What to do about haemorrhoids

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Some women have a passing encounter with haemorrhoids during pregnancy.

If there's evidence of rectal bleeding or blood in the stool, a sigmoidoscopy or colonoscopy may be recommended to rule out conditions such as colorectal polyps or cancer, especially in people over age 50.

For purposes of determining the best treatment, internal haemorrhoids are often classified according to the degree of protrusion into the anal canal. First-degree haemorrhoids don't protrude, and they may or may not bleed; second-degree haemorrhoids protrude with defecation and retract on their own; third-degree haemorrhoids protrude and must be manually reduced (pushed back into their normal position); and fourth-degree haemorrhoids protrude and cannot be reduced.

Conservative treatment

Most haemorrhoid symptoms improve dramatically with simple measures. Here are some things to try:

Add fibre: Boost the fibre in your diet with either high-fibre foods or a fibre supplement or both. When taken with adequate fluid, fibre softens stools and makes them easier to pass, reducing pressure on haemorrhoids and the resulting risk of bleeding, inflammation, and swelling.

High-fibre foods include prunes, dates, apples, pears, strawberries, broccoli, Brussels sprouts, carrots, peas, spinach, legumes (for example, baked beans or kidney beans), bran cereals, and oatmeal.

Fibre supplements include psyllium (Metamucil, Konsyl, Perdiem), methylcellulose (Citrucel), calcium polycarbophil (FibreCon, Fibre-Lax, Mitrolan), and wheat dextrin (Benefibre). Fibre can cause bloating or gas, so start slowly, and gradually increase your intake to 25 to 30 grams of fibre per day. Increase your fluid intake at the same time.

Exercise: You can stimulate bowel function with moderate aerobic exercise, such as brisk walking 20 to 30 minutes a day.

Establish a regular bowel habit: When you feel the urge, go to the bathroom immediately; don't wait for a more convenient time. Stool can back up, leading to increased pressure and straining. Also, schedule a time each day, perhaps just after a meal, to sit on the toilet for a few minutes.

Sit in a sitz: You can often relieve itching, irritation, and spasm of the sphincter muscle with a warm water bath for the buttocks (sitz bath). Sit in a regular bathtub with a few inches of warm water, or go to a pharmacy and buy a small plastic tub that fits over a toilet seat.

Try a 20-minute sitz bath after each bowel movement and an additional two or three times a day. Afterward, gently pat the anal area dry; don't rub or wipe hard. You can also dry the area with a hair dryer on a cool setting.

Try something topical: Over-the-counter analgesic creams can temporarily soothe pain, irritation, and itching. Creams and suppositories containing hydrocortisone are also effective, but don't use them for more than a week at a time, because they can cause the skin to get too thin (atrophy). Witch hazel wipes (Tucks) are soothing and have no harmful effects.

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