Hemorrhoids, also called piles, are a common health condition affecting middle aged and elderly people. According to statistics, around 50% of people will develop hemorrhoids by age 50,1 and 75% of Americans will experience symptoms of this condition at some point in their lives.2
Many people consider hemorrhoids an embarrassing topic to discuss, even with their doctor, which has led to numerous misconceptions as to why they develop and how they can be treated or managed. This article will help clear up some of the misunderstandings about hemorrhoids and helpful solutions and lifestyle changes to ease the discomfort.
Technically Speaking, We All Have Hemorrhoids
The word “hemorrhoid” came from two Greek terms — “haema” and “rhoos” — referring to the flow of blood.3 To put it simply, hemorrhoids or hemorrhoidal tissues are vascular tissues found in the anal canal. They are composed of loose connective tissue, smooth muscle and blood vessels with numerous arteriovenous connections.4
Hemorrhoids are a normal part of human anatomy — everyone has them. In a Time article, Dr. Titi Adegboyega, chief of colorectal surgery at South Shore University Hospital in Long Island, New York, said “We’re born with hemorrhoidal tissue. When people say they ‘have hemorrhoids,’ what they’re really saying is, ‘This thing that is normal is now acting abnormally or bothering me.'”5
Hemorrhoidal tissues act as a cushion, helping with stool continence by providing bulk to the anal canal and protecting the sphincter muscle (which relaxes or tightens the anal canal) during defecation.6,7 However, these anal tissues are sensitive.
When there’s extra pressure on the veins due to external factors, they become irritated, inflamed or swollen, and itchy. In some cases, bleeding also occurs. This is when hemorrhoids become a pain in the butt (literally speaking).
Hemorrhoid Symptoms and Factors That Increase Your Risk
Certain factors raise your chances of developing hemorrhoids. In women, for example, pregnancy increases your risk, as carrying a child in your womb puts extra pressure on the blood vessels in your pelvic area. Childbirth also causes hemorrhoids — this usually happens when you strain to push the baby out.
Constipation is another common cause. When you’re constipated, you need to strain during bowel movements, putting pressure on the blood vessels. Having either chronic constipation or diarrhea causes hemorrhoids as well. Other risk factors include:8
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Sitting on the toilet for a long time |
Being obese |
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Having anal intercourse |
Consuming a low-fiber diet |
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Frequently lifting heavy objects |
Having a family history of hemorrhoids |
Hemorrhoids aren’t life-threatening, but they do affect your quality of life and day-to-day activities. The discomfort could last for days, sometimes even weeks. Symptoms associated with hemorrhoids include:9
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An itchy anus |
Pain around (or inside) the anus |
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Lump/s around your anus |
Bright red blood after you defecate |
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Still feeling a need to poop even after you’ve gone to the toilet |
Mucus in your underwear or toilet after wiping |
Hemorrhoids are also classified as internal hemorrhoids, which are found inside the rectum, or external, meaning they are under the skin around the anus. Depending on which tissues are swollen or strained also affects your symptoms.
External hemorrhoids, for example, cause itching, pain, inflammation, and bleeding — these are the ones that are extremely uncomfortable. They can also fill with blood, forming a blood clot. Meanwhile, internal hemorrhoids cannot be seen and rarely cause discomfort; however, when you strain while using the toilet, you might notice bright red blood in toilet or tissue paper after wiping.10,11
According to Dr. David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital: “External hemorrhoids often feel like a bump, whereas internal hemorrhoids cannot be seen unless they prolapse outside the anal opening.”12 When a hemorrhoid prolapses, it stretches and bulges out of the anus; this can happen to both internal and external hemorrhoids.
Addressing Constipation Is Vital to Prevent Hemorrhoids
While some triggers of hemorrhoids, like pregnancy, cannot be controlled, preventing constipation is one common risk factor that you’ll be able to deal with. Constipation causes you to produce dry, hard stools that are difficult to pass and irritate your rectum.
