It was news to me when Dr. Sean J. Langenfeld, a professor of surgery, said that we actually all have hemorrhoids. The doctor, who serves at at the Division of Colon and Rectal Surgery at the University of Nebraska Medical Center Divsion, asserts that it’s only when these ever present small vascular tissues inside the anal canal become enlarged or inflamed that they can cause issues in the form of bleeding, protrusions and sharp pain.
“They can sometimes become enlarged and inflamed from excessive pressure, straining during bowel movements, or spending a long time on the toilet during bowel movements,” Langenfeld said.
According to Dr. Karen Zaghiyan, the director and colorectal surgeon at Los Angeles’ Cedar Sinai Medical Center cautions, not every anal symptom is the sign of a hemorrhoid.
“Often anal skin tags, anal fissures, warts, and sometimes even an infection, rash, or cancer can be mistaken for hemorrhoids – and each of these has a unique treatment that is different from that for hemorrhoids,” Zaghiyan said.
Langenfeld added that anal fissures, which are small rips or tears in the lining of the anal canal, are usually to blame, as they are quite common. He said that The American Society of Colon and Rectal Surgeons is a great resource to help determine your specific conditions.
Both Zaghiyan and Langenfeld said that if you do find out that hemorrhoids are in fact the culprit, most over-the-counter treatments are only meant to be used short term, otherwise, they can cause even more irritation or thinning of the skin.
Take a look at some of the prescription-free products that Zaghiyan and Langenfeld recommend to help manage either internal or external hemorrhoids like pain-relieving creams, soaks and helpful supplements that may prevent future aggravation.
But before you do, both of these colorectal experts stress the importance of seeking guidance from a medical professional, especially if your symptoms last for more than two to four weeks or occur repeatedly.
The experts consulted for this story do not necessarily endorse the products ahead unless otherwise noted.
A soothing Epsom salt soak
One way to soothe anal discomfort, according to Langenfeld, is to do a sitz bath where a person sits and soaks in warm water and salts for 20 minutes two to three times a day. Sitz Soak is an Epsom salt-based mixture that breaks down into magnesium — a mineral that can be absorbed into the skin to relax muscles, reduce swelling and offer pain relief. This particular formula also contains pure essential oils and vitamin C for added antioxidant benefits.
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A toilet seat Sitz bath
Although you can certainly use your Sitz Soak salts directly in the bath, this toilet seat is made specifically for hemorrhoid-relieving soaks and takes less effort than filling an entire tub. Made with a wider sitting area compared to other models and a deeper bowl to hold more water, this seat pops open to fit over your toilet seat. The holes at the back are designed to prevent overflowing, and it also comes with a flusher hose for targeted relief.
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Medicated witch hazel pads
Zaghiyan said that thrombosed, or clotted, external hemorrhoids can be treated with witch hazel, an astringent that she said can reduce swelling. Zaghiyan mentioned Tucks, which are medicated cooling pads conveniently soaked in witch hazel that can be folded and used as a moist compress on inflamed tissue. The ultra-soft pads are pH-safe, hypoallergenic and dye-free so they’re safe to use on sensitive areas.
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A Lidocaine-containing hemorrhoid cream
When it comes to topical pain relief creams for external hemorrhoids, Zaghiyan suggests RectiCare, a prescription-free product that contains 5% lidocaine to numb the area. The advanced formula also contains 0.25% phenylephrine, which aims to reduce swelling, along with white petroleum and mineral oil, both of which can provide topical protection for inflamed and compromised tissue.
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A soothing hydrocortisone cream for external hemorrhoids
According to Zaghiyan, hydrocortisone-based creams such as Preparation H, can also help treat external hemorrhoids by acting as an anti-inflammatory to help reduce itching and swelling. The maximum-strength formula also contains a proprietary blend of antioxidant-rich vitamin E, aloe and pantheon — all of which can impart soothing relief, while 1% pramoxine temporarily numbs the surface. This cream may also help protect compromised skin thanks to the addition of glycerin, a popular humectant that draws moisture into the skin, and white petroleum.
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Hydrocortisone suppositories for internal hemorrhoids
“Prolapsing or bleeding internal hemorrhoids can be treated with hydrocortisone suppositories [like] Preparation H,” Zaghiyan said. Essentially these hemorrhoidal suppositories deliver the same anti-inflammatory formula as the topical cream, but deeper into the anal canal to provide temporary relief and possibly prevent further irritation.
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A gentle and non-habit-forming laxative
“The best way to avoid or improve hemorrhoidal symptoms is to alleviate constipation, reduce straining, and reduce time on the toilet during bowel movements,” Langenfeld said. “We typically recommend a high-fiber diet, increased water intake, and gentle non-habit forming laxatives such as polyethylene glycol powder. This will allow the hemorrhoids to cool off and cause less bleeding and prolapse.”
Based on this guidance, we selected MiraLax, a popular gentle and polyethylene glycol-based laxative that “works naturally with the water in your body to hydrate, soften, and ease stool through the colon,” according to the brand. This osmotic-type formula is different from stimulant laxatives, which work by stimulating the colon to perform a bowel movement.
Please note that, as is the case with any supplement, always take this with caution and consult with your doctor first before consuming.
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A 4-in-1 fiber supplement
As Langenfeld mentioned earlier, a high-fiber diet is highly recommended for preventing and reducing inflamed hemorrhoids. Although you can consume an adequate amount of fiber from fruits, vegetables and whole grains, sometimes you need a little extra help and this is a popular fiber supplement that I myself swear by.
Originally recommended to me by my endocrinologist, this particular Metamucil fiber powder is sugar-free (great for diabetics like me) and has a 4-in-1 formula that can help promote digestive health and regularity, reduce cholesterol and maintain good blood sugar levels. It uses naturally sourced psyllium fiber as the active ingredient and the orange flavor is not at all unpleasant.
Please note that, as is the case with any supplement, always take this with caution and consult with your doctor first before consuming.
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