A Working Checklist for Hemorrhoids
Hemorrhoids: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
Swollen blood vessels in and around the anus, sometimes called piles. They are very common and usually settle with simple measures, and the danger is assuming any rectal bleeding is them.
Key takeaways
- Typical symptoms: bright red bleeding on wiping, itching, discomfort, a lump
- Main contributor: straining and constipation
- Most useful single change: Treat constipation; it is the underlying cause for most people.
- Commonest mistake: Assuming all rectal bleeding is hemorrhoids.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Treat constipation; it is the underlying cause for most people
- Avoid straining and do not sit on the toilet for long periods
- Use a footstool to raise the knees above the hips
- Try a warm sitz bath and keep the area clean and dry
Do not
- Assuming all rectal bleeding is hemorrhoids
- Long-term use of steroid creams without advice
- Prolonged straining or scrolling on your phone on the toilet
The numbers behind the list
Those two lists follow from the published figures here.
| Measure | Figure |
|---|---|
| Typical symptoms | bright red bleeding on wiping, itching, discomfort, a lump |
| Main contributor | straining and constipation |
| First-line management | treat constipation, increase fiber and fluid |
| Over-the-counter creams | for symptom relief, short-term use |
| Persistent or heavy bleeding | always needs assessment |
If you change one thing
Treat constipation; it is the underlying cause for most people. It is first on the list above. If the rest feels like too much at once, start there and leave the others.
Related topics
- Colorectal Cancer: Sorting the Evidence From the Noise (Cancer Awareness)
- Severe Bleeding: What the Evidence Actually Says (Emergency Care)
- Bruising and Bleeding: Sorting the Evidence From the Noise (Blood Health)
- Swollen Ankles: What Published Guidance Supports (Foot Health)
Where to go next
- Starting Out With Hemorrhoids
- Your Questions About Hemorrhoids, Answered
- Hemorrhoids — the reference entry
- Digestive Health: The Complete Guide
- Food Intolerance: What the Evidence Actually Says
- What the Guidance Really Says About Probiotics
When to speak to a doctor
See your doctor for any rectal bleeding, particularly if it is dark, mixed with stool, persistent, or accompanied by a change in bowel habits, weight loss or abdominal pain — colorectal cancer can cause the same symptoms. Guidelines recommend colorectal cancer screening from age 45. Go to the emergency room or call 911 for heavy bleeding with dizziness or fainting, and seek prompt care for severe anal pain with a hard lump.
Where this comes from
- National Institute of Diabetes and Digestive and Kidney Diseases — Hemorrhoids
- US Preventive Services Task Force — Colorectal Cancer: Screening
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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