Haemorrhoids: self-care, and when to see a doctor

Haemorrhoids are very common and rarely talked about. The result is that most people put up with them for a long time, buy something over the counter, and only come in when they are very uncomfortable. This article covers two things: what you can do yourself, and when you should stop managing it alone.

Haemorrhoids are not a growth

First, a common misunderstanding. There is normally a ring of cushions made of blood vessels and connective tissue inside the anus. They help with bowel control and prevent leakage — they are normal anatomy, and everyone has them.

What we call haemorrhoids are those cushions becoming congested, swollen and slipping downwards under long-term pressure, until they cause symptoms. So the aim of treatment is not to "clear them out" but to bring the symptoms under control. That is why most people never need an operation.

What makes them worse

The common factor is sustained pressure on the anus:

• Constipation and straining.
• Sitting on the toilet too long — especially common now that people take their phones in with them. Fifteen or twenty minutes of sitting keeps the area congested.
• Long periods of sitting or standing.
• Chronic diarrhoea.
• Pregnancy and childbirth.
• Obesity and regularly lifting heavy loads.

What you can do

These sound ordinary, but they really are first-line treatment and they are supported by evidence. Done properly, most people's symptoms improve noticeably.

• More dietary fibre and fluid. Stool that is soft and formed but not hard removes the need to strain. Of everything here, this has the clearest effect.
• Do not linger on the toilet. If nothing comes, get up and go back when you feel the urge. Leave the phone outside.
• Go when you need to. Holding on makes the stool drier and harder.
• Warm sitz baths. During a flare-up, ten minutes or so in warm water eases discomfort and relaxes the muscle.
• Clean gently afterwards. Rinse with water or dab with a damp wipe rather than rubbing hard.
• Keep moderately active and avoid long periods of sitting.

About creams and suppositories

Creams and suppositories, whether bought or prescribed, relieve symptoms, but they treat the discomfort rather than the cause. Short-term use is reasonable; relying on them long-term means it is time to be seen. Steroid-containing products in particular are not for long-term use.

When surgery is needed

The general rule: mild symptoms are managed conservatively; surgery is considered when prolapse is severe, repeated bleeding affects daily life, or conservative treatment has not worked. Your doctor judges this from both the grade of the haemorrhoids and how much they trouble you. Having haemorrhoids does not mean needing an operation.

There are also outpatient procedures that sit between conservative treatment and conventional surgery, which suit some patients. Ask in clinic which options apply to you.

At the appointment a digital rectal examination will be needed, with anoscopy or colonoscopy arranged if necessary. It is quicker than most people imagine and less awkward than they fear — this is what we do every day. Setting embarrassment aside is the most effective thing you can do for yourself.