Does Massage Help Hemorrhoids? What to Do Instead

No clinical evidence supports massaging hemorrhoids directly, and doing so can irritate or worsen the swollen tissue. Hemorrhoids are engorged vascular cushions with weakened connective-tissue support, not tight muscles that benefit from manual pressure. The confusion likely stems from the fact that abdominal massage can help with constipation, which is a major driver of hemorrhoid symptoms. That indirect connection is real, but it is very different from rubbing the affected area itself. Effective treatments range from simple dietary changes to office procedures, and most people improve without surgery.

Why Massage Does Not Address the Underlying Problem

Hemorrhoids develop when the blood vessels and connective tissue in the anal cushions become abnormally dilated and weakened. The cushions themselves are normal anatomy: everyone has them, and they help with fine continence control. Problems start when increased pressure, straining, or other factors cause those vessels to swell and the surrounding tissue to stretch and deteriorate.¹ Internal hemorrhoids, located above the dentate line inside the anal canal, tend to bleed and prolapse. External hemorrhoids sit below that line and can become acutely painful when a blood clot forms inside them.²

Massage therapy works well on musculoskeletal problems because it targets muscles, fascia, and soft tissue that respond to pressure by releasing tension and improving blood flow. Hemorrhoidal tissue is a different beast entirely: it is already engorged with blood, often inflamed, and held together by weakened connective tissue. Applying direct pressure to a swollen hemorrhoid risks further irritation, increased swelling, and potentially disrupting a clot in a thrombosed external hemorrhoid. There is no peer-reviewed research showing that direct perineal or perianal massage improves hemorrhoid symptoms.

The Constipation Connection and Abdominal Massage

Where massage does enter the picture is through the gut. Constipation and hard stools force people to strain during bowel movements, and that straining is one of the primary drivers of hemorrhoid development and flare-ups. A systematic review and meta-analysis found that functional constipation and dyssynergic defecation are significantly more common in people with hemorrhoids than in controls, and that treating constipation may reduce hemorrhoid recurrence.³ Anything that reliably eases constipation can, in turn, take pressure off hemorrhoidal tissue.

Abdominal massage is one such tool. A narrative review of the available literature concluded that abdominal massage effectively reduces the severity of constipation in adults, including elderly populations.⁴ A randomized trial in hospitalized elderly patients confirmed that abdominal massage improved stool consistency and reduced constipation severity.⁵ The technique typically involves gentle clockwise circular movements over the abdomen, following the path of the colon. It stimulates peristalsis, the wave-like muscle contractions that move stool along.

A related approach, perineal self-acupressure (pressing on the perineum, the area between the genitals and anus), has also shown promise for constipation. In a randomized controlled trial, participants who used this technique experienced significantly better quality-of-life scores related to constipation and improved bowel function compared to controls.⁶ This is not the same as massaging a hemorrhoid; it targets a different structure for a different purpose. But by making bowel movements easier and reducing straining, these approaches address one of the root causes of hemorrhoid symptoms.

Dietary Fiber and Sitz Baths

If you have hemorrhoids and are looking for what actually works, fiber is the single most studied conservative treatment. A meta-analysis of seven randomized trials found that fiber supplementation cut the risk of persistent symptoms by about half and reduced the risk of bleeding by a similar margin, with benefits holding steady at six weeks and three months.⁷ Both soluble fiber supplements (like psyllium husk) and dietary fiber from whole grains, fruits, and vegetables contribute. The goal is softer, bulkier stools that pass without straining. Adequate fluid intake alongside the fiber matters: fiber without enough water can actually make constipation worse.⁸

Sitz baths, where you sit in a few inches of warm water for ten to fifteen minutes, are another mainstay. Nearly every clinical guideline recommends them, though the direct evidence base is thinner than you might expect. Researchers who reviewed the literature on sitz baths found that the proposed mechanism involves relaxation of the internal anal sphincter muscle, which can relieve pain and discomfort from both internal and external hemorrhoids.⁹ The practice is low-risk and inexpensive. Most people use plain warm water, though some add Epsom salts. Two to three baths a day during a flare-up is a common recommendation.

