Hemorrhoids are incredibly common, even if most people don’t want to talk about them. Symptomatic hemorrhoids affect about 1 in 20 Americans and about half of adults older than age 50, the National Institute of Diabetes and Digestive and Kidney Disease reports.
And that’s just the incidence of symptomatic hemorrhoids. The thing is, everyone has hemorrhoids, whether you realize it or not. “Hemorrhoids are normal anatomical structures. Everybody has hemorrhoids,” says Dr. Syed Husain, a colorectal surgeon with the Ohio State University Wexner Medical Center in Columbus.
What Are Hemorrhoids?
“Hemorrhoids are a cushion of blood vessels that we have around the anus, and each time we cough or sneeze or lift anything heavy, those blood vessels get engorged and help to seal the area. They have a very important physiologic function in the human body,” Husain says.
Dr. Jeffery Nelson, surgical director of the center for inflammatory bowel and colorectal diseases at Mercy Medical Center in Baltimore, puts it this way: It’s “kind of like a washer that seals a pipe connection in plumbing.”
But sometimes, Husain says, “for reasons we do not understand very clearly, they become enlarged and when that happens, they start producing symptoms.”
“When someone says they have hemorrhoids they’re referring to swelling of these hemorrhoidal veins, which often lead to symptoms,” says Dr. Michael Dann, a gastroenterologist with Manhattan Gastroenterology in New York.
Symptoms of enlarged hemorrhoids include:
— Bulging or swelling around the anus.
— Itching or irritation around the anus.
— Pain or discomfort.
Dr. Danielle Carter, a practicing family physician in Jacksonville, Florida, and a member of the American Academy of Family Physicians Board of Directors, says that hemorrhoids come in two varieties: internal and external.
“Internal hemorrhoids usually don’t cause pain, but can cause bleeding. Sometimes these can prolapse, or feel like swelling coming out of the anus. External hemorrhoids are more likely to be itchy and painful, and are located around the rectum. They also sometimes bleed.”
Causes of Hemorrhoids
“It’s not exactly known why hemorrhoids become a problem in any given individual, but time and gravity likely play a role,” Nelson says, as hemorrhoids are more common among adults over age 45.
“Increased pressure in the lower rectum,” is also to blame, Dann says, and that pressure could come from a number of sources including:
— Pregnancy. In pregnancy, it’s believed that hemorrhoids are caused by increased pressure and weight on the pelvis that can cause the veins around the anus to dilate and potentially cause symptoms.
— Childbirth. “With vaginal child birth, the hemorrhoids can become significantly engorged and even clot off, or thrombose, after delivery. This leads to long-term hemorrhoid difficulties afterwards, usually from redundant skin (also known as skin tags) that are left over once the swelling goes down,” Nelson explains.
— Obesity. Carrying around excess weight can add pressure to the lower body, and could increase the chances of developing symptomatic hemorrhoids.
— Genetics. “Hemorrhoid problems can run in families,” Nelson says.
— Chronic constipation. When you’re frequently constipated, you may be more likely to strain when defecating, and that’s a “known association,” Nelson says. Dr. Hardeep Singh, a gastroenterologist with St. Joseph Hospital in Orange, California, adds that “prolonged straining and/or hard bowel movements can increase the pressure in the veins of the rectum and anal canal. This causes them to distend and sometimes bleed or tear.”
— Diet. Not eating enough fiber can also be implicated in the development of hemorrhoids, Carter says. Low-fiber diets can lead to chronic constipation and the type of straining and pressure that can result in symptomatic hemorrhoids.
Home Remedies for Hemorrhoids
If you find yourself struggling with painful or irritating hemorrhoids, try the following six home remedies that may provide some relief.
— Warm bath with Epsom salt.
— Stool softeners.
— Over-the-counter ointments or wipes.
— Anesthetics and anti-inflammatories.
— Witch hazel.
— Aloe vera.
[READ: How to Stop Diarrhea.]
