How to Alleviate Hemorrhoid Pain and Find Relief

Everyone has hemorrhoids. These clusters of veins that lie just beneath the lining of the anus only come to our attention when they start causing trouble. Uncomfortable symptoms that include itching, swelling and burning make painful hemorrhoid flare-ups a reality for every 1 in 20 Americans¹. Effective at-home, over-the-counter, and medical treatments can help put an end to hemorrhoid pain. Learn more about the many options for hemorrhoid pain relief and how your daily habits play a part.

Who are we? We’re Doctor Butler’s, experts in down-there care of hemorrhoids and related conditions. We make proctologist-developed hemorrhoid ointments and complementary products to help you quickly leave the pain behind. Dr. Robert Cutler medically reviews all of the information here.

What are Hemorrhoids?

Hemorrhoids are pillow-like in nature, forming a cushion of veins in the highly sensitive region along the anal canal. They are your body’s way of aiding in the control of bowel movements. The term “hemorrhoid” is usually only invoked once these veins have become swollen, a common occurrence given their tendency to engorge and prolapse². There are both internal and external hemorrhoids, with different symptoms and treatment strategies for each. 

Internal hemorrhoids are typically painless, with drops of blood on toilet paper or in the toilet bowl often being the only indication they are present. Internal hemorrhoids are covered by the anal lining, or mucosa, making them less sensitive to pain. They are graded on a system based on their degree of prolapse, as hemorrhoids that push through the anus are still considered internal hemorrhoids. Internal hemorrhoid pain is thus largely dependent on grade, with fully prolapsed hemorrhoids posing the highest risk for increased symptoms and co-occurring pathologies (anal fissures, perianal abscesses). 

External hemorrhoids form beneath the skin outside of the anus, often appearing as small blue or purplish bumps. As the skin covering the hemorrhoid is still attached to the tissue beneath, external hemorrhoids can be acutely painful, especially if they become thrombosed. External hemorrhoids are usually visible, and if not the hemorrhoid itself, then the effects of its numerous resulting symptoms. Learn more about external vs. internal hemorrhoids.

Symptoms and Causes of Hemorrhoids

Hemorrhoids pain is caused by increased pressure both inside the abdominal and on to the lower rectum. The pressure can stem from chronic gastric conditions (constipation, diarrhea, Irritable Bowel Syndrome), pregnancy, obesity or lifting heavy objects. Diet and lifestyle factors that contribute to digestive issues include over-consuming processed foods, improper hydration and a lack of exercise. Prolonged periods of sitting, whether at jobs with exceedingly sedentary schedules or using your phone on the toilet, places pressure on hemorrhoids. Age, genetics and nutrition can also play a part. 

What do hemorrhoids feel like? There are a wide range of hemorrhoid symptoms, most of them a result of the effect of swelling and inflammation on the surrounding skin. Itching, burning, redness and irritation are all common. Bleeding can occur as droplets on toilet paper, in the toilet bowl or in the stool itself. Pain or ache in the anus and in tender areas of skin around external lumps or as a result of wiping irritated patches can make it difficult to sit.

At-Home Hemorrhoid Pain Relief

The one silver lining of hemorrhoids is the abundance of convenient, affordable and effective options for at-home treatments and symptom relief. Targeting the painful hemorrhoid itself is best accomplished by diminishing symptoms and establishing an environment conducive to healing. Using a mix of home remedies and over-the-counter solutions is the first line of defense in tackling hemorrhoid pain.

Over-the-Counter (OTC) Topical Treatments

Creams, ointments, and sprays are all over-the-counter options for the relief of hemorrhoid symptoms. They have long been popular as a non-prescription choice for an issue that many people feel uncomfortable discussing with their physician. Ingredients such as lidocaine serve as a local anesthetic to numb the pain. Corticosteroids, like hydrocortisone, activate the skin to reduce swelling. Phenylephrine is a vasoconstrictor that temporarily narrows blood vessels, decreasing blood flow to the area to slow inflammation and swelling. Plant based ingredients such as witch hazel and aloe vera are often combined within medicated formulas to add natural benefits. 