Toilet Habits and Lifestyle Changes

How you sit on the toilet and how long you spend there turn out to matter quite a bit. A study examining smartphone use on the toilet found that prolonged toilet sitting may be a stronger predictor of hemorrhoids than straining alone. The researchers proposed that sitting on a standard toilet seat, which provides no support to the pelvic floor, disproportionately increases pressure on the hemorrhoidal cushions the longer you sit there.¹⁰ The practical takeaway is simple: leave the phone outside the bathroom. Sit down, do what you need to do, and get up. Five minutes is a reasonable upper limit.

Your posture on the toilet also makes a difference. Squatting straightens the anorectal angle, which makes the rectum empty more easily with less straining. A study on defecation posture modification devices, essentially a small footstool that elevates your knees while you sit on a Western toilet, found that using one mimicked the benefits of squatting: participants reported more complete emptying, less straining, and shorter time on the toilet.¹¹ For someone with hemorrhoids, less straining means less pressure on already vulnerable tissue. A seven-inch stool under your feet costs very little and can make a noticeable difference.

Moderate physical activity also helps by keeping the digestive system moving. Walking, swimming, and other low-impact exercise promote regular bowel function. Heavy lifting with breath-holding (the Valsalva maneuver) is one exercise pattern that can spike intra-abdominal pressure and aggravate hemorrhoids, so people with active symptoms may want to modify their lifting technique or temporarily lighten the load.

Topical Treatments and Oral Medications

Over-the-counter creams, ointments, and suppositories are often the first thing people reach for, and they can provide meaningful symptom relief even though they do not fix the underlying vascular problem. Most contain a combination of a local anesthetic (like lidocaine or pramoxine), a vasoconstrictor (like phenylephrine), and sometimes a low-dose corticosteroid to reduce inflammation. A large retrospective study of a hydrocortisone-containing ointment prescribed to 578 patients with hemorrhoids found no adverse reactions across the group, with a median prescription duration of about 20 days.¹² The caveat with steroid-containing products is that prolonged use beyond a few weeks can thin the perianal skin, so they are best used in short courses during flare-ups.

An oral option that gets less attention outside of Europe is micronized purified flavonoid fraction, a plant-derived compound that strengthens vein walls and reduces capillary fragility. A systematic review and meta-analysis found that it significantly reduced bleeding, discharge, and overall symptom burden in hemorrhoid patients. The odds of improvement were roughly five times higher in the treatment group compared to controls.¹³ Additional evidence suggests it can also reduce pain, bleeding duration, and the need for pain medication after hemorrhoid surgery.¹⁴ It is available over the counter in many countries under various brand names.

Herbal remedies represent another avenue people explore. A comprehensive literature review found that witch hazel, horse chestnut, and triphala (an Ayurvedic formulation) have shown beneficial effects on hemorrhoid-related pain, bleeding, and swelling in clinical studies.¹⁵ Witch hazel pads, in particular, are widely available and commonly used as topical astringents. The evidence for herbal approaches is generally less robust than for fiber or flavonoids, but they represent reasonable complementary options for mild symptoms.

