Hemorrhoids—clumps of swollen veins in or just outside the anal canal, which may cause discomfort along with bleeding during bowel movements—have long been the subject of jokes, but to millions of us they offer little reason for humor.

Up to 75 percent of all Americans may develop hemorrhoids at some point in their lives, usually between the ages of 45 and 65. The likelihood is a bit higher in women, in part because hemorrhoids are common during pregnancy.

Experts aren’t sure what really triggers the development of hemorrhoids, but inflammation and breakdown of the tissue in anal cushions—pads of thickened tissue that protect the anal canal—are involved. And long-standing constipation, straining to have a bowel movement, sitting on the toilet for a long time, and a low-fiber diet may make exacerbate the problem.

Self Care for Hemorrhoids

If you have hemorrhoids, your first step might be an over-the-counter hemorrhoid relief product such as a cream or ointment, found on drugstore shelves. But these haven’t been proven effective in clinical trials: they won’t shrink your hemorrhoids, stop bleeding, or reverse what’s called prolapse (when hemorrhoids protrude from the anus). In fact, they can increase irritation by making your skin more sensitive. For that reason, hemorrhoid creams shouldn’t be used for more than a week.

Instead, you might want to try some self-care strategies. A 10-minute “sitz bath” two to three times a day will soothe irritation and relax the internal sphincter muscle. Run a few inches of warm water in your bathtub or use a small sitting tub, available at pharmacies and big-box stores. Keeping stools soft and easier to pass also helps; laboring to have a bowel movement exerts extra pressure on anal cushions. And aim to keep yourself as regular as possible: exercise consistently, drink six to eight glasses of water a day, and consume plenty of fiber-rich vegetables, fruit, beans, and whole grains. Adding a fiber supplement containing psyllium or unprocessed bran may also help in both keeping you regular and preventing the return of your hemorrhoids once they’re under control. And don’t linger on the toilet—it can make things worse even if you’re not actively pushing to have a bowel movement. Do your reading elsewhere.  

When to See a Doctor for Hemorrhoids

If your hemorrhoids haven’t responded to self-care steps within two weeks, see your doctor. Your problem could be something else, such as an abscess (pus that collects near the anus) or fissure (a tear in the tissue lining the anus). If you’re also experiencing bleeding or you’re age 50 or older and have never had a colonoscopy, your doctor may order one to rule out the possibility of cancer or inflammatory bowel disease.

You may want to ask for a referral to a colorectal surgeon, who can discuss whether you might benefit from an in-office procedure. For internal hemorrhoids, for example, your doctor may use infrared light to shrink hemorrhoids or rubber band ligation, where an elastic band is wrapped around hemorrhoids so they shrivel up.