How to Manage Your Hemorrhoids and Prevent Future Flare-Ups

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An estimated 50 percent of people over 50 will have to deal with bothersome bumps on their bottoms that can be itchy and painful. Surprised? What’s more shocking is that we all have them. Yes, you. Right now. “Hemorrhoids are completely normal anal tissue that gives support in the anal canal,” says Dr. Terry Zwiep, a colorectal surgery fellow at The Ottawa Hospital. Usually they’re just doing their job, helping to control the release of stools and gas, but when they become symptomatic, people start to notice them, he says.

Types of hemorrhoids

When hemorrhoids become inflamed, veins, similar to varicose veins, in your anus or lower rectum swell, causing discomfort. There are three types that cause complaints: internal hemorrhoids (which doctors will grade for severity on a scale of one to four), external hemorrhoids (which develop under the skin around the anus) and thrombosed hemorrhoids (which occur when blood pools in an external hemorrhoid and causes a clot; resulting in a lump near your anus).

What causes hemorrhoids to be problematic

According to The College of Family Physicians of Canada (CFPC), excessive pressure on the veins in your anus or rectum from obesity, jobs that involve heavy lifting, and pregnancy (due to the weight of the uterus and pressure during delivery) will up your odds of problematic hemorrhoids. Hemorrhoids are also frequently associated with chronic constipation, because straining and long stints sitting on the toilet put pressure on the area, too. Check out these natural remedies for relieving constipation.

Typically, hemorrhoids are painless, but they can still cause worrisome symptoms, like light to moderate bleeding when you wipe. If they do hurt or itch, it’s likely because internal hemorrhoids have prolapsed outside of the anal canal during a bowel movement and become enlarged.

Chances are, your doctor will be able to diagnose symptomatic external hemorrhoids with a simple physical exam. According to the CFPC, a rectal exam using an anoscope may be required to accurately diagnose internal hemorrhoids. If you have bleeding, you’ll likely be referred to a specialist to rule out more serious conditions.

For the most part, a mild case of hemorrhoid flare-up is easily managed. In some severe cases, you may need surgery to remove the offending blood vessels in external or internal hemorrhoids (called a hemorrhoidectomy), or rubber bands may be used to tie them off, stopping blood flow to the area and causing them to wither away (called a rubber band ligation).

How to best manage discomfort

There are some things you can do at home to shrink a mild or moderate case of bothersome hemorrhoids and prevent future flare-ups.

Consult your doctor if you think you have a problem with hemorrhoids.

It’s important to get a diagnosis so that you can properly treat your condition and rule out something more serious. In general, hemorrhoids don’t pose a significant health issue, says Dr. Zwiep, but they can some-times be mistaken for other conditions. Bleeding, for example, can also signal more serious diseases, including colorectal cancer and other disorders of your digestive tract, such as colitis, which require treatment.

Do practise good toilet habits.

It’s important to go when you get the urge and not strain or sit on the toilet for too long because this position puts increased pressure on the area and can cause inflamed hemorrhoids to worsen. A good guideline is about two minutes in the bathroom. “Don’t take your phone, a book or a magazine with you to the toilet,” says Dr. Zwiep. “These distractions will keep you there longer than necessary — just do what you need to and get out.”

Take a sitz bath.

Soaking the area in warm water for 10 to 15 minutes twice a day will reduce swelling and itching. (Any longer or more often can be counterproductive, though, since keeping the area too moist can cause the skin to break down, making matters worse, says Dr. Zwiep.) Using a sitz bath, which fits right over your toilet, is the easiest way to soak and soothe the area.

Find ways to sneak in more fibre and water.

A diet loaded with fibre-rich foods, including vegetables, fruits and whole grains, is key for preventing and treating hemorrhoids because softer stools will keep things moving more easily. “We typically recommend increasing your fibre intake to 20 to 25 grams a day, which is double what most people normally eat,” says Dr. Zwiep. “Drinking six to eight glasses of water a day is also important for soft bowel movements with no straining.” Here’s more proof that you should be drinking eight glasses of water every day.

Make a cold pack for your booty.

In some cases, a bit of cold, in tandem with a warm sitz bath, can reduce swelling and provide some soothing relief. Use a soft ice pack wrapped in a towel, or make your own by cutting or folding a large sanitary pad in half, wetting it with water and then freezing it. When it’s frozen, put it in your underwear, positioned farther back over your bum, and you’ve got a form-fitting ice pack. During a flare-up, lay down with it in place for a few minutes, several times a day, to help shrink swollen hemorrhoids.

Try sleeping on your stomach.

If you’re not pregnant, snoozing on your tummy with a pillow wedged under your hips will take pressure off your bottom, helping to reduce pain.

Check with your doctor before you try natural remedies.

Tea tree oil and apple cider vinegar are among the often-touted natural cures for hemorrhoids, but Dr. Zwiep warns that these are not well studied and could do more harm than good, especially if they irritate the area. There are plenty of simple home remedies that can soothe sore bottoms, though. See below for the best remedies from the pharmacy.

Find at-home relief

When hemorrhoids flare up, you’ll be glad your bathroom is stocked with the necessary remedies to give you some sweet relief. Here’s what you should add to your shopping cart.

Pain relievers

Acetaminophen (like Tylenol) can help reduce swelling and pain.

Sitz bath

Soaking in the bathtub will soothe the area, but a sitz bath (a small plastic tub that fits over the toilet) is the easiest way to treat your bottom several times a day.

Epsom salts

Add a few tablespoons of plain Epsom salts to your sitz bath for some added relief.

Wet wipes

External hemorrhoids are often caused or exacerbated by poor hygiene. Use a wet wipe after a bowel movement instead of toilet paper to ensure that the area is really clean. A packaged compress containing witch hazel (like Tucks) can temporarily help with burning and itching.

Fibre supplements

If you can’t seem to get enough from your diet, consider adding a fibre supplement to get — and keep — things moving.

Creams and ointments

Dr. Zwiep recommends staying away from over-the-counter creams because they aren’t usually effective and may exacerbate things. Talk to your doctor about a prescription hydrocortisone cream, which can treat some of the symptoms but won’t deal with the underlying cause (plus, it can be detrimental if used for more than seven days). Calmoseptine is one of the few topical treatments that Dr. Zwiep recommends. Next, learn everything you need to know about chronic pain.