Hemorrhoids are a common condition involving the swelling of veins in the rectum or anus, similar to varicose veins found elsewhere in the body. They typically result from increased pressure in the lower rectum. Most cases of discomfort, itching, and minor bleeding resolve quickly with basic home care, such as over-the-counter creams and sitz baths. The persistence or recurrence of symptoms signals that the underlying issues causing the pressure or irritation have not been fully addressed.
Daily Habits That Hinder Healing
Chronic hemorrhoid problems are often traceable to modifiable daily behaviors that repeatedly traumatize the anal area. The most impactful habit is chronic straining during bowel movements, which significantly increases pressure on the delicate veins in the lower rectum. This forceful action prevents the swollen tissue from resting and healing properly.
Prolonged sitting on the toilet, often while reading or using a phone, is another habit that actively works against recovery. This position causes the anal veins to engorge with blood due to gravity and the ring-like pressure of the toilet seat opening. Limiting toilet time to five minutes or less helps reduce this unnecessary pressure and allows the inflamed tissue to begin recovering.
Inadequate dietary fiber and hydration are often the root cause of the straining behavior. A low-fiber diet leads to small, hard stools that are difficult to pass. Fiber needs to be paired with sufficient fluid intake, ideally six to eight glasses of water daily, because fiber without water can lead to worsening constipation. Waiting to have a bowel movement when the urge arises also contributes to the problem, as the stool loses moisture and becomes harder.
Underlying Medical Conditions Sustaining the Problem
When good daily habits fail to resolve the issue, the persistence is often driven by chronic health states or physical conditions that create constant, unavoidable pressure on the rectal veins. Chronic constipation and chronic diarrhea are two opposite but equally damaging conditions that prevent healing. Constipation forces repeated straining, while chronic diarrhea causes frequent bowel movements and chemical irritation to the anal lining.
Conditions that chronically increase intra-abdominal pressure can also sustain hemorrhoids by restricting blood flow and causing vein swelling. This category includes obesity, where excess weight places direct pressure on the lower abdomen, and pregnancy, due to the growing fetus and hormonal changes that relax blood vessel walls. A chronic cough, often seen in smokers or those with respiratory conditions, also repeatedly elevates abdominal pressure, exacerbating the condition.
Certain gastrointestinal disorders, such as inflammatory bowel disease (IBD), can cause persistent irritation that mimics or worsens hemorrhoidal symptoms. While IBD does not directly cause hemorrhoids, the associated chronic inflammation and frequent, urgent bowel movements create a hostile environment for the anal tissue. If a hemorrhoid problem remains stubborn despite lifestyle corrections, a medical assessment is necessary to rule out these chronic systemic issues and other potential causes of bleeding or discomfort.
When Home Treatment Fails and Professional Options
If hemorrhoidal symptoms like bleeding, pain, or discomfort do not improve after a week of consistent home care, or if they repeatedly return, seek professional medical intervention. Persistent rectal bleeding must always be evaluated by a doctor to ensure that the symptoms are not caused by more serious conditions, such as anal fissures, polyps, or colorectal cancer. Severe, sudden pain accompanied by a hard, painful lump near the anus can indicate a thrombosed external hemorrhoid, which may require immediate drainage.
For internal hemorrhoids that fail to respond to conservative management, office-based procedures offer effective, minimally invasive solutions. Rubber band ligation is a common procedure where a small elastic band is placed around the base of the hemorrhoid, cutting off its blood supply, causing the tissue to shrink and fall off. Sclerotherapy involves injecting a chemical solution into the hemorrhoid to cause it to scar and shrink, which is often used for smaller hemorrhoids.
These non-surgical treatments are highly effective for Grade I, II, and some Grade III internal hemorrhoids. When hemorrhoids are large (Grade III or Grade IV) or have not responded to multiple office treatments, a surgical hemorrhoidectomy may be necessary. This procedure involves the removal of the tissue and offers the lowest recurrence rate, though it is associated with a longer recovery time and greater post-operative pain.