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Ask Dr. K: Simple strategies for relief of hemorrhoids

DEAR DOCTOR K: What are some self-help strategies to treat hemorrhoids?

DEAR READER: Hemorrhoids are a common but painful and uncomfortable problem. Fortunately, simple measures can ease most hemorrhoid discomfort and help them heal.

Hemorrhoids are swollen veins. Veins carry blood back to the heart. Hemorrhoids can develop in the anus and the rectum, just inside the anus. Many people have both. These swollen blood vessels can bleed. When they get inflamed, they can make bowel movements intensely painful. (I’ve put an illustration of hemorrhoids on my website, AskDoctorK.com.)

I spoke with my long-time colleague Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard Medical School. She offered this advice to care for hemorrhoids:

— Step up the fiber. Start by adding fiber to your diet. Fiber makes stools softer and easier to pass. It also reduces bleeding. Aim for 25 to 30 grams a day.

The best food sources of fiber include beans, broccoli, carrots, bran, whole grains and fresh fruits. You can also take a fiber supplement. Try an over-the-counter powder such as psyllium (Metamucil) or methylcellulose (Citrucel). Some of my patients prefer the newer soluble fiber preparations, such as dextrin. (There are several brand names, but you can find dextrin in the “ingredients” list on the bottle.) To avoid bloating and gas, add fiber to your diet gradually over several days.

Dr. Wolf also recommends the following during flare-ups: Mix a tablespoon of mineral oil with applesauce or yogurt and eat it at breakfast or lunch. This allows stool to slide by more easily.

— Strain less. Don’t sit or strain on the toilet for long periods of time. This can cause more hemorrhoids and worsen symptoms.

Don’t delay bowel movements during flare-ups. Putting off bowel movements can worsen constipation, aggravating hemorrhoids. Elevate your feet with a step-stool as you sit on the toilet. Doing so changes the position of the rectum, making stools easier to pass.

— Consider off-the-shelf remedies. Many over-the-counter products, such as witch hazel-infused pads and soothing creams, are effective. Your doctor can also prescribe stronger preparations if needed.

— Don’t forget sitz baths. Simply soaking the inflamed area in warm water can help reduce inflammation and discomfort. The easiest way to do this is to sit in a bathtub filled with enough water to soak your behind. Some people alternate hot and cold water baths; some add vinegar, salt or baking soda to the water. I’m not sure any of this adds value.

If, despite these measures, symptoms worsen or don’t improve, you may need to talk to your doctor about various medical procedures. Some can be done in the office; some involve minor surgery. But the self-help strategies outlined above give relief to most people with hemorrhoids.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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