Asking for a friend: What can you do about hemorrhoids?

They’re a common problem, but rarely mentioned in public: Hemorrhoids. After all, who wants to talk about itching and pain around their anus, or even bleeding or something protruding?

If you are experiencing bleeding from the rectum, you should talk to your doctor, said Falmouth gastroenterologist Joseph P. Cobb, MD.

“Rectal bleeding, that’s a red flag for the colon,” he said. This should be checked out to see if the bleeding is coming from hemorrhoids or something else, like cancer, Crohn’s disease or colitis, he said.

What Causes Hemorrhoids?

Hemorrhoids are veins around the anus and lining of the lower rectum that have become inflamed and swollen, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). They can form inside the body (internal hemorrhoids) or under the skin outside the anus (external hemorrhoids). They’re part of the tissue that senses if you have stool, diarrhea or gas to pass.

“All of us have it – we’re born with them,” Dr. Cobb said of hemorrhoidal tissue.

Chronic constipation, straining to poop, staying too long on the toilet and sitting for long periods of time can contribute to developing hemorrhoids. Chronic diarrhea, a sedentary lifestyle, a low-fiber diet and lifting heavy weights can also contribute to the condition, according to the National Library of Medicine.

Hemorrhoids are more common as you age, but age alone isn’t a cause, Dr. Cobb said. The problem is associated with certain jobs, such as driving a truck, and with pregnancy, he said.

“A baby in the uterus exerts pressure downward,” Dr. Cobb said. “Pregnant women get constipation from prenatal vitamins – the iron in them.”

You’re also at risk if you take other medications that cause constipation, including Ozempic and the other GLP-1 agonists used to treat diabetes and obesity.

How to Avoid Hemorrhoids

“In general, eat a high-fiber diet, definitely take stool softeners with prenatal vitamins and stay active, and drink water (about 2 liters a day),” Dr. Cobb said.

Water and other liquids work with fiber to help soften stool and move it through your lower intestines. Ironically, too much exercise – especially types that put pressure on the lower abdomen – can cause or exacerbate hemorrhoids.

An endurance athlete he knew years ago found he had flare-ups when training for marathons and ran more than 40 miles a week.

Dr. Cobb suggested this trick to make it easier to poop: Prop up your feet on a low stool or a couple of thick books.

“It changes the angle of the path of the stool; you don’t have to strain.”

Home Treatment and When to Seek Surgery

“The vast majority of folks don’t need surgical intervention,” Dr. Cobb said.

If you’re not experiencing rectal bleeding, first try over-the-counter creams, ointments, suppositories and pain relievers to reduce itch and discomfort. Soaking several times a day in a bath or sitz bath may help, according to the NIH.

The problem should resolve within a week for most cases. This includes most prolapsed internal hemorrhoids that protrude through the anus, says the NIDDK.

When to see a doctor?

“When they don’t go away,” Dr. Cobb said.

If you’re experiencing rectal bleeding, a doctor will probably want to do a colonoscopy to see if it’s coming from internal hemorrhoids or another condition. For other cases, a doctor may first do a digital exam. To get rid of an internal hemorrhoid that’s bleeding or prolapsed, a small rubber band may be placed around the inflamed vein, cutting off the blood supply. This shrinks the hemorrhoid, which dies and falls off.

The NIDDK lists other surgical treatments for internal hemorrhoids that also work by creating scar tissue to cut off blood supply. These might be done in a doctor’s office or clinic:

• Electrocoagulation: A tool sends electricity into the hemorrhoid.
• Infrared photocoagulation: A tool directs infrared light into the hemorrhoid.
• Sclerotherapy: A solution is injected into the hemorrhoid.

Surgeries done in a hospital or outpatient center include:

• Hemorrhoid stapling: A tool removes hemorrhoidal tissue and can push a prolapsed hemorrhoid back through the anus.
• Hemorrhoidectomy: Surgical removal of large or prolapsed hemorrhoids.

Once you have had hemorrhoids, they may recur, even after surgery. A September 2021 paper in ANZ Journal of Surgery looked at data from 1,958 patients who each had one of three techniques performed by the same surgeon between 2000 and 2015. By about 3.5 years after surgery, hemorrhoids recurred in 12 percent of patients. Most (73 percent) had rubber band ligation. The rest had hemorrhoidectomy (16 percent) or hemorrhoid stapling (11 percent).

If you have a concern about hemorrhoids, talk to your primary care provider about whether a referral to a gastroenterologist is needed.