There is no clinical evidence that massaging hemorrhoids helps them heal, and in most cases applying pressure to inflamed hemorrhoidal tissue risks making the swelling, pain, and bleeding worse. The idea circulates on wellness forums and social media, but it does not appear in any medical guideline or peer-reviewed treatment study. Hemorrhoids are engorged vascular cushions, not knotted muscles, and the logic that works for a sore shoulder does not transfer to swollen anal tissue.
Why Massaging Swollen Vascular Tissue Is a Bad Idea
Hemorrhoids develop when the normal cushions of blood vessels inside and around the anal canal become abnormally dilated and displaced. The underlying problem involves distorted blood vessels and weakened connective tissue that can no longer hold those vessels in place.1PubMed Central. Hemorrhoids: from basic pathophysiology to clinical management When you press on or knead these engorged vessels, you are squeezing tissue that is already inflamed and fragile. The likely outcomes include increased blood flow to the area (which can worsen engorgement), irritation of the mucosal surface (which can trigger bleeding), and pain from direct pressure on exposed nerve endings, particularly with external hemorrhoids.
Thrombosed hemorrhoids, the hard, purplish lumps that form when blood pools and clots inside an external hemorrhoid, are especially vulnerable to manipulation. Pressing on a thrombosed hemorrhoid can rupture the clot through the skin surface, leading to significant bleeding without actually resolving the underlying clot. There is also a small but real risk of introducing bacteria into broken tissue, which can lead to infection in an area that is difficult to keep sterile.
The One Clinical Setting Where “Massage” Appears in the Literature
If you search medical databases for hemorrhoid massage, you will find exactly one scenario where the word shows up in a treatment context: removing a misplaced rubber band during an office procedure called rubber band ligation. When a band is accidentally deployed too close to the sensitive dentate line and causes pain, the clinician can roll the band off by directly massaging the hemorrhoid in a circular motion.2Clinical Gastroenterology and Hepatology. Clinical Practice Update AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review This is a specific rescue maneuver performed by a trained gastroenterologist during a procedure, not a home remedy. The fact that it is the only mention of massage in professional hemorrhoid guidelines tells you something about how useful the technique is outside that narrow context.
Manual Reduction Is Not Massage
Some people confuse hemorrhoid massage with manual reduction, which is the process of gently pushing a prolapsed internal hemorrhoid back inside the anal canal. These are entirely different things. Reduction is a brief, directed push to reposition tissue that has slipped out of place. Massage implies sustained rubbing or kneading, which serves no repositioning purpose and only irritates the tissue.
Manual reduction of a prolapsed hemorrhoid is sometimes appropriate and can be done at home with clean hands and gentle pressure. In severe cases where the tissue is strangulated (trapped outside the anal sphincter with its blood supply compromised), clinicians have used techniques like applying granulated sugar to the surface to draw fluid out of the swollen tissue through osmotic effects, making it small enough to push back in.3Cureus. Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report That technique works by shrinking the tissue, not by massaging it. If you have a hemorrhoid that prolapses and you can gently push it back inside, that is fine. But rubbing it, kneading it, or applying sustained circular pressure is a different action with no therapeutic benefit.
What Actually Helps: Fiber and Fluids
The single most consistently supported conservative treatment for hemorrhoids is increasing dietary fiber. A meta-analysis covering several trials found that fiber supplementation cut the risk of persisting symptoms by about half and reduced the risk of bleeding by a similar margin.4American Journal of Gastroenterology. Fiber for the Treatment of Hemorrhoids Complications: A Systematic Review and Meta-Analysis Those are strong numbers for something you can get from a psyllium supplement or a bowl of lentils.
A separate trial tracking patients over 40 days found that fiber supplementation progressively reduced bleeding episodes, with the benefit growing over time. By the final stretch of the study, patients on fiber averaged about one bleeding episode compared to more than five in the control group. The number of visibly congested hemorrhoidal cushions also dropped, and hemorrhoids that previously bled on contact stopped doing so entirely in the fiber group.5PubMed. Effect of fiber supplements on internal bleeding hemorrhoids Fiber works by softening stool and increasing its bulk, which reduces the straining that puts pressure on anal cushions. More water intake amplifies this effect. The improvement is not instant, but it builds reliably over days and weeks.