While it’s normal to experience temporary constipation, such as when you ate an unhealthy diet for a day or two, chronic constipation — having three (or fewer) bowel movements in a week that lasts for three months or more13 — is no laughing matter. It’s been linked to serious health conditions like ulcerative colitis,14 diverticulitis,15 kidney disease,16 and colorectal17 and gastric cancer.18
There are several ways to address constipation, and adopting simple changes to your lifestyle and bathroom habits will help resolve it and keep you from developing hemorrhoids. One of the top things you need to do is to stay hydrated. Getting sufficient pure water helps keep your stools soft and promotes regular bowel movements.
However, don’t rely on the conventional advice to drink eight glasses a day — instead, rely on your thirst and urine color as guides to determine if you’re sufficiently hydrated. Use your thirst as a gauge if you need to drink more water, enough to turn your urine a light yellow color.
You also need to keep your stools as soft as possible, so they will not aggravate your hemorrhoidal tissues when you defecate. Eating enough dietary fiber is one way to do this.
Ideally, aim to get around 50 grams of fiber for every 1,000 calories you consume. Make sure you’re getting both soluble (dissolves in water) and insoluble (stays intact while moving through the colon) fiber, as they’re both essential to proper digestion.
High-fiber fruits and vegetables, like apple, broccoli and bananas are some of the best sources. Taking organic psyllium husk also helps, and provides other benefits, such as weight management and blood sugar support.19
It’s also essential to evaluate your toilet habits, as they also impact your risk for constipation, therefore aggravating your hemorrhoids. For example, did you know that the typical (yet incorrect) way you sit on the toilet increases your chances of becoming constipated?
Check Your Toilet Habits (and Posture)
Despite its convenience, the modern pedestal toilet that you’re accustomed to actually forces your body into an unnatural position that affects your intestines’ ability to eliminate stool efficiently. This is because the human body is not designed to sit while defecating; rather, squatting is the proper posture for eliminating waste.
Your body has a natural valve, called the anorectal angle,20 that helps maintain continence when you’re not ready for elimination. However, when you sit, the anorectal angle remains partially kinked, meaning you’re required to strain to overcome the obstruction. But when you squat, the anorectal angle is straightened, creating a clear pathway and making elimination effortless — no need to push or strain.
This doesn’t mean that you should abandon your standard toilet, however. There’s a simple tool called the potty stool (like the Squatty Potty) that you can use to adopt a squat-like posture while on the toilet. If you don’t have a potty stool yet, a simple footstool is enough to help you do a squatting position. Read more about this in my article, “Constipated? Try These Sitting Positions.”
Another toilet habit that I highly recommend is to install a bidet in your bathroom. As opposed to using just toilet paper to clean up after bowel movements, which irritates your hemorrhoids further, a bidet cleanses your anus and nether regions, providing a refreshing feeling while reducing the risk of infections and inflammation. According to the blog Many Bidets:
“Hemorrhoids result from an increase in rectal pressure, which can be caused or aggravated by straining to go and sitting on the toilet for long periods. Wiping causes additional irritation and may even lead to bleeding.
[B]idets take wiping out of the equation, giving inflamed tissue the chance to heal. The customizable water wash also facilitates thorough cleansing, which is key in reducing itching and discomfort and preventing infection.”21
Limiting your time spent on the toilet is another habit you must change. While many people spend a long time sitting on the toilet, sometimes even using their phone, this is actually doing more harm than good, as it puts added strain on your hemorrhoids, worsening the irritation and prolonging your symptoms. According to Dr. Nina Paonessa, a colorectal surgeon based in New Jersey:
“Spending too much time on the toilet places extreme pressure on your rectum and anus. On a toilet seat, your rectum is lower than the rest of your buttocks. As a result, gravity pushes down on the veins and blood pools in the veins. If you strain due to constipation, you further increase the pressure.”22
Hence, it’s important to only spend enough time on the toilet to complete your bowel movement, then clean yourself and stand up. It’s also important not to delay bowel movements. If you feel the urge to go to the toilet, go immediately; don’t wait. The longer you withhold a bowel movement, the longer the stool stay in the colon, removing water and making it harder to pass.