When Hemorrhoids Need a Procedure

If conservative measures fail after several weeks or your hemorrhoids are more advanced (significant prolapse, persistent bleeding, or recurring thrombosis), office-based and surgical procedures become relevant. Rubber band ligation is the most common office treatment for internal hemorrhoids. A doctor places a small rubber band at the base of the hemorrhoid, cutting off its blood supply so it shrivels and falls off within a week or so. In a study of 100 patients, the overall success rate was 89%, with a significant improvement in quality-of-life scores within the first month that was maintained through six months. About three-quarters of patients reported high satisfaction.¹⁶

Rubber band ligation is not without complications, though serious ones are rare. A large long-term follow-up study found a roughly 70% success rate (excluding patients lost to follow-up), with bleeding occurring in about 3% of treatment sessions and thrombosed external hemorrhoids in about 1.5%.¹⁷ Mild pain is the most common side effect. More serious complications, including severe bleeding and pelvic infection, are uncommon but documented, particularly in patients taking blood thinners.¹⁸

For the most severe cases, surgical hemorrhoidectomy remains the gold standard. Newer combined techniques, such as pairing a traditional excision with Doppler-guided ligation of the feeding arteries, aim to reduce blood loss and postoperative pain. One comparative study found that the combined approach cut intraoperative blood loss in half and reduced the number of days patients needed pain medication, though return to normal activities took somewhat longer.¹⁹ Surgery is generally reserved for grade III and IV hemorrhoids that do not respond to banding, or for acutely complicated cases.

The Role of Stress and Pelvic Floor Tension

One dimension of hemorrhoid management that often goes overlooked is the role of stress and pelvic floor muscle coordination. Mental stress measurably increases anal canal pressure. In a study of both healthy and constipated women, performing a stressful mental task raised anal pressure significantly in both groups, while a relaxation period lowered it in the constipated participants.²⁰ Chronically elevated anal resting pressure contributes to the same vascular congestion that drives hemorrhoid symptoms. This is one reason why people notice hemorrhoid flare-ups during periods of high stress, even when their diet and bowel habits haven’t changed.

Dyssynergic defecation, a condition where the pelvic floor muscles contract rather than relax when you try to have a bowel movement, is particularly relevant. As noted earlier, it is more common in people with hemorrhoids, and the paradoxical muscle contractions create exactly the kind of high-pressure straining that damages anal cushions.³ If standard fiber and lifestyle changes are not resolving your constipation, pelvic floor physical therapy and biofeedback training can retrain those muscles. This is the one context where a specialized form of manual therapy intersects with hemorrhoid management, though it targets the pelvic floor muscles rather than the hemorrhoids themselves.

Hemorrhoids During Pregnancy

Pregnancy creates a perfect storm for hemorrhoid development. The growing uterus increases abdominal pressure and compresses the veins that drain the rectal area, leading to blood pooling and vascular dilation. On top of that, circulating blood volume increases by roughly a quarter to 40% during pregnancy, further engorging the pelvic veins.²¹ Hormonal changes that relax smooth muscle can also slow gut motility, worsening constipation. The combination means many pregnant people develop hemorrhoids for the first time or see existing ones flare dramatically, especially in the second half of pregnancy and after vaginal delivery.

Treatment options during pregnancy are more limited because of medication safety concerns. Fiber supplementation, adequate fluids, sitz baths, and gentle topical treatments (witch hazel pads, for example) form the core approach. Most pregnancy-related hemorrhoids improve substantially in the weeks after delivery as the mechanical and hormonal factors resolve. If symptoms persist beyond the postpartum period, the full range of treatments discussed earlier becomes available.

When Rectal Bleeding Needs More Than Home Treatment

One important caveat in any discussion of hemorrhoid self-care: rectal bleeding should never be automatically attributed to hemorrhoids without proper evaluation. The American Society of Colon and Rectal Surgeons guidelines emphasize that while hemorrhoids are the most common cause of blood in the stool, other conditions, including colorectal cancer, inflammatory bowel disease, and diverticular disease, can produce identical symptoms. Bleeding attributed to hemorrhoids represents the most commonly missed opportunity to diagnose colorectal cancer early.²² If you have bleeding that does not resolve with hemorrhoid treatment, new abdominal symptoms, a family history of colorectal cancer, or you are over 45 and have not had a colonoscopy, getting evaluated is essential. Hemorrhoids are common and usually benign, but ruling out something more serious is always worth the visit.