1. Warm bath with Epsom salt.
Sitting in a bath full of warm water with two cups of dissolved Epsom salt is a time-tested home remedy to soothe inflamed anal tissue and reduce the symptoms of hemorrhoids. If a sitz bath isn’t an option, Husain recommends using a warm compress or a heating pad. Applying warmth to the area “helps minimize swelling.”
2. Stool softeners.
Because constipation and straining to defecate is a known risk factor for hemorrhoids, stool softeners that make it easier for you to move stool out of the body may be helpful for relieving enlarged hemorrhoids. “Stool softeners are available over the counter, and those can help with the elimination of fecal material,” Husain says.
3. Over-the-counter ointments or wipes.
A wide range of ointments, creams and wipes that contain ingredients meant to soothe inflamed tissue are readily available at any pharmacy and are often the first remedy people reach for.
These options can lubricate the area or provide a soothing or numbing sensation that takes away some of the irritation. Some contain a substance — called a vasoconstrictor — that constricts small blood vessels, which could reduce swelling temporarily. These ointments don’t cure the hemorrhoid, but can make it feel better.
“All the creams and ointments you can think of have no effect on the hemorrhoidal tissues themselves,” Nelson explains. “They can relieve the skin irritation caused by large hemorrhoids, but nothing can make them smaller other than a procedure that removes the hemorrhoids.”
In other words, the ointments can help alleviate itching and can temporarily reduce swelling if they contain vasoconstrictors, but they won’t provide a permanent solution.
4. Anesthetics and anti-inflammatories.
Along with over-the-counter medicated ointments and wipes, “some prescription creams are also used for pain relief,” Carter says. These may contain a steroid that helps reduce inflammation.
Other over-the-counter options include low-dose cortisone cream, which Singh says “can be used intermittently when hemorrhoids are painful.” And Dann recommends using a “barrier cream like zinc oxide and topical anesthetics such as dibucaine and lidocaine” to stop further irritation and reduce pain.
5. Witch hazel.
Witch hazel is a plant extract that has astringent, or drying, properties. It’s often used as a facial toner to cleanse the skin and shrink pores, and the Mayo Clinic reports that it’s often a component of over-the-counter creams, ointments, suppositories or pads marketed to soothe hemorrhoids.
You can also apply liquid witch hazel directly to the hemorrhoid. Tannins and oils in witch hazel have an anti-inflammatory effect on the skin that can reduce inflammation and a mild vasoconstriction effect that may shrink tissue or slow bleeding.
6. Aloe vera.
Aloe vera is a cactus-like plant that has historically been used for skin conditions. The National Center for Complementary and Integrative Health reports that the sap of the plant is viscous and can be used on burns and wounds to provide relief and speed healing. Applying aloe to the irritated hemorrhoid can help soothe inflammation and pain.
[See: Colon Cancer Diet.]
Tips to Help Prevent Hemorrhoids
In addition to these home remedies, it’s a good idea to wear loose, cotton clothing so you don’t trap moisture in the area, which can exacerbate symptoms. Making a few other simple lifestyle changes can also help reduce the chances you’ll develop hemorrhoids in the future.
1. Increase fiber intake.
Constipation is a primary cause of hemorrhoids, and the best way to reduce that issue is to boost the amount of fiber in your diet. “Increasing fiber in your diet can improve symptoms and even decrease hemorrhoid risk by up to 50%,” Carter says. She recommends aiming for 25 to 35 grams of fiber a day.
Eating more high-fiber foods such as leafy greens, crunchy vegetables, fruit and whole grains can help you produce bulkier stool that’s easier to move through the digestive tract. Singh notes that “fruits like prunes can be particularly helpful.” Nelson adds, “The best therapy to use at home is fiber supplementation along with a high-fiber diet.”
2. Minimize exacerbating foods.
Husain says that in his practice, “we recommend that you minimize dietary elements that increase the acidity of stools. Those include caffeine, chocolate, very spicy food, citrus fruits, juices, tomatoes and tomato-based products and a lot of nuts and seeds.” These items can be irritating when waste is excreted, so eliminating them might make defecating less painful when you have hemorrhoids.
3. Drink lots of water.
Staying well hydrated can also help you stay more regular and reduce symptoms of constipation. Singh says you “should have a goal of drinking at least 64 ounces of liquid per day,” preferably mostly plain water.