Try These Natural Remedies to Help Soothe Hemorrhoids
Hemorrhoids usually go away on their own, though it could take a few days or several weeks. Small hemorrhoids heal after a few days, while larger hemorrhoids sometimes take longer to do so; there’s also a chance that they will recur.23
If the discomfort is too much for you to handle, there are some remedies that will help provide some relief, listed below. However, if you experience severe anal pain, bleeding that may or may not be associated with abdominal pain, diarrhea, or fever, I advise consulting with your healthcare provider to rule out other health conditions.
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Sitz bath — “Sitzen” is a German word that means “to sit,”24 as this is exactly what you need to do in a sitz bath. Basically, this is a type of bath where you soak your hips and buttocks, helping ease the pain of hemorrhoids. A sitz bath also eases itching, irritation and spasms of the sphincter muscles. When doing a sitz bath, make sure the water is warm, not hot. Doing two to three 20-minute sitz baths per day, plus an additional bath after every bowel movement, is recommended. Pat the area dry; don’t rub it to avoid irritating your hemorrhoids. Using the cool air setting of your hairdryer to dry your nether regions is also a good idea. |
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Aloe vera — The anti-inflammatory properties of aloe vera have been valuable in many products designed to ease hemorrhoid symptoms. According to Medical News Today,25 there are no scientific studies confirming its benefits for hemorrhoids, although many studies have shown its healing and soothing effects against other skin conditions. In 2010,26 a study found that aloe vera cream is more effective in reducing post-hemorrhoidectomy (removal of hemorrhoids) pain and improving healing time compared to a placebo. |
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Witch hazel — A 2020 study published in Acta Biomedica27 found that using a rectal ointment combined with herbal extracts, which included witch hazel, calendula and chamomile, helped ease itching, swelling and pain caused by hemorrhoids. Applying a small amount of witch hazel to your hemorrhoids provides relief. Dilute it in a carrier oil before using. Avoid using alcohol to dilute witch hazel (or any other essential oil), as it will dry out the hemorrhoids and cause irritation. |
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Epsom salts and glycerin — Combine 2 tablespoons of Epsom salt and glycerin on a gauze pad, and apply to painful areas for 15 minutes. Rinse it off afterwards.28 |
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Ice pack — Applying an ice pack or a cold compress to the affected area helps curb the pain and reduce the swelling. Remember not to apply ice cubes directly on the skin; you’ll need to wrap them in a small towel to avoid skin damage. Use the ice packs every one or two hours, for 15 minutes at a time, until the pain subsides. |
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Coconut oil — A study published in 202029 notes that an ointment made from coconut oil helps improve hemorrhoid symptoms in pregnant women. Simply apply it on the affected areas; the anti-inflammatory properties of this moisturizer help reduce irritation and swelling. |
Don’t Be Sedentary — Exercising Can Help
If your hemorrhoids are particularly inflamed and are bothering you, I recommend wearing loose fitting clothes and underwear that do not rub the area. I also advise you to avoid being sedentary and sitting down for long periods, as it can aggravate the condition. According to Paonessa:30
“When you sit, the pressure on your buttocks makes the gluteal muscles spread out. In the process, the small veins around the anus and rectum are stretched and lose elasticity. Then the fragile veins become engorged with blood, and you have hemorrhoids.
The intense pressure from prolonged sitting leads to new hemorrhoids and aggravates existing ones. But not all sitting have the same effect. Sitting on a hard chair causes more pressure than a soft chair.”
If the pain is manageable, I recommend following a daily exercise routine to help facilitate healing. Exercise helps increase circulation, strengthens bones and muscle, and supports your digestive process.31
However, not all exercises are recommended. For example, cycling and heavy weightlifting are not recommended. Walking outdoors is a good option, as well as doing yoga.