While side effects to OTC products are rare, it is always important to keep an eye on your skin’s reaction to different products. Any OTC treatment should only be applied to thoroughly cleansed and dried skin and used as directed. If you are concerned you are having an allergic reaction, it is always recommended to stop using the product and consult a healthcare professional at once.

Warm Sitz Baths

Fill a clean bathtub with 2 to 3 inches of warm water (we recommend adding a handful of epsom salt here; try it with and without and see what works best for you). Gently lower yourself into the tub, ensuring that your lower rectum and any affected skin is submerged (bending your knees may be helpful in exposing additional skin). The water may sting open wounds at first, but this will subside and the pain will ease. Remain in the water for 10 to 20 minutes as desired, and make sure to completely pat dry the lower rectum once you are finished. Not only will a sitz bath help clean this sensitive region when it may be painful to wipe, it helps promote blood flow in the anal tissue, lessening the swelling that’s causing uncomfortable symptoms.

Cold Compresses

Cold therapy is effective for treating external hemorrhoids. Use an ice pack or make your own cold compress (dampen a cloth, place it in a ziplock and freeze it for fifteen minutes before use). Wrap whichever you’re using in a thin cloth to prevent burning the skin, or simply wear loose, breathable clothing, and place it against the affected area for 15-20 minutes. This can be repeated as necessary throughout the day. Using a cold compress to cool your tissue temperature reduces blood flow and stops inflammation at the hemorrhoid site.

Pain Relievers

Many over-the-counter painkillers are designed to target more than just headaches and fever. Ibuprofen, aspirin and acetaminophen are all antiinflammatories in addition to pain relievers, making them suitable for the relief of hemorrhoid symptoms. Particularly, it’s how to relieve hemorrhoid pain at night. Pain relievers offer temporary reprieve from soreness and swelling so that you can get the sleep you need to heal. Pairing this treatment with creams or ointments applied to the hemorrhoid site is an effective solution for how to sleep with hemorrhoids. 

OTC pain relievers pose the risk of intestine and liver damage if not taken as advised. While prescription opioid analgesics for more severe pain have a known risk of constipation, over-the-counter pain relievers come with a much lower risk of constipation.

OTC Stool Softeners

As for how to relieve hemorrhoid pain during bowel movement, stool softeners can help. They are an emollient or surfactant laxative that increases the amount of water absorbed by your stool, making it easier to pass. They are typically used after childbirth or recovering from anorectal surgery, conditions that mimic the sensitivity and pain you encounter during bowel movements with a hemorrhoid. Softening your stool will reduce the strain caused by constipation, allowing the hemorrhoid to heal without risk of tearing or further exacerbation.

There are different types of laxatives and not all of them are suitable for treating hemorrhoid pain. Stool softeners contain the active ingredients docusate sodium and docusate calcium; common brands are Colace and Dulcolax. Use as directed and do not take any laxative for more than a week. If your constipation persists, seek medical attention.

Lifestyle and Dietary Treatments

The best treatment for hemorrhoids is always prevention. There are many daily choices we make that significantly decrease the risk of hemorrhoids and lessen the impact of symptoms when a flare-up occurs. Learning which lifestyle, diet, and proper anal hygiene practices help fight hemorrhoids is the most effective solution for long term relief from hemorrhoid pain.

High-Fiber Diet

There are two types of fiber – soluble and insoluble. Soluble fiber adds water to your stool and turns into a gel-like material that helps slow digestion and promote fermentation in the gut. Insoluble fiber does not dissolve, rather it absorbs water to bulk up stool and gives it a solid form that’s easier to pass. Both types of fiber help prevent constipation and keep bowel movements consistent. Good sources of fiber include beans, nuts, whole grains, vegetables and fruit. Fiber from food sources is always recommended over fiber supplements, which can be helpful but lack many of the beneficial nutrients and variety of fiber found in food. Dr. Cutler routinely recommends Konsyl to patients as a quick fix.

