Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like
varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are
irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and
bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch
and bulge the walls of the veins, sometimes rupturing them. Listed below are the most
frequent causes of hemorrhoids:
- Constant sitting
- Straining with bowel movements (from constipation or hard stools)
- Sitting on the toilet for a long time
- Severe coughing
- Heavy Lifting
There are two kinds of hemorrhoids: internal and external
- Internal hemorrhoids usually don't hurt or itch; you can't feel them because they are
deep inside the rectum. Internal hemorrhoids are pretty harmless. But since their bleeding
could mask blood from a dangerous source like colorectal cancer, they should be treated.
- External hemorrhoids cause most of the symptoms we commonly hear about --- pain,
burning, and itching. If an external hemorrhoid becomes strangulated (cut off from blood
supply), a clot can form in it and become an excruciatingly painful thrombosed hemorrhoid.
Because of these unpleasant symptoms, external hemorrhoids get the most treatment
Once the rectal veins have been stretched out and hemorrhoids created, they are
difficult to get rid of completely and tend to recur with less straining than it took to
cause them in the first place. Fortunately, good habits and simple medical treatment
usually control hemorrhoids well, and surgery is only recommended in unusually severe
Avoiding the causes listed in Basics will prevent most cases of
hemorrhoids, but this advice is sometimes hard to follow. For example, how can you avoid
sitting all day if you have a seated job? And most of us would like to avoid coughing,
diarrhea, and childbirth, but that's pretty much impossible, isn't it? Here are some
practical hints to help:
- If your main job activity is seated, always stand or walk during your breaks. Make it a
point to stand and walk at least 5 minutes every hour and try to shift frequently in your
chair to avoid direct rectal pressure.
- Always exhale as you strain or lift. Don't hold your breath.
- Control coughing, diarrhea and constipation with early treatment since hemorrhoids may
- Make a rule: No reading or other relaxing activity while on the toilet. If bowel
movements take longer than 3-5 minutes, something is wrong. If you want to keep
hemorrhoids away, maintaining good bowel habits and softer stools should be your highest
priority (see Treatment section).
If these preventive measures fail, you must take action right away! Hemorrhoids are one
condition that can be mild in the morning and become intolerable by nightfall.
You must first find the cause of your hemorrhoids and stop it. Treating the hemorrhoids
themselves is pointless if you keep re-creating them. Click here to review the causes
listed in Basics. You should also read the Self Care Advisory section
on Constipation, since it's probably
the major cause of hemorrhoids.
Once you have eliminated factors causing your hemorrhoids, it's time to treat them.
There are two treatment goals: first, take away the symptoms (burning, pain, itching) and
second, shrink the hemorrhoids.
- Sitz baths (soaking the rectal area in hot water, in a shallow bath) for 15-20 minutes,
3-4 times/day are a simple and effective treatment for both goals.
- Pain medicine should be used for aching, but burning and itching respond best to
surface-acting creams and suppositories found in the Recommended Products
- To shrink your hemorrhoids back down to normal size, topical medications are again
- Cleanse the entire rectal area with warm water after each bowel movement, and use a bulk
fiber laxative to soften stools. This helps eliminate straining with bowel movements.
- Many people use bulk fiber supplements daily to prevent recurrences of hemorrhoids. But
remember, bulk fiber may take several days to work. If you have existing hemorrhoids and
hard stools are already present, you may want to use an immediate-acting stool softener
and laxative to encourage elimination without straining and further aggravating your
- Venapro is an interesting new product that we have discovered. It is a natural hemorrhoids treatment that can help reduce
flare-ups and alleviate painful symptoms. Other treatments include:
- Aleve (naproxen sodium 220 mg). Use this quick acting
anti-inflammatory for the aching discomfort of severe hemorrhoidal flare-ups.
- Tucks (Formerly Anusol) HC cream (hydrocortisone 1%). For swollen external
hemorrhoids, brands containing hydrocortisone such as this one are effective at reducing
the swelling, burning, and itching sensations.
- Tucks (Formerly Anusol) Suppositories (topical
suppositories should be used for internal itching, burning and discomfort.
- Citrucel (methycellulose 2 grams/tbs.). Softening stools and
treating constipation are crucial aspects of treating your hemorrhoids. Many find this
brand of bulk fiber laxative to be less gritty than others, and it comes in both sugared
and sugar-free versions.
- Senokot, Senokot S (senna concentrate, various concentrations;
docusate sodium 50 mg per tablet is the softener in Senokot S). The active ingredient
senna is a bowel contraction stimulant. If you desire stool softening or lubrication along
with the stimulant effect, Senakot S is the recommended combination.
Aggressive treatment using the above techniques should improve hemorrhoids within days,
but they may need 2-4 weeks of treatment to completely calm down. If they have not
resolved to your satisfaction in that time, consult a physician. Other medical problems
such as inflammatory bowel disease or bowel infection can cause hemorrhoid-like symptoms.
So if the problem does not clear up promptly with basic OTC treatment, see your doctor.
None of the OTC treatment methods listed above will be effective for thrombosed
hemorrhoids (click here to review Thrombosed Hemorrhoids). These
clotted hemorrhoids are always very hard, have a smooth black or purple surface, and feel
like a growth coming from the anus. They are extremely painful, and a tiny incision made
by a physician to remove the clot alleviates pain and bulging immediately. Don't delay
seeing your doctor for a thrombosed hemorrhoid. Left alone, they take days or even weeks
to go away.
More than hemorrhoids on our Self Care Home Page
Copyright and Privacy Notice