Best prevention for hemorrhoids

Causes and Risk Factors of Hemorrhoids

Hemorrhoids are swollen veins located in the anus and lower rectum. They can develop inside the rectum, or externally, under the skin around the anus. Hemorrhoids develop when the veins in these areas become stretched and bulge due to increased pressure.

One of the most common causes of hemorrhoids is constipation and straining during bowel movements. When you strain to pass hard stools, it puts extra pressure on the veins, causing them to swell and become irritated.

Pregnancy is another major risk factor, as the growing uterus puts pressure on the pelvic veins. The increase in the hormone progesterone during pregnancy can also relax the walls of veins, making them more likely to swell. Obesity, a sedentary lifestyle, and genetics can contribute to developing hemorrhoids as well.1

Some people may have conditions that cause weakened vein walls or connective tissue in the anal area. Certain inherited disorders, such as Ehlers-Danlos syndrome, can also increase the risk due to a lack of collagen.6

Diet is another important factor to consider. Studies have found that a diet low in fiber and high in unhealthy fats and carbohydrates can cause an imbalance in gut bacteria, which may increase the risk of hemorrhoids by causing constipation.7,8 Eating a high-fiber diet, on the other hand, helps soften stools and promotes regular bowel movements.

Lifestyle Changes for Hemorrhoid Prevention

Making simple adjustments to your daily habits can help prevent hemorrhoids or manage symptoms if they do occur. Here are some lifestyle changes to consider:

• Increase fiber intake: A high-fiber diet helps soften stools and promotes regular bowel movements. If you have trouble getting enough fiber from food, consider a supplement. Aim for 25-30 grams of fiber per day from fruits, vegetables, whole grains, and legumes.22,23 Fiber-rich foods include:
• berries
• pears
• apples
• broccoli
• Brussels sprouts
• peas
• oats
• barley
• brown rice
• lentils
• beans
• chickpeas
• nuts and seeds
• Stay hydrated: Drinking enough water and other fluids helps keep stools soft and prevents constipation. Aim for at least 8 glasses of water per day, and more if you exercise or live in a hot climate.18,20 Other hydrating fluids include fruit juices and clear soups. Staying well-hydrated helps the fiber in your diet work more effectively.
• Exercise regularly: Physical activity stimulates digestion and bowel function. Aim for at least 30 minutes of moderate exercise most days of the week.18,21 Walking, swimming, and yoga are all great options that can help improve circulation and digestion. However, avoid heavy lifting or straining exercises that raise abdominal pressure, as these may worsen hemorrhoids.
• Maintain a healthy weight: Excess body weight increases the risk of hemorrhoids by putting added pressure on the pelvic veins. Losing weight through a balanced diet and regular exercise can help improve symptoms and prevent future hemorrhoids.18,19 Studies have found that a higher waist-to-hip ratio is linked to a higher risk of hemorrhoids.38,39
• Practice proper bathroom habits: Try to avoid spending long periods of time on the toilet or straining during bowel movements. When you feel the urge to go, go. Raising your feet on a step stool while sitting on the toilet can help make bowel movements easier.17,18

These lifestyle changes can significantly reduce your risk of developing hemorrhoids. However, if hemorrhoids do develop, there are several over-the-counter treatments that can help.

Over-the-Counter Treatments for Hemorrhoids

For mild to moderate hemorrhoids, over-the-counter products can help improve symptoms like pain, itching, and swelling. Here are some options:

• Creams and ointments: Look for products with hydrocortisone, lidocaine, or witch hazel. These ingredients help reduce inflammation, numb pain, and soothe irritated skin.3,4 Hydrocortisone works by reducing inflammation, while lidocaine helps numb pain. Witch hazel can help shrink swollen tissues. Apply the product directly to the affected area up to 4 times daily.
• Medicated wipes: Pre-moistened wipes with witch hazel or aloe vera can provide cooling relief and gentle cleansing after bowel movements.5,6 These wipes are to be used instead of dry toilet paper, which can further irritate inflamed hemorrhoids. Look for alcohol-free types to avoid further irritation. Popular options include Tucks Medicated Pads and Preparation H Medicated Wipes.
• Suppositories: Some products come in suppository form, which are inserted into the rectum to deliver medication directly to the affected area. These may contain ingredients like hydrocortisone to reduce swelling.5,6 Suppositories can be helpful for internal hemorrhoids that are harder to treat with topical creams. Follow package instructions for proper use and dosing.
• Sitz baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help soothe discomfort and promote healing. You can use a bathtub or a special sitz bath that fits over the toilet.4,7 Epsom salts or baking soda in the water may provide more relief. Sitz baths increase blood flow to the area and can help lower inflammation.

