams of fiber per 1,000 calories — for a standard 2,000-calorie diet, that’s about 28 grams of fiber per day.
This can mean eating more fiber-rich foods, such as beans, lentils, vegetables, fruit, whole grains, nuts, and seeds. Some people may also benefit from a fiber supplement, though it’s best to increase fiber gradually to reduce gas and bloating.
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Healthy Bathroom Habits
If hemorrhoids are an issue for you, try to avoid straining and don’t camp out on the toilet.
A best practice is leaving your cell phone outside the bathroom. A recent study found that adults who brought their smartphone to the bathroom spent more time on the toilet and had a nearly 50 percent higher risk of hemorrhoids.
Some Common Remedies Have So-So Evidence
Home remedies and over-the-counter creams, pads, and ointments may help your symptoms, but they haven’t been well studied, according to the guidelines. “Topical ointments provide symptomatic relief only,” Dr. Qureshi says.
The guidelines explain:
- Products with lidocaine, pramoxine, or benzocaine may help numb burning or soreness.
- Hydrocortisone creams or ointments may help short-term inflammation or itching, but people shouldn’t use topical steroids for more than two weeks at a time because these drugs can make the skin thinner and lead to inflammation.
- Witch hazel and barrier products such as zinc oxide, mineral oil, or petrolatum may soothe irritated skin.
- Sitz baths — soaking the anal area in a shallow bath of warm water — may feel soothing, and doctors often recommend them for anorectal discomfort. The evidence they actually improve hemorrhoid symptoms is weak, but if it helps, there’s really no downside.
When Is It Time to See a Doctor?
The majority of symptomatic hemorrhoids require treatment by a healthcare provider, says Qureshi.
According to Ahn, you should see a medical professional for help if:
- You see blood.
- You have severe and persistent pain.
- Symptoms last longer than a week or two.
- Prolapse or protrusion of hemorrhoids don’t go back in.
- You are concerned for any reason.
While hemorrhoids can cause rectal itching, bleeding, or pain, you should see a healthcare provider for confirmation. These symptoms can also be a sign of more serious, underlying disease such as colon cancer, says Qureshi.
You should also call a healthcare provider if hemorrhoid-like symptoms come with abdominal pain, chronic constipation or diarrhea, fever and chills, nausea and vomiting, or severe rectal bleeding and pain. Other gastrointestinal conditions can cause symptoms suggesting hemorrhoids, and, and some can be serious.
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How Will a Doctor Treat Hemorrhoids?
A quick and painless office-based treatment (no need for anesthesia) may be the next step, says Qureshi. One common option is banding or rubber band ligation. A small band is placed around an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off.
Another nonsurgical option is infrared coagulation, which uses heat to shrink internal hemorrhoid tissue.
Surgery is usually reserved for more advanced hemorrhoids, symptoms that don’t improve after office procedures, or cases involving significant external hemorrhoids.
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Hemorrhoids Are Common — and Nothing to Be Ashamed Of
Hemorrhoids are not a sign that you did something wrong or anything to be embarrassed about, says Ahn.
Qureshi agrees that any awkwardness is unnecessary — your doctor hears about hemorrhoids on the regular — and embarrassment shouldn’t delay care.
“The sooner you see your doctor, the better the overall outcome,” he says.
Hemorrhoids usually respond well to treatment and the outlook is generally good, but they can come back. “Hemorrhoid symptoms can recur years after the initial banding or surgery,” says Qureshi.
They are more likely to come back if the root cause isn’t addressed, says Ahn. Underlying constipation, pushing too hard, and spending too long on the toilet can make them come back, he adds.
If that happens, people should follow the same recommendations on treating symptoms, seeing their provider, and continuing to work on diet and bathroom habits.
