Hemorrhoids are one of the most common reasons people seek care from a colorectal specialist, yet they remain widely misunderstood. According to Dr. Frances Hu, a board-certified general surgeon with Georgia Colon & Rectal Surgical Associates, hemorrhoids are not abnormal.
“We actually all have hemorrhoids,” Dr. Hu said. “They are a normal part of our anatomy.”
These vascular cushions sit at the bottom of the anal canal and help maintain continence by preventing accidental leakage of gas or stool.
While hemorrhoids are normal, they can become symptomatic. One factor people cannot avoid is aging.
“As we age, our tissues change and that alone can be enough to start to have symptoms from a flare,” Dr. Hu said.
What causes hemorrhoid flare-ups?
According to Dr. Hu, hemorrhoid symptoms are often linked to changes in bowel habits. Constipation, diarrhea, straining during bowel movements and sitting on the toilet for extended periods can all contribute to a flare. Heavy lifting and other activities that increase pressure in the abdomen and pelvic area may also contribute.
Symptoms can vary depending on whether hemorrhoids are internal or external. Internal hemorrhoids commonly cause bleeding, swelling and prolapse, when tissue protrudes from the anal canal. External hemorrhoids are more likely to cause pain, burning, itching and difficulty with hygiene.
Focus on healthy bowel habits
For many people, managing hemorrhoids begins with lifestyle changes designed to promote regular, healthy bowel movements.
The goal, Dr. Hu said, is “going consistently and having soft and formed bowel movements.”
Staying hydrated and increasing dietary fiber are two of the most effective strategies.
“One thing that you'll often times hear in a colorectal surgery office is fiber, fiber, fiber,” Dr. Hu said.
Dr. Hu recommends aiming for 25 to 30 grams of fiber per day, although she acknowledges that can be challenging. Fruits, vegetables, oatmeal, popcorn and nuts can all help increase fiber intake.
Fiber supplements may also be beneficial.
There are many different fiber supplements available, and no prescription is required. Dr. Hu does not recommend any brand, but she said patients sometimes need to try different options before finding one that works best for them. She also recommends starting slowly and allowing the body time to adjust before increasing the amount consumed.
Patients should also avoid prolonged toilet sitting. Dr. Hu advises limiting bathroom visits to about three to five minutes and returning later if a bowel movement does not occur. This helps reduce pressure on swollen hemorrhoidal tissue.
At a point, if you still have a lot of hemorrhoid symptoms and you feel like you've been doing what you can to try and have more regular bowel movements, Dr. Hu said you may need a bowel regimen consisting of either stool softeners and/or laxatives.
Relief during a flare
When symptoms flare, warm sitz baths may provide comfort.
“You do not necessarily need to put anything other than the warm water,” Dr. Hu said.
Soaking for 15 to 20 minutes can help relieve irritation and discomfort.
Other options include gentle cleansing methods, such as a bidet or peri bottle, as well as topical treatments that target itching, burning, and inflammation. While these approaches can relieve symptoms, Dr. Hu noted they will not eliminate hemorrhoids or prevent future flares.
For patients whose symptoms persist despite lifestyle changes and medical management, procedures ranging from office-based rubber band ligation to surgical hemorrhoidectomy may be appropriate.
The good news is that many hemorrhoid symptoms can be managed with simple daily habits. Staying hydrated, eating enough fiber and avoiding excessive straining can go a long way toward improving comfort and reducing flare-ups as the body ages.
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