Hemorrhoids are a common condition where the veins in the lower rectum and anus become swollen and inflamed. They can be located internally within the rectum or externally under the skin around the anus. Hemorrhoids are highly prone to recurrence if the underlying contributing factors are not permanently addressed. While temporary relief from creams or suppositories is possible, preventing the issue from returning requires lasting behavioral and dietary changes.
Why Hemorrhoids Are Prone to Returning
The primary reason hemorrhoids often return is that the high-pressure environment that caused them initially is typically not resolved. Hemorrhoids develop when veins in the anal area stretch under increased pressure, causing them to bulge or swell. The most frequent trigger for this pressure is chronic or intermittent straining during bowel movements, which directly stresses the rectal blood vessels.
This straining is often a result of chronic constipation, where hard stools require excessive force to pass, or chronic diarrhea, which causes repeated irritation and inflammation. Prolonged sitting on the toilet is also a major contributing factor because gravity causes blood to pool in the anal veins, significantly increasing pressure. Spending too much time sitting restricts blood flow and stretches the delicate anal cushion tissue.
Once the anal cushions—the normal tissue that helps seal the anus—have been stretched or damaged, they are structurally weaker and more susceptible to future swelling and displacement. Other activities that increase abdominal pressure, such as regularly lifting heavy objects, being overweight, or pregnancy, also make recurrence more likely. If these lifestyle and physical factors remain unchanged after the initial symptoms subside, the conditions for a flare-up simply re-establish themselves.
Essential Strategies for Preventing Recurrence
Preventing the return of hemorrhoids centers on maintaining soft, easy-to-pass stools and minimizing pressure on the anal region. Increasing dietary fiber intake is foundational, as fiber adds bulk to the stool and makes it easier to pass, avoiding the need to strain. Adults should aim for approximately 25 to 30 grams of fiber per day, sourcing it from a mix of fruits, vegetables, whole grains, and legumes.
To allow fiber to work effectively, adequate hydration is necessary, with a goal of drinking at least eight glasses of water and other non-alcoholic liquids daily. Water allows the fiber to absorb moisture, creating a softer stool mass that moves smoothly through the colon. Fiber intake should be increased gradually to avoid uncomfortable side effects like gas and bloating.
Modifying bathroom habits is equally important for long-term prevention. When the urge to have a bowel movement arises, it should not be delayed, as putting it off can cause the stool to become harder. Time spent sitting on the toilet should be limited to only a few minutes, specifically avoiding reading or using a phone. Using a footstool to elevate the knees can also help by changing the angle of the rectum, which may facilitate easier passage of stool.
Regular, moderate physical activity promotes healthy bowel function and helps prevent constipation. Exercise also assists in weight management, and reducing excess weight decreases the abdominal pressure that contributes to hemorrhoid formation. For individuals whose jobs require long periods of sitting, taking short breaks every hour to stand or walk is recommended to relieve pressure on the anal veins.
When to Seek Advanced Medical Treatment
While lifestyle adjustments are the first line of defense, a medical professional should be consulted if symptoms are severe, persistent, or fail to respond to these changes. Signs that necessitate a doctor’s visit include persistent bleeding, which can occasionally lead to anemia, severe pain, or a hemorrhoid that remains prolapsed (protruding). A physician can confirm the diagnosis and rule out other serious conditions that may present with similar symptoms.
For recurring or advanced internal hemorrhoids, several minimally invasive, non-surgical procedures are available in an outpatient setting. Rubber band ligation, one of the most common treatments, involves placing a small elastic band around the base of the hemorrhoid to cut off its blood supply. This causes the hemorrhoid to shrink and fall off within about a week. Sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue, which causes it to shrivel and form scar tissue.
Another option is coagulation, which uses heat from laser or infrared light to cause small, internal hemorrhoids to harden and collapse. For large, Grade IV, or severely recurrent hemorrhoids that have not responded to other treatments, a surgical hemorrhoidectomy may be recommended. This procedure, which involves the complete removal of the hemorrhoidal tissue, is considered the most effective option for preventing long-term recurrence in severe cases.