4. Exercise regularly.
Regularly getting your sweat on can help keep your bowels more regular and improve overall health and wellness.
5. Avoid straining.
Husain says you can minimize your chances of developing symptomatic hemorrhoids if you “avoid straining. If you’re moving your bowels and it’s not happening,” don’t force it. Spending a long time trying to evacuate your stools could be setting you up for a problem. Strain less and clean up your diet to develop a more regular bowel pattern.
6. Lighten your load.
Husain says that there’s some limited evidence that connects lifting heavy weights to hemorrhoids. So, if you work in manual labor or otherwise routinely lift heavy weights and hemorrhoids are a problem, consider lightening the load if you can.
When to See a Doctor
“Hemorrhoids in themselves are not associated with anything serious in most cases,” Husain notes and “occasional symptoms in the area are very common.” But if you’re bothered by the symptoms or they become chronic, it’s best to seek medical attention to ascertain what’s causing them.
“Persistent or recurrent symptoms is something that raises our concerns,” he adds, so if symptoms have lasted longer than a week or if they return within a couple weeks after resolving, definitely reach out to your health care professional for advice.
Carter notes that if the home remedies above don’t help or when symptomatic hemorrhoids develop “over and over again or they get larger or more painful” then it’s probably time to talk to your doctor. “There are procedures that can be done in a physician’s office as well as same day surgeries to treat them.”
Usually, symptomatic hemorrhoids resolve on their own, “but you can have the hemorrhoid removed in the office under local anesthesia,” Nelson says. “This relieves the pain and prevents recurrence at that location in the future.”
In some cases, hemorrhoids can prolapse, or fall out, during a bowel movement and have to be manually pushed back in. “Many times, this can also be treated in the office with rubber band ligation or infrared coagulation,” Nelson says.
“Internal hemorrhoids can be treated this way because there’s no pain sensation in the lower rectum where internal hemorrhoids reside. In the case where the hemorrhoids are too large or symptomatic to be treated in the office, a surgical procedure in the operating room may be necessary,” Nelson says.
Take Bleeding and Infection Seriously
If you do get hemorrhoids with some regularly, one key sign to watch out for is bleeding, as that can be an indication of a more serious issue. “Hemorrhoids are one of the most common causes of rectal bleeding,” Dann says.
Nevertheless, “patients should never assume that rectal bleeding is due to hemorrhoids, as this can be a sign of more serious abnormalities such as polyps or tumors,” Singh says. As such, if you have rectal bleeding, you “should always seek the attention of a doctor for an evaluation.”
And if you or a family member has a history of colon cancer, definitely err on the side of caution and seek medical addition if you develop hemorrhoid symptoms. Even if you aren’t high risk, you should get screened for colon cancer.
The American Cancer Society recommends routine screening starting at age 45 if you’re at normal risk and earlier if you’re at higher risk. Talk to your doctor about the right starting time and screening interval for you based on your family and personal history and risk level.
Another concern is that the hemorrhoid could become infected, Dann says. So when in doubt talk to a doctor. “Hemorrhoids can be managed by your primary care physician, gastroenterologist or surgeon,” he says. There are a range of treatment options available to address the problem.
Don’t Be Shy
Lastly, Nelson wants you to know that while symptomatic hemorrhoids “cause a great deal of unnecessary suffering,” they can “very frequently be dealt with by management in the doctor’s office. Colorectal surgeons are best qualified to treat this problem because they have the most experience. However, general surgeons are also very adequately trained to treat hemorrhoids.”
Your family medicine practitioner can also help, Carter says. “Hemorrhoids are very common and can occur in all ages, so don’t be embarrassed or afraid to talk with your family physician. We want to help you feel good and enjoy life without the pain and inconvenience of hemorrhoids.”
While it might seem embarrassing to ask for help, Nelson urges you to get beyond that. “It’s hard to combat this perception, but people should be aware that colorectal surgeons and general surgeons deal with anorectal issues on a daily basis.”
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Update 07/21/21: This story was previously published at an earlier date and has been updated with new information.