Stay Hydrated

Your digestive system breaks down food so that it can be absorbed and released. Water is a key component in every step of this process, from helping the digestive juices mix with the food, helping your body absorb proper nutrients and importantly for preventing hemorrhoids, softening the food as it moves through the digestive tract. Without enough water, a multitude of issues can arise that increase the risk of hemorrhoid pain and inflammation. While the general guidance is eight glasses of water a day, your actual intake depends on factors like age, level of physical activity, environment and more. Making sure your pee remains a clear pale yellow in color³ is the goal for keeping track of proper hydration.

Avoid Straining During Bowel Movements

We’ve all experienced a bowel movement that is difficult to pass. Straining during the occasional bowel movement isn’t abnormal, but frequent straining places pressure on your rectum that is likely to cause hemorrhoids. Constipation or stool that is hard and dry will trigger your body to forcefully attempt to push it out. Practicing proper toilet techniques can help cut down on straining, such as keeping your back straight, placing your forearms on your knees and elevating your knees above the level of your hips using a toilet stool or squatty potty. Make sure you keep your mouth open and avoid holding your breath to pass a bowel movement.

Good Anal Hygiene

When we think of sensitive skin, we don’t often include the anus. This area is not only notoriously difficult to keep clean due to location, but inflamed skin during flare-ups can mean we wipe so gently it fails to properly remove the fecal particles. External or prolapsed hemorrhoids are already more prone to infection, so keeping your anus free of bacteria and harsh irritants is essential. Using wet wipes, rinsing the area with warm water, or taking a sitz bath helps keep it clean without the aggravation or chaffing caused by toilet paper. Pre-rinsing or wet wiping your anus before applying over-the-counter hemorrhoid pain relief cream ensures a hygienic surface for more effective treatment.

Avoid Sitting for Prolonged Periods

Hemorrhoids are situated in and around your anus and lower rectum. As a result, anything that places pressure on this region pushes those veins downward and traps the blood that causes swelling, irritation and pain. Sitting is a main source of this type of pressure. A desk job, checking your phone while on the toilet, hopping in the car for errands – the amount of time we spend seated each day often adds up without warning. Staying on top of your seating habits by taking breaks to stand up and move, leaving your phone outside of the bathroom and using a seat cushion for hemorrhoid relief can all help prevent flare-ups exacerbated by sitting.

Wear Cotton Underwear

The irritated and inflamed skin that accompanies hemorrhoids is very painful and difficult to target. While some amount of moisture helps keep alive the cells your skin needs to heal, an excess of moisture can lead to the growth of yeast, fungus or infection-causing bacteria. Underwear made of synthetic material traps heat and moisture, while all natural cotton is a breathable fabric that absorbs moisture and allows for ventilation. Medicated cream or ointment applied before wearing this hypoallergenic fabric will still be effectively soaked up by skin, making it the best choice for daily wear during a flare-up.

Avoid Irritating Foods

Processed food, fast food, soda, alcohol and sugar-loaded fruit drinks are all hard on your body’s digestion. They lack fiber and include ingredients that often cause constipation and diarrhea, two leading culprits behind hemorrhoids. Spicy food can lead to irritation as it leaves your system and the stool comes in painful contact with the inflamed anal lining. Other food and drink, such as dairy and caffeine, cause a reaction in some while remaining harmless to others. It’s important to learn your stomach’s preferences and what you should avoid when managing hemorrhoid pain and symptoms. 

Lift Properly

Whether your hemorrhoids were the result of weight lifting or you’re interested in continuing a workout routine during a flare-up, it’s important to learn techniques that minimize stress on your lower rectum. Lower the weight you are lifting to help ensure you are using proper form. Practice correct breathing and refrain from holding your breath, which can cause a sudden surge of pressure in your blood vessels. Skip parts of your routine that involve compression of your lower rectum, such as squats. Remember, it isn’t weight lifting itself that causes hemorrhoids – it’s improper technique, so lift with caution and stay on top of your form.

Medical Interventions

While hemorrhoid pain is treatable with a number of at-home and over-the-counter options, it is important to monitor your condition and seek medical attention when necessary. Symptoms that do not improve in two weeks with the use of medicated treatment, or any increase in bleeding, indicates the need for a more thorough medical examination. Depending on the severity of the hemorrhoid, medical interventions can include both minimally invasive and surgical options. A physical examination will also help determine if your symptoms actually point to a more serious condition, such as diverticulitis or colorectal cancer.

