Hemorrhoids

Prevent constipation (MOST IMPORTANT): high-fiber diet, adequate hydration, regular exercise, magnesium supplementation if needed, respond to urge to defecate promptly (don't delay—stool hardens, requires straining), Toilet habits: don't strain (increases pressure, worsens hemorrhoids), don't sit on toilet >5 minutes (prolonged sitting worsens congestion), use Squatty Potty or footstool (raises knees above hips—opens anorectal angle, easier defecation without straining), relax (don't force), Hygiene: clean gently after bowel movements (use moist wipes or bidet—not dry toilet paper which irritates), pat dry (don't rub), avoid harsh soaps, Sitz baths: warm water 10-15 minutes 2-3x/day (reduces pain, swelling, promotes healing—especially after bowel movements), add Epsom salts optional, Topical treatments: witch hazel pads (Tucks—soothing, reduces swelling), hemorrhoid cream (Preparation H, others—temporary relief), aloe vera gel, calendula cream, lidocaine gel if very painful (numbing), ice packs (if acute swelling—10-15 min several times/day), Reduce pressure: avoid prolonged sitting (get up, move every hour), avoid heavy lifting or lift with proper technique (don't hold breath, strain), lose weight if overweight (reduces abdominal pressure), Avoid: prolonged standing, sitting on hard surfaces, For pregnant women: sleep on side (reduces pressure on rectal veins), pelvic floor exercises, avoid constipation, symptoms often improve after delivery, Exercise: regular walking, swimming (improves circulation, prevents constipation), avoid heavy weightlifting, straining, Medical treatments if conservative fails: Rubber band ligation (most common—band placed around internal hemorrhoid base, cuts off blood supply, hemorrhoid falls off in 7-10 days, 70-80% effective, may need multiple sessions, complications—pain, bleeding, infection—rare), Infrared coagulation (IRC—heat coagulates blood vessels, 70-80% effective, less painful than banding), Sclerotherapy (inject solution to shrink hemorrhoid—less effective, used less commonly), Hemorrhoidectomy (surgical excision—for large, prolapsing, thrombosed hemorrhoids not responding to other treatments, 95%+ effective but painful recovery 2-4 weeks, complications—bleeding, infection, anal stenosis, incontinence—rare), Stapled hemorrhoidopexy (less painful than hemorrhoidectomy, repositions prolapsed hemorrhoids, higher recurrence rate), Thrombosed external hemorrhoid (blood clot—very painful): if <72 hours—incision and clot removal in office (immediate relief), if >72 hours—sitz baths, topical treatments, oral pain medication (clot reabsorbs in 1-2 weeks), Most hemorrhoids improve with: high-fiber diet, adequate hydration, topical treatments, sitz baths, avoid straining—surgery rarely needed.