DEAR DOCTOR K: What can I do to ease the discomfort of hemorrhoids?
DEAR READER: Hemorrhoids are quite common, and they’re not a “serious” medical problem. But, figuratively and literally, they’re a real pain in the butt. Hemorrhoids develop when veins in the anus and rectum swell and widen. (I’ve put an illustration on my website, AskDoctorK.com.) They can be extremely painful and uncomfortable, causing bleeding and painful bowel movements. There are surgical treatments that can help when you have recurrent, painful flare-ups of hemorrhoids.
However, most of the time, simple self-help measures can ease the discomfort and allow healing. Hemorrhoids often are linked to constipation. When a person is constipated, stool piles up in the rectum and hardens. This can press on the veins that are returning blood from the rectum to the rest of the body. As a result, blood builds up in the veins, causing them to stretch. So the treatments for hemorrhoids often are treatments for constipation, as well.
I spoke to my colleague Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. She suggested some effective steps you can take to help relieve a hemorrhoid flare-up:
• STEP UP THE FIBER. Fiber draws water into stools, making them softer and easier to pass. Increasing fiber also reduces bleeding. Increase high-fiber foods (fruits, vegetables, whole grains) in your diet. Consider taking a psyllium husk fiber supplement, such as Metamucil. If psyllium causes gas or bloating, try a supplement containing wheat dextrin or methyl-cellulose. Aim to get 25 grams (women) to 38 grams (men) of fiber a day.
• TRY MINERAL OIL. Mix 1 tablespoon of mineral oil with applesauce or yogurt and eat it at breakfast or lunch. This allows the stool to slide by more easily.
• WHEN YOU HAVE TO GO, GO. Don’t delay bowel movements. Putting them off can worsen constipation, which then aggravates the hemorrhoids. Also, as you sit on the toilet, elevate your feet a bit with a step-stool. Doing so changes the position of the rectum in a way that could allow stools to pass more easily.
• SOAK IN SITZ. Sitz baths are warm, shallow baths done in a basin that fits under the toilet seat. Take sitz baths three or four times a day, for 15-20 minutes each. The water will keep the area clean, and the warmth will reduce inflammation and discomfort. Dry the rectal area thoroughly after each bath.
• SOOTHE YOURSELF. Apply a cold compress or icepack to the anal area. Or try a cool cotton pad soaked in witch hazel. Many over-the-counter hemorrhoid products, like the iconic brand Preparation H soothing cream, are available.
You can also ask your doctor about prescription preparations, which contain stronger anti-inflammatory drugs and numbing medications. If, despite all of these measures, your hemorrhoids start to bleed, continue to bleed or hurt more, or begin to interfere with bowel movements, talk to your doctor. He or she can tell you about procedures to remove or reduce hemorrhoids.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115