Hemorrhoids

High-fiber diet MOST IMPORTANT: 25-35g/day (softens stool, reduces straining—prevents and treats hemorrhoids), increase gradually (sudden increase causes bloating), soluble and insoluble fiber (oats, beans, lentils, vegetables, fruits, whole grains, flax seeds), fiber supplements if diet inadequate (psyllium husk 5-10g/day—start low, increase gradually), Adequate hydration: 8-10 cups/day (fiber needs water—dehydration worsens constipation), Prune juice (natural laxative if constipated), Avoid: low-fiber processed foods (white bread, white rice, cheese, fast food—cause constipation, straining), spicy foods (may irritate hemorrhoids during flare), alcohol (dehydrates), excessive caffeine (dehydrates), Foods that support vascular health: citrus fruits (bioflavonoids), berries (anthocyanins strengthen blood vessels), leafy greens (vitamin K), fatty fish (omega-3 anti-inflammatory).

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.