What role do toilet habits play?

Straining during a bowel movement can be painful and make hemorrhoid problems worse. But you can avoid straining by

• preventing constipation, because hard stools automatically make you push harder;
• paying attention to your body’s signals, such as the urge to go to the toilet – waiting too long before you go can lead to constipation;
• being relaxed and taking your time when you go to the toilet.

How can you prevent constipation?

To avoid constipation and straining during bowel movements, people are often advised to change their diet, drink enough fluids (1.5 to 2 liters per day), and regularly get enough exercise. High-fiber foods like fruits, cereals, vegetables and legumes are generally recommended to try to make stools softer.

Studies suggest that plant products with fibers such as psyllium husk can reduce the frequency of bleeding. There is a lack of good research on whether or not they relieve other symptoms too. People who use psyllium husk must make sure that they drink enough fluids.

What role does hygiene play?

Moisture that is left behind after wiping can aggravate enlarged hemorrhoids even more. So it’s important to carefully cleanse the anus after going to the toilet, for example by wetting toilet paper with water first, and then using dry toilet paper to dry it off. This can help avoid wiping yourself too roughly and making the symptoms worse.

But cleaning too much can also make the symptoms worse. Many people use things like liquid soaps and wet wipes. But these may contain substances that can irritate the skin and lead to allergic reactions.

Is bathing helpful or harmful?

When bathing to treat hemorrhoids, people usually sit in shallow clear water. If you like, you can add something else to the water – such as chamomile, witch hazel, arnica, oak bark or tea tree oil. These are available from pharmacies and drug stores without a prescription. There isn't enough research on whether bathing the area in this way helps, though. Some of the added substances may irritate or discolor your skin. It is best to avoid using soaps or bath lotions because they can aggravate the sensitive skin around the anus.

What creams can be used?

Creams and pastes containing ingredients like zinc, panthenol or herbal substances like witch hazel or aloe vera are often recommended for the treatment of hemorrhoids. They are available from pharmacies and drug stores.

Some doctors also prescribe creams to numb the skin locally, for example with the drug lidocaine. Steroid creams are sometimes used to reduce the inflammation too. These kinds of creams are prescription-only, and should only be used for a limited amount of time.

All of these creams are used to temporarily relieve acute symptoms like skin irritation and itching.

Are suppositories an option?

Some medications can also be applied in the form of normal suppositories or suppositories with gauze inserts (“anal tampons”). They are available from pharmacies. Anal tampons are inserted into the anus, where they are left for some time. They are removed once they have released the medication. There is no good-quality research on whether suppositories or anal tampons can relieve the symptoms of hemorrhoids.

Sources

• Abramowitz L, Weyandt GH, Havlickova B et al. The diagnosis and management of haemorrhoidal disease from a global perspective. Aliment Pharmacol Ther 2010; 31 (Suppl 1): 1-58. [PubMed: 20500735]
• Alonso-Coello P, Guyatt GH, Heels-Ansdell D et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 2005; (4): CD004649. [PMC free article: PMC9036624] [PubMed: 16235372]
• Dat AD, Poon F, Pham KB et al. Aloe vera for treating acute and chronic wounds. Cochrane Database Syst Rev 2012; (2): CD008762. [PMC free article: PMC9943919] [PubMed: 22336851]
• Deutsche Gesellschaft für Koloproktologie (DGK). Hämorrhoidalleiden (S3-Leitlinie). AWMF-Registernr.: 081-007. 2019.
• Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. Am Fam Physician 2011; 84(2): 204-210. [PubMed: 21766771]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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