Toilet Habits and the Smartphone Problem
One of the more underappreciated risk factors for hemorrhoids is how long you sit on the toilet. A standard toilet seat provides no support to the pelvic floor, and sitting on one disproportionately increases pressure in the hemorrhoidal cushions. The longer that pressure persists, the more those cushions can engorge and eventually develop into symptomatic hemorrhoids.6PubMed Central. Smartphone use on the toilet and the risk of hemorrhoids Scrolling through your phone while sitting on the toilet is one of the most common ways people extend their time there without realizing it.
The practical fix is straightforward: go when you need to, finish the job, and leave. If you find yourself straining for more than a minute or two, stop and try again later rather than pushing harder. Straining with a closed glottis (holding your breath and bearing down) is one of the worst things you can do for existing hemorrhoids. For people who strain habitually due to difficulty coordinating their pelvic floor muscles, biofeedback therapy can help retrain those muscles. Randomized controlled trials have shown biofeedback to be more effective than laxatives or general relaxation exercises for this specific problem.7PubMed Central. Biofeedback therapy for dyssynergic defecation
Sitz Baths, Topical Creams, and Oral Medications
Sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes, are one of the most widely recommended home treatments for hemorrhoid discomfort. The warm water increases blood flow, relaxes the anal sphincter, and provides temporary pain relief. Unlike massage, a sitz bath does not apply direct mechanical pressure to the tissue. You can buy a shallow basin that fits over your toilet seat, or simply use a clean bathtub. Two to three times a day during a flare-up is standard advice.
Over-the-counter topical treatments like hydrocortisone suppositories or creams containing lidocaine can help with itching and pain. Hydrocortisone works by reducing inflammation, though its response rate for resolving acute hemorrhoid symptoms is modest compared to some newer approaches. One trial comparing hydrocortisone suppositories to a recombinant streptokinase preparation found that the hydrocortisone group had a complete response rate of only about 27% by day five, whereas the alternative treatment achieved over 90%.8PubMed Central. Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial That does not mean hydrocortisone is useless; many people find it provides enough symptom relief to get through a flare. But if your hemorrhoids are not responding to topical treatment within a week or two, the answer is to see a doctor, not to start massaging them.
Oral flavonoid supplements, particularly mixtures of diosmin, hesperidin, and troxerutin, have shown benefit in controlled trials. One prospective trial found that flavonoid treatment led to faster control of pain, bleeding, edema, and thrombosis compared to placebo over 12 days.9PubMed. Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial Flavonoids are thought to work by improving vascular tone and reducing capillary fragility, which addresses part of the underlying mechanism of hemorrhoid development. They are available over the counter in many countries and are worth discussing with your doctor if you have recurrent flare-ups.
When You Need a Procedure
If conservative measures do not resolve your hemorrhoids, office-based procedures are the next step. The two most common are rubber band ligation and injection sclerotherapy. Rubber band ligation involves placing a tiny elastic band around the base of an internal hemorrhoid to cut off its blood supply; the tissue withers and falls off within a few days. Sclerotherapy involves injecting a chemical solution directly into the hemorrhoid to shrink it.
A meta-analysis comparing the two found that rubber band ligation controlled prolapse and bleeding significantly better, with a 93% success rate for prolapse control versus 66% for sclerotherapy.10PubMed Central. Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy − Systematic Review and Meta-Analysis Patient satisfaction was also higher with banding. The trade-off is that banding causes more post-procedural pain. Neither technique requires anesthesia or an operating room, and both can be done during a regular office visit.
A more recent trial comparing endoscopic rubber band ligation, injection sclerotherapy, and a combination approach called sclerobanding found that sclerotherapy alone had higher recurrence rates for moderate hemorrhoids (about 46%) compared to the combination approach (about 20%). For mild, grade I hemorrhoids, the difference between techniques was less pronounced.11PubMed Central. Endoscopic rubber band ligation, injection sclerotherapy, and sclerobanding for the treatment of internal hemorrhoids Your gastroenterologist will recommend a technique based on the grade and location of your hemorrhoids.
