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Self-help steps to get through hemorrhoid flare-ups

JUL 2013

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Half of us develop hemorrhoids in our lifetimes, but these easy remedies help to soothe while you heal.

Hemorrhoids are common and can be extremely painful and uncomfortable during occasional flare-ups. These swollen blood vessels on the outer rectum and anus can bleed and turn bowel movements into intensely painful experiences. But simple self-help measures can ease the ordeal of most hemorrhoids and allow healing. Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center, suggests some effective steps you can take to care for hemorrhoids—and when it's time to seek out a procedure to remove them.

Step up the fiber

Hemorrhoids come in two varieties. The internal type sprout from within the rectum. External hemorrhoids develop on the anus itself. Either way, passing stools by them may cause pain and bleeding.

The road to less painful bowel movements starts with the foods you consume. "The most important thing is to add fiber to your diet," Dr. Wolf says. This is best done with food, but some men may need to take a fiber supplement to get 20 to 30 grams of fiber per day.

Fiber draws water into stools, making them softer and easier to pass. This is helpful if you have hemorrhoids that protrude (prolapse) through the anus during a bowel movement. Research shows that increased fiber reduces bleeding.

To start, try a psyllium husk fiber supplement, such as Metamucil or a generic equivalent. In some men, psyllium causes gas or bloating. In that case, try a supplement containing wheat dextrin or methyl-
cellulose. Check the label on the brand or generic products you buy to find out which fiber source they contain.

Here is another tip that helps during flare-ups: mix a tablespoon of mineral oil with applesauce or yogurt and eat it at breakfast or lunch. "It allows the stool to slide by more easily, but don't take it for a long period," Dr. Wolf says. While taking mineral oil, consider placing a liner in your undergarments to absorb any oil leakage.

Internal vs external hemorrhoids

Normal anatomy & Hemorrhoids

Hemorrhoids develop when the channels that carry blood away from the anus and rectum become dilated (widened). They are classified according to their location. External hemorrhoids develop in the anus, internal hemorrhoids in the rectum. Many people have both.

Less strain, more gain

Prolonged sitting or straining, often associated with constipation or diarrhea, may lead to hemorrhoids. "By straining you are causing more hemorrhoids and creating more symptoms," Dr. Wolf says.

Don't delay bowel movements during hemorrhoid flare-ups. Go when you need to go, because putting off bowel movements can worsen constipation, which then aggravates the hemorrhoids.

Also, elevating your feet a bit with a step stool as you sit on the toilet changes the position of the rectum in a way that could allow for easier passage of stools.

Off-the-shelf remedies

Many over-the-counter products are available for hemorrhoids, such as witch hazel infused pads and soothing creams, like the iconic brand Preparation H and its generic equivalents. Also, ask your doctor about prescription preparations, which contain stronger anti-inflammatory drugs and numbing medications.

And don't forget sitz baths. They're done in a basin that fits under the toilet seat. Soak the inflamed area in warm water for 10 to 15 minutes, two to three times per day.

Some hemorrhoid sufferers use dietary supplements containing plant-based chemicals called flavonoids. A flavonoid preparation called Daflon is alleged to reduce hemorrhoid flare-ups and calm symptoms by shrinking the swollen tissues. There is preliminary evidence that it may work.

As with any dietary supplement, approach with caution. The evidence for Daflon is not conclusive, and remember that in the United States, dietary supplements are not regulated tightly for safety or quality.

Time for hemorrhoid removal?

Your doctor can tell you about medical procedures to remove or reduce hemorrhoids. You might consider these options if, despite all the ordinary measures, your hemorrhoids continue to bleed, start to bleed or hurt more, or begin to interfere with bowel movements. In the meantime, self-care will get most men through hemorrhoid flare-ups.