While over-the-counter treatments can provide temporary relief, they do not cure hemorrhoids. If symptoms persist or worsen despite home treatment, visit your healthcare provider.

When to See a Doctor for Hemorrhoids

Many people feel embarrassed to talk about hemorrhoids, but it's important to seek medical care if you experience severe or persistent symptoms. Here are some signs that it's time to see a healthcare provider:

• Significant pain or discomfort that interferes with daily activities
• Bleeding from the rectum, especially if it's heavy or persistent
• Painful lumps or swelling around the anus that don't improve with home treatment
• Symptoms that persist for more than a week despite over-the-counter remedies

Your healthcare provider can diagnose hemorrhoids through a physical exam and recommend treatment. They may perform a rectal exam with their finger to feel for any swollen veins or abnormalities.28,29 In some cases, they may use an anoscope or proctoscope, small scopes with lights, to get a better look inside the anus and rectum.28,29

If the diagnosis is hemorrhoids, your healthcare provider can recommend treatment options, which may include in-office procedures like rubber band ligation, sclerotherapy, or coagulation therapy.8,9

• Rubber band ligation involves placing a small elastic band around the base of the hemorrhoid to cut off blood supply and cause it to shrink.11,12
• Sclerotherapy involves injecting a chemical solution into the hemorrhoid to make it shrink.
• Coagulation therapy uses heat or cold to destroy hemorrhoid tissue.8,9

In some cases, your healthcare provider may recommend a colonoscopy or other tests to rule out more serious conditions like colorectal cancer, especially if you have risk factors or experience unexplained changes in bowel habits.9,10

Early diagnosis and proper treatment can help prevent complications and make sure you get the appropriate care. Don't let embarrassment keep you from getting the care you need—hemorrhoids are very common and most treatments are relatively simple.

Surgical Options for Severe Hemorrhoids

When hemorrhoids are very large, come back frequently, or don't respond to other treatments, surgery may be recommended. Here are some common surgical procedures:

• Hemorrhoidectomy: This procedure surgically removes the hemorrhoid tissue. It can be done under local or general anesthesia and may have a recovery period of a few weeks.13,16 A hemorrhoidectomy is typically recommended for recurrent or advanced (grade III or IV) hemorrhoids or when other non-surgical treatments have failed.30 While effective, hemorrhoidectomy can be quite painful after the procedure.
• Stapled hemorrhoidopexy: Stapled hemorrhoidopexy removes a portion of the hemorrhoidal tissue and repositions the remaining tissue, cutting off the blood supply to the hemorrhoid.30,31 It may cause less postoperative pain and a quicker recovery compared to traditional hemorrhoidectomy.33,34
• Rubber band ligation: While often performed as an in-office procedure, rubber band ligation can also be done surgically for larger hemorrhoids. A small rubber band is placed around the base of the hemorrhoid, cutting off blood flow and causing it to shrink and fall off within a few days.15 Rubber band ligation is often effective for grade I-III hemorrhoids, but may need to be repeated to fully treat the condition.35

Other minimally invasive surgical options include sclerotherapy, infrared coagulation, and laser hemorrhoidoplasty. These procedures are typically less painful and have a faster recovery time than hemorrhoidectomy, but may be less effective long-term, especially for more advanced hemorrhoids.32

Recovery from hemorrhoid surgery can take several weeks and may cause significant discomfort, especially in the first few days. Pain management is important during this time, and your healthcare provider may prescribe pain medications or recommend warm sitz baths to help with discomfort.36,37

Complications are rare but can include pain, bleeding, infection, urinary retention, and anal stenosis (narrowing of the anus). Following your healthcare provider’s instructions for post-operative care, including managing pain, preventing constipation, and attending follow-up appointments, is important for a smooth recovery.

It's important to address any underlying causes of hemorrhoids, such as constipation or straining, to prevent it from coming back. The lifestyle changes discussed earlier can help you avoid future problems with hemorrhoids.

Conclusion

Hemorrhoids are a common but often uncomfortable condition that can significantly impact daily life. Fortunately, there are many ways to prevent and manage hemorrhoids through simple lifestyle changes and over-the-counter treatments.

Eating a high-fiber diet, staying hydrated, exercising regularly, and practicing proper bathroom habits can be helpful in preventing hemorrhoids from developing in the first place. If hemorrhoids do occur, topical creams, medicated wipes, and sitz baths can provide relief for mild to moderate cases.

For severe or persistent hemorrhoids, it's important to seek medical care. Your healthcare provider can recommend appropriate treatments, including in-office procedures or surgery if needed. Don't let embarrassment keep you from getting the care you need - hemorrhoids are very common and most treatments are relatively simple.

Citations:

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