Prescription Medications

If a doctor determines that your hemorrhoid is best treated with a medication, it’s likely you’ll be prescribed a mix of 2% lidocaine and hydrocortisone. In recent years however, these kinds of solutions have become available over-the-counter. Doctor Butler’s Maximum Strength Hemorrhoid & Fissure Ointment, for instance, features 4% lidocaine as its active ingredient. Some ointments contain 5% lidocaine, but we’ve found that 4 percent mixed into our holistic formula works best while minimizing irritation.

Minimally Invasive Procedures

Non-surgical interventions are typically used on internal hemorrhoids that are causing persistent symptoms. The goal of these procedures is to cut off the blood supply, allowing the hemorrhoid to shrink and the pain and discomfort to subside.

Infrared coagulation (IRC) achieves this by applying a pulse of infrared light to the hemorrhoid site, causing scar tissue to form and blocking blood flow.

A sclerotherapy injection involves a chemical solution shot directly into the internal hemorrhoid, causing scar tissue to form and blocking blood flow.

Rubber band ligation is used on protruding internal hemorrhoids by placing a specialized band around the base of the hemorrhoid, causing the banded portion to shrink and fall off. Scar tissue then forms over the remaining hemorrhoid site, blocking blood flow.

Surgery

If your symptoms become especially severe, or if there is a need to immediately drain a blood clot that has formed via a thrombosed hemorrhoid, there are a few surgical options for treating hemorrhoids.

A hemorrhoidectomy removes enlarged external or severely prolapsed internal hemorrhoids via a scalpel or scissors.

A hemorrhoidopexy, also called stapling, is used on prolapsed internal hemorrhoids. The prolapsed hemorrhoid is placed back inside the rectum and securely stapled, blocking off the blood supply so that the tissue shrinks and is absorbed. Pain during bowel movements or while sitting is common following the procedure.

Surgery comes with increased risk of postoperative infection, abscesses, anal stenosis and in rare instances, fecal incontinence⁴.

Why Do Hemorrhoids Cause Pain?

The network of veins that form your hemorrhoids are not painful until they become swollen from an excess of blood flow. Pressure placed upon your lower rectum (be it straining from bowel movements, lifting weights, pregnancy, etc.) forces this swelling and causes a number of uncomfortable symptoms. These symptoms can range from itching and bleeding to general soreness. What does hemorrhoid pain feel like? It is the combined effect of this discomfort that makes hemorrhoids painful.

Why Do Some Hemorrhoids Hurt More Than Others?

Hemorrhoids that remain inside the rectum are almost always painless, and often unnoticeable, save for occasional bleeding you may find on toilet paper or in the toilet bowl. This is because much of the pain associated with hemorrhoids is a result of the prolapsed or external hemorrhoid’s contact and irritation of the skin and painful disruption of bathroom habits and daily life.

Internal hemorrhoids that prolapse and bulge outside of the anus may cause a pinching sensation or anal itching around the bumps that form.

External hemorrhoids, unprotected by the rectal lining like their internal counterparts, tend to form painful, purplish lumps under the sensitive and nerve-rich skin. 

Thrombosed hemorrhoids occur when a blood clot develops inside the hemorrhoids, stopping blood flow and causing an acutely painful swelling of the anal tissue. Thrombosed hemorrhoids are particularly throbbing when they first appear, eventually receding in pain and size.

What Does Hemorrhoid Pain Feel Like?

Hemorrhoid pain can take many different forms and change throughout treatment. How long does hemorrhoid pain last? It’s usually dependent on factors like location, history of hemorrhoids and how diligently they are being treated.

• Internal hemorrhoids may cause the sensation of rectum or bowel fullness.
• Prolapsed internal hemorrhoids can cause itching and skin irritation, as the protruding lumps make wiping difficult and dried fecal matter gets caught around the hemorrhoid site.
• Swollen external hemorrhoids can cause inflamed, red and irritated skin, and soreness may ensue when trying to sit or perform movements.
• External hemorrhoids may also cause a burning sensation when urinating or passing a bowel movement, as these contents come in contact with irritated skin.
• Thrombosed hemorrhoids can cause sharp pain upon their onset, and ulceration or necrosis of the thrombosed tissue can be extremely agonizing. 

