Haemorrhoids
Swollen blood vessels in and around the anus. Very common, especially with constipation, straining and pregnancy. They can cause bright red bleeding, itch, a lump or discomfort. Most settle with softer stools.
Treatment options
Ratings show how strong the research is.
- Strong evidenceRubber band ligationA tiny band on an internal haemorrhoid cuts off its blood supply so it drops off. A quick procedure for ongoing bleeding or prolapse.
- Strong evidenceSurgeryFor large or persistent haemorrhoids. Most effective long-term, but recovery is more painful.
- Moderate evidenceFibre and waterAim for 25 to 30 g of fibre a day from fruit, vegetables, legumes and wholegrains, or a supplement such as psyllium. Roughly halves bleeding.
- Limited evidenceHaemorrhoid creams and suppositoriesPharmacy products with a numbing agent or mild steroid ease itch and pain short-term. Use for no more than a week at a time.
- Limited evidenceWarm bathsSit in warm water for 10 to 15 minutes, 2 to 3 times a day, to ease pain.
- Limited evidenceClot removalA sudden, very painful purple lump is a clotted external haemorrhoid. It settles over 1 to 2 weeks, or a doctor can remove the clot in the first few days.
- Not recommendedCodeine painkillersCause constipation and make haemorrhoids worse.
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.
- If you’re 45 to 74, do the free bowel screening test every 2 years.
See your GP if
- You notice 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.
Evidence and more information
maladywise.com/haemorrhoids/