Haemorrhoids
Swollen blood vessels in and around the anus. Bright red bleeding, itch, a lump. Very common, very fixable, and usually down to straining. Softer stools solve most of it.
The haemorrhoids ladder
Most people fix this at the bottom of the ladder. Pun fully intended.
- Step 1 · Self-careFibre and waterAim for 25–30 g of fibre a day from food, or add psyllium, with plenty of water.
- Works
- Roughly halves ongoing symptoms and bleeding (Cochrane review of 7 trials)
- Cost
- Groceries; psyllium about $15–35 a tub
- How long
- Up to 6 weeks for full effect, then keep going
- Watch for
- Wind and bloating if you increase too fast.
Your bottom is only as happy as your stool is soft.
- Step 2 · Self-careBetter toilet habits and warm bathsGo when you feel the urge, don’t strain, feet on a footstool, warm water soaks for pain.
- Works
- Not well tested in trials; sensible, low-risk help for symptoms
- Cost
- Free; a footstool about $20–40
- How long
- Soaks of 10–15 minutes, 2–3 times a day while sore
- Watch for
- Long sessions on the toilet make it worse.
The toilet is not a reading room. Leave the phone outside.
- Step 3 · PharmacyCreams and suppositoriesWith a numbing agent or mild steroid, to ease itch and pain.
- Works
- Short-term relief in small trials (weak evidence); they don’t shrink haemorrhoids
- Cost
- About $10–25
- How long
- No more than a week at a time
- Watch for
- Steroid creams can thin the skin if overused. Skip codeine painkillers: they constipate.
A cream is a bandaid. The fibre is the fix.
- Step 4 · ProcedureClot removal (clotted external haemorrhoid)A sudden, very painful purple lump. A doctor can cut out the clot under local anaesthetic.
- Works
- If done in the first few days, symptoms settled in about 4 days vs about 3 weeks without it (one large case series)
- Cost
- Often bulk-billed at a GP; free in emergency
- How long
- Best within about 3 days of the lump appearing
- Watch for
- Bleeding for a day or two; keep it clean.
After day 3 or 4, it’s usually easier to let it settle.
- Step 5 · ProcedureRubber band ligationA tiny band on an internal haemorrhoid cuts off its blood supply so it drops off.
- Works
- About 5–6 in 10 still fixed at a year in a large UK trial, more with repeat banding; some come back
- Cost
- Free as a public patient; privately, typical out of pocket about $190 plus any hospital excess
- How long
- Minutes; sometimes 2–3 sessions
- Watch for
- Dull ache for a few days, a small bleed around day 7–10. Fever, heavy bleeding or can’t pass urine: urgent.
Sounds medieval. Quick in practice.
- Step 6 · SpecialistSurgery (haemorrhoidectomy)Removing large or persistent haemorrhoids.
- Works
- About 3 in 4 still fixed at 2 years: fewer come back than after stapling (1 in 4 vs 4 in 10)
- Cost
- Free as a public patient (waits vary); privately, median about $350 out of pocket plus hospital excess
- How long
- 2–4 weeks recovery
- Watch for
- Pain for 1–2 weeks, bleeding, trouble passing urine at first.
Fixes it best, hurts the most. Hence step 6.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Ring (donut) cushionsNo trials show they help haemorrhoids heal. A comfier seat at best, not a treatment.
- Flavonoid tablets (diosmin, hesperidin)Trials suggest a little less bleeding and itch, but they’re low quality and may overstate the benefit. Fibre is cheaper and proven.
- Laser haemorrhoid treatmentHeavily marketed, but studies are mostly small and short-term, and it often costs more than banding. Ask about banding first.
- Home remedies (vinegar, tea tree oil, toothpaste)No evidence, and they can sting and inflame already sore skin. Your bottom is not a science experiment.
What you can do
- Go when you feel the urge. Don’t strain or sit on the toilet scrolling your phone.
- Raise your knees on a footstool.
- Paracetamol for pain, and a stool softener if needed. Common in pregnancy: fibre and fluids first.
- If you’re 45 to 74, do the free bowel screening test every 2 years.
See your GP if
- Bleeding from the bottom that hasn’t been checked
- Blood is dark or mixed through the stool, or comes with a change in bowel habit, weight loss or tiredness
- No better after 2 weeks, or pain is severe (could be a fissure or abscess)
Go to the emergency department for heavy bleeding, feeling faint, or a hot, very painful lump with fever.
Common questions
How long do haemorrhoids last?
Most settle once stools are softer. A sudden, very painful purple lump (a clotted haemorrhoid) usually settles over 1 to 2 weeks. See your GP if you’re no better after 2 weeks.
Do haemorrhoid creams work?
Pharmacy creams and suppositories ease itch and pain in the short term, but don’t shrink haemorrhoids. Use them for no more than a week at a time. More fibre and water roughly halves bleeding.
Is bleeding from the bottom always haemorrhoids?
No. Get any bleeding checked, especially dark blood, blood mixed through the stool, or a change in bowel habit, weight loss or tiredness. If you’re 45 to 74, do the free bowel screening test every 2 years.
What is haemorrhoid banding?
A tiny rubber band is placed on an internal haemorrhoid to cut off its blood supply so it drops off. It’s a quick procedure for ongoing bleeding or prolapse.
What causes haemorrhoids?
Straining on the toilet, constipation, sitting on the toilet for a long time (scrolling on phones counts), pregnancy, heavy lifting and getting older. Sitting on cold or hard surfaces doesn’t cause them; that’s a myth.
What is a thrombosed haemorrhoid?
A blood clot in a haemorrhoid near the anus, causing a sudden, very painful, firm purple lump. Pain is worst in the first 2 to 3 days and settles over 1 to 2 weeks. If seen early, a doctor may remove the clot under local anaesthetic for quicker relief.
Can I push a haemorrhoid back in?
Yes, if it comes out after a poo, you can gently push it back with a clean, lubricated finger. If it won’t go back, is very painful or has turned dark, see a doctor.
Helpful resources
- Queensland Health: Are you pooing properly?How to sit on the toilet (knees up, lean forward) and stop straining. Free.
- National Continence HelplineFree, confidential advice from continence nurses on bowel problems. 1800 33 00 66, weekdays. Australia.
- Cancer Council: Bowel cancer screeningHow to get your free home test kit every 2 years from age 45 to 74. Australia.
Evidence and more information
- Healthdirect: Haemorrhoids
- Cochrane: Fibre for haemorrhoids
- AAFP: ASCRS haemorrhoid guidelines
- Compare the Market: Haemorrhoid procedure costs
- AAFP: Haemorrhoids (banding success, clot removal within 72 hours)
- Health Technology Assessment (2016): Banding vs artery ligation (HubBLe trial)
- NIHR: Stapled vs traditional haemorrhoid surgery (eTHoS trial)
- J Fam Pract: Which haemorrhoid treatments work best
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