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 plenty of fluids, and 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 fibers such as psyllium husk can reduce the frequency of bleeding. Whether or not they relieve other symptoms too hasn’t been well studied. People who use psyllium husk must make sure that they drink enough fluids. But fiber can also cause diarrhea, which in turn leads to hemorrhoids being irritated even more by frequent bowel movements.

What role does hygiene play?

Stool 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 drying the anus afterwards. This can help avoid wiping yourself too roughly and making the symptoms worse.

Exaggerated hygiene can make symptoms worse too, though. Many people use things like liquid soaps and alcohol-based or perfumed wipes. But these often 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 clear water. It’s also possible to add an anti-inflammatory substance to the water – such as chamomile, witch hazel, arnica, oak bark or tea tree oil. There isn't enough research on whether this helps. Some of the added substances may irritate or discolor the skin. It’s best to avoid using soap because it can aggravate the sensitive skin of the anus.

What creams can be used?

Anti-inflammatory creams and pastes containing ingredients like zinc and panthenol, or herbal substances like witch hazel and aloe vera, are often recommended for the treatment of hemorrhoids. These aim to relieve skin irritations and itching.

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

Are suppositories an option?

Some drugs can also be used in the form of normal suppositories, or suppositories with gauze inserts (“anal tampons”). These are inserted into the anus, where they stay and release the drug – unlike “normal” suppositories that release the drug further up the bowel. It's not clear whether suppositories can relieve the symptoms of enlarged hemorrhoids.

Sources

• Abramowitz L, Weyandt GH, Havlickova B, Matsuda Y, Didelot JM, Rothhaar A 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, Johanson JF, Lopez-Yarto M, Mills E 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, Doust J. Aloe vera for treating acute and chronic wounds. Cochrane Database Syst Rev 2012; (2): CD008762. [PMC free article: PMC9943919] [PubMed: 22336851]
• 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. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.