What Are Hemorrhoids, and What Helps?

It’s a quiet topic, until it’s you. A spot of bright red on the toilet paper, an itch you can’t address in public, a tender lump that makes sitting through a meeting a negotiation. You’re embarrassed, and you’ve been putting off looking it up.

Two kinds

The NIDDK¹ says external hemorrhoids form under the skin around the anus, and internal hemorrhoids develop in the anus and lower rectum lining.

External ones may cause anal itching and one or more hard, tender lumps near the anus. Internal ones often show up as bright red blood on the stool, on toilet paper or in the toilet bowl after a bowel movement. The NHS² describes bright red blood after you poo, itching, a feeling of not finishing, and lumps that may be pink, purple or grape-sized.

Why they happen

The NIDDK³ lists straining during bowel movements, sitting on the toilet for long periods, chronic constipation or diarrhea, low fiber intake, weakening of tissue with age, pregnancy and heavy lifting. The NHS² adds being overweight.

That’s why constipation matters beyond comfort. If constipation and straining keep happening, ask about causes such as IBS.

What helps at home

The NIDDK⁴ says to start with fiber and fluids, and its list for mild symptoms includes:

• Fiber and water. Eat foods high in fiber and drink water or other nonalcoholic liquids every day.
• Stool softeners, and avoiding straining.
• Less time on the toilet.
• Sitz baths. A tub of warm water several times a day to relieve pain. The NHS² suggests a warm bath for itching and pain, and ice packs.
• Over-the-counter creams or suppositories for mild symptoms.

The NHS² adds to pat the area dry rather than rubbing, to avoid alcohol, caffeine and codeine-containing painkillers, and says a pharmacist can recommend creams, laxatives and cold packs.

If home care isn’t enough

For persistent internal hemorrhoids, the NIDDK⁴ says doctors offer office procedures such as rubber band ligation, which places a band around the base of the hemorrhoid, plus sclerotherapy and other treatments that cut off the blood supply. Surgery, such as hemorrhoidectomy to remove large external hemorrhoids, is for more severe cases, and the NIDDK says it’s done under anesthesia.

The play

Try this: a soft-stool week

Drink water or other nonalcoholic drinks through the day, and add fiber from food at each meal.

Don’t sit on the toilet longer than you need to, and don’t strain. Leave your phone outside the bathroom.

Use a warm bath or sitz bath for pain, and pat dry. Note whether the bleeding or itching eases. If it doesn’t, that’s information for your clinician.

When to get checked

Don’t wait if

1. Emergency

   Get care right away if you have severe anal pain and bleeding, especially with abdominal pain, diarrhea or fever, as the NIDDK⁴ says. The NHS² says to call emergency services for bleeding that won’t let up, large clots or severe pain.

The NIDDK³ says to see a doctor if symptoms persist beyond one week despite home remedies, or if you have bleeding from your rectum. It notes that hemorrhoids are common, but similar symptoms can indicate other conditions such as Crohn’s disease or colorectal cancer, which is why professional evaluation is important. The NHS² says to see your GP if symptoms worsen or don’t improve.

Book an appointment if any of these fit:

• Any rectal bleeding, especially if it’s new
• Symptoms haven’t improved after a week of home care
• You have a lump that’s extremely painful or doesn’t go away
• Your bowel habits have changed
• You have chronic constipation or straining

It’s an awkward topic and a treatable problem. Make the call, and get back to your meeting.