I have hemorrhoids that every so often bleed after a bowel movement. Should I be concerned about this, and what can I do when they act up to ease the discomfort?

If you know for sure that the bleeding is due to hemorrhoids and not something more serious, such as ulcerative colitis, Crohn’s disease, or even colon cancer—that is, you have previously been evaluated and diagnosed by your doctor—then you can consider this more of a nuisance than something to worry too much about.

The good news is that there are various home treatments that can provide relief, as well as ways to reduce hemorrhoid flare-ups (when an existing hemorrhoid temporarily acts up) and recurrences (when symptoms come back after a hemorrhoid has resolved).

In brief, hemorrhoids—also known as piles—can occur when there is excess pressure in the anal area, such as from habitual straining on the toilet, pregnancy, prostate enlargement, being overweight or sedentary, or eating a low-fiber diet. Genes may play a role, too. And, as you likely know, the main symptoms are itching and irritation or pain in the anal area. But sometimes there is bleeding after a bowel movement. You may spot blood on the toilet paper or notice some blood in the stool or even in the toilet. The blood from bleeding hemorrhoids is typically bright red.

There are two types of hemorrhoids based on their location: external (which are visible) and internal (not visible). Usually, it’s the internal hemorrhoids that can bleed. Bleeding from internal hemorrhoids can occur when, for example, you have a hard stool or you’re straining on the toilet, both of which put pressure on or otherwise irritate the hemorrhoid. Internal hemorrhoids lack pain sensory nerves and so do not hurt, although they can prolapse (meaning they bulge out from the anal opening) and then can be painful.

External hemorrhoids can also bleed, though—for example, if you wipe too hard or vigorously after a bowel movement. And they can bleed—a lot—if a blood clot has formed in the hemorrhoidal tissue (referred to as a thrombosed hemorrhoid) and then it spontaneously ruptures, which can cause severe pain. (In this case, the color of the blood can be a darker—not bright—red, and it can take a few minutes to stop bleeding.)

If you have only occasional bleeding or discomfort from hemorrhoids, you can wait for the symptoms to improve on their own (usually within a few days), or you can try some home remedies. Note: If there is a lot of bleeding, it’s getting worse, or you see dark red blood, it’s time to revisit your doctor; same goes if you experience severe rectal pain or bleeding not associated with bowel movements.

• To ease external itching and irritation that often occur after a bowel movement, use a soft, warm, wet cloth on the area—or a medicated cooling pad with witch hazel (an astringent), such as Tucks, sold in pharmacies; alternatively, you can saturate a cotton gauze pad or cotton balls with witch hazel yourself.
• Try over-the-counter topical medicines. Dab a little zinc oxide paste or powder, such as in Desitin, on the area—or apply an OTC hydrocortisone cream (but limit use of the latter to no more than a week because it could result in thinning of the tissues). Some hemorrhoid medicines come as OTC suppositories.
• Apply a cold compress or ice pack a few times a day—for about 10 to 20 minutes a session—to reduce inflammation and discomfort. The cold also constricts blood vessels to stop the bleeding. Wrap the compress or ice pack in a clean towel to avoid direct contact with the skin and possible injury.
• Sit in a warm sitz bath for 10 minutes, several times a day. There are plastic sitz baths that fit over the rim of the toilet. Afterward, dry the area—you can use a hair dryer on a low setting, to reduce moisture that can increase irritation. 

To reduce hemorrhoid flare-ups and recurrence, the following lifestyle steps can help:

• Eat a diet rich in fiber (think whole grains, beans, vegetables, fruits), consume adequate amounts of water (so your urine runs pale), and step up your physical activity. A psyllium supplement, such as Metamucil, may be beneficial. These measures will help reduce the risk of constipation, so your stool won’t be as hard and you won’t need to strain while on the toilet (never strain!), which can increase bleeding. For some people, hemorrhoids can be exacerbated by loose stools rather than constipation, but a diet high in soluble fiber (such as psyllium) is often recommended for that, too.
• Make a habit of going to the bathroom as soon as you feel the urge, rather than delaying (since that leads to more water reabsorbed, which then leads to harder stool and consequent straining). But don’t sit too long on the toilet, either (that’s neither the time nor place to read War and Peace).
• Practice good hygiene. Wipe gently after defecating using soft dampened toilet paper or unscented premoistened wipes (don’t dispose of them in the toilet, though, even if they claim to be safe to flush). Avoid rough or dry toilet paper.
• Be aware of specific foods and beverages that may aggravate hemorrhoids. For some people, coffee, alcohol, red pepper, and mustard are prime culprits.
• Maintain an optimal body weight. Being overweight increases pressure on the veins in the anal canal and so may contribute to hemorrhoids.
• Don’t sit—or stand—too long (switch between the two during the day), and be careful of lifting heavy objects, as abdominal strain can increase pressure on the veins in the rectum and anus.

If your hemorrhoids are chronically bleeding or irritated and don’t resolve or improve with home remedies or lifestyle changes—and they’re causing more than just mild discomfort—your doctor may prescribe suppositories or other medications or therapies. Other interventions short of surgery include rubber band ligation, sclerotherapy (injection of a chemical solution), and heat-based treatments such as infrared photocoagulation and laser therapy. Surgery is usually considered a last resort.

By the way: Did you know that everyone technically has “hemorrhoids”? Anatomically speaking, the word “hemorrhoid” refers to the normal ring-shaped, cushion-like vascular tissues within the anal canal that help maintain continence. These tissues, which contain many blood vessels, are important for controlling the passage of gas and stool, so that when, for example, you have lower intestinal gas, you can expel the gas and not release stool at the same time. However, when someone says or is told they have hemorrhoids, they are usually referring to the abnormal condition whereby these tissues become swollen or inflamed.