Possible Complications of Hemorrhoids

While hemorrhoids are treatable, they can also lead to more serious complications. Monitoring symptoms during treatment is the best defense against such complications. Changes in pain level and an increased amount of bleeding are two of the signs that your hemorrhoid situation has escalated and may need medical attention.

Thrombosed Hemorrhoids

If a blue or purplish lump pops up outside your anus, chances are it’s a thrombosed hemorrhoid. When a blood clot forms within a hemorrhoid vein, it blocks off blood flow and creates the painful, grape-sized bump that appears. The pain is worst during the initial two days of the thrombosed hemorrhoid, after which the blood clot should slowly be reabsorbed by the body. 

Thrombosed hemorrhoids differ from external hemorrhoids in both appearance and treatment. External hemorrhoids will not be dark in color, as the blood clot is what causes the thrombosed hemorrhoids to turn this shade. OTC creams and ointments applied to an external hemorrhoid should help relieve symptoms, as the ingredients help cool surface-level pain and discomfort. Thrombosed hemorrhoids will not respond to such treatment, as the severe pain is the result of the blocked blood flow causing pressure within the tissue. 

If the thrombosed hemorrhoid does not begin to recede on its own, or if complications such as ulceration or infection set-in, it may be necessary to use a minimally invasive procedure to remove the thrombosed hemorrhoid.

Anemia

Hemorrhoids that are bleeding for more than a week or show a steadily increasing blood flow should be brought to the attention of your doctor at once. In rare instances, the continued loss of blood over time from hemorrhoids may contribute to anemia. Anemia occurs when your blood has a lower-than-normal amount of red blood cells, preventing your body tissue from getting the oxygen it needs. This can lead to lightheadedness, dizziness, shortness of breath, paleness and fatigue. Monitoring your hemorrhoids and administering effective treatment will curb blood loss and eliminate the risk of anemia as the result of bleeding from hemorrhoids.

Strangulated Hemorrhoid

A strangulated hemorrhoid starts as an internal hemorrhoid that prolapses from within the anal canal. In pushing outside of the canal, pressure is placed on the hemorrhoid by the anal sphincter, trapping the hemorrhoid between the anal muscles and cutting off blood supply to the tissue. This creates an extremely painful condition known as a strangulated hemorrhoid. The loss of blood flow can eventually lead to tissue death and infection, and a doctor should be consulted for immediate treatment if you suspect you have a strangulated hemorrhoid.

When to See a Doctor

While hemorrhoids are the culprit behind a large proportion of anorectal discomfort, it is important to rule out other, more serious conditions before diagnosing a hemorrhoid. Anal fissures, diverticulosis, and colon polyps are all examples of anal pathologies that share symptoms with hemorrhoids and could be misdiagnosed without seeking the advice of a physician.

Symptoms that do not respond to attempts at treatment, and pain, bleeding or irritated areas that do not improve after two weeks of OTC treatment should be brought to a medical professional for examination. Any sign of infection (pus, fever, redness not caused by irritation) also indicates the need for immediate medical attention.

Don’t Suffer in Silence: Act Now for Hemorrhoid Relief

Hemorrhoid pain doesn’t have to hold you back! Employ hemorrhoid prevention strategies, pay attention to symptoms and manage the at-home treatment and over-the-counter care that works best for you. Doctor Butler’s is here to help you fight hemorrhoid pain every step of the way.

Medical Citations

1. Hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/definition-facts. October 2016.
2. Lawrence A, McLaren ER. External Hemorrhoid. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK500009/
3. Water, Drinks and Hydration. National Health Services. https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/. 17 May 2023. 
4. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. Enlarged hemorrhoids: What surgical procedures are used to treat hemorrhoids? 2014 Jan 29 [Updated 2017 Nov 2]. https://www.ncbi.nlm.nih.gov/books/NBK279465/