Surgery for Advanced Cases
Surgical hemorrhoidectomy, the traditional open removal of hemorrhoidal tissue, remains the gold standard for severe or recurrent hemorrhoids that have failed other treatments. A newer alternative, stapled hemorrhoidopexy, was developed to reduce post-operative pain. It works by stapling the prolapsed tissue back into position rather than cutting it away entirely.
However, a Cochrane systematic review comparing the two found that patients who underwent stapled hemorrhoidopexy were significantly more likely to have recurrent hemorrhoids in the long term. About 8% of stapled patients experienced recurrence compared to roughly 2% of those who had conventional surgery. Stapled patients were also more likely to need an additional operation later and to have persistent prolapse symptoms.12PubMed Central. Stapled versus conventional surgery for hemorrhoids A separate meta-analysis confirmed these findings, reporting over five times the odds of prolapse recurrence with stapling at a minimum of one year.13PubMed. Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials
The stapled approach does offer real short-term advantages: less pain in the first few days, faster return to normal activities, and shorter operative times. Whether to accept a higher recurrence rate in exchange for an easier recovery is a legitimate choice, and different patients land on different sides of it. What is clear is that surgery of any kind is reserved for hemorrhoids that have not responded to less invasive options. Most people will never need it.
Hemorrhoids During Pregnancy
Pregnant people are particularly susceptible to hemorrhoids because of increased pelvic pressure, hormonal changes that relax vein walls, and the constipation that frequently accompanies pregnancy. This is also a population that often searches for home remedies like massage, since many medications are off-limits during pregnancy. The good news is that the first-line approach is simple and safe: increase fiber intake, use stool softeners, drink plenty of fluids, and establish regular toilet habits. For most pregnant people, hemorrhoid symptoms resolve on their own after delivery.14PubMed Central. Hemorrhoids in pregnancy Sitz baths are safe throughout pregnancy and can ease discomfort. If symptoms are severe, talk to your obstetrician before starting any topical medication, as some ingredients are not recommended during pregnancy.
How to Tell If Your Problem Is Actually Hemorrhoids
Before you treat anything at home, whether with fiber, sitz baths, or the massage you should now be reconsidering, it helps to know that you are actually dealing with hemorrhoids and not something else. Rectal bleeding, pain, and lumps near the anus can also be caused by anal fissures, perianal fistulae, rectal prolapse, or in rarer cases, colorectal cancer. Most common anorectal disorders can be diagnosed by simple visual inspection or proctoscopy.15PubMed. Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases
Certain red flags warrant a prompt visit to your doctor rather than home management. Bleeding that is dark or mixed with stool (rather than bright red on the paper), unexplained weight loss, a change in the caliber of your stool, or any lump that is growing or feels hard and fixed should be evaluated. Hemorrhoids are overwhelmingly benign, but assuming every rectal symptom is “just hemorrhoids” without at least one proper examination is a gamble that occasionally costs people dearly. If you have not had hemorrhoids confirmed by a clinician, get them confirmed before committing to a treatment plan.
Why the Massage Myth Persists
The appeal of hemorrhoid massage seems to come from analogy: massage helps sore muscles, so it should help sore anything. But hemorrhoids are not a musculoskeletal problem. They are swollen blood vessels held in place by weakened connective tissue. The mechanism behind massage therapy, improving circulation and breaking up adhesions in muscle fibers, does not apply to dilated veins bulging out of the anal canal. If anything, increasing blood flow to an already engorged hemorrhoid through vigorous rubbing would make the engorgement worse before it got better.
There is also likely some confusion between massage and the gentle digital pressure used for manual reduction of prolapsed tissue. People describe pushing a hemorrhoid back inside as “massaging” it, and that language gets repeated until others interpret it as a sustained rubbing technique. The distinction matters. A brief, gentle push to reposition prolapsed tissue is medically reasonable. Kneading, rubbing, or applying circular pressure to hemorrhoidal tissue is not supported by any evidence and carries real risks of increased swelling, bleeding, and pain.
Perineal massage, which is sometimes recommended during late pregnancy to prepare the tissue between the vagina and anus for childbirth, is yet another concept that can get tangled into this. Perineal massage targets the skin and muscle of the perineum, not hemorrhoidal tissue, and its purpose is entirely different. None of the evidence behind perineal massage extends to hemorrhoid treatment.