Hemorrhoids 101: From Causes to Creams

What Are Hemorrhoids and Why Do They Develop

Hemorrhoidal tissue is present in every person — that's completely normal. These are clusters of veins in the lower part of the rectum and around the anus that, together with surrounding muscles, help control bowel movements. In their healthy state, they cause no discomfort whatsoever — most people don't even know they exist.

Problems begin when these veins become enlarged, the vessel walls stretch, and blood starts to pool inside them. The nodes increase in size, become irritated, may bleed, or even prolapse. That's the condition we call hemorrhoids.

There are two types: internal and external. Internal hemorrhoids develop in the lower part of the rectum, above the anal canal. In the early stages they're not visible from the outside, but they can bleed and cause discomfort during bowel movements. External hemorrhoids form under the skin around the anus. They can be felt or seen as lumps or swellings, and tend to be more painful — especially when a blood clot forms.

 

Hemorrhoids develop gradually through several stages. In stage one, the nodes are enlarged but don't prolapse — there may be minor bleeding. In stage two, they begin to prolapse during straining but retract on their own. In stage three, prolapsed nodes need to be pushed back manually. By stage four, they remain outside permanently and cannot be reduced.

Why Hemorrhoids Develop: The Main Causes

Hemorrhoids are a condition shaped by lifestyle and genetics. They rarely develop from a single cause — it's usually a combination of factors that create conditions for blood pooling and weakened vessel walls.

Main causes of hemorrhoid development:

• Chronic constipation and repeated straining during bowel movements — this creates increased pressure in the pelvic veins
• Sedentary lifestyle and lack of movement — blood pools in the pelvic organs
• Pregnancy and childbirth — the growing uterus presses on the veins, and pushing during labor sharply raises pressure
• Heavy physical exertion, especially weightlifting — causes sudden spikes in intra-abdominal pressure
• Poor diet — low in fiber, high in spicy and rich foods, which irritates the mucosa and promotes constipation
• Excess weight — puts additional strain on the pelvic blood vessels
• Hereditary predisposition — a natural weakness in the vein walls

Hemorrhoids are particularly common in certain professions: drivers, office workers, programmers, hairdressers, teachers — anyone who spends long hours sitting or standing. Weightlifters and strength athletes are also at higher risk due to extreme exertion.

Discomfort That Deserves Your Attention

Hemorrhoids rarely appear suddenly. Discomfort usually develops gradually, and many people ignore it for a long time, attributing the discomfort to anything but hemorrhoids.

Early signs you shouldn't ignore:

1. Itching and burning around the anus, especially after a bowel movement
2. Discomfort or mild pain during bowel movements
3. Traces of blood on toilet paper — typically bright red, fresh blood
4. A feeling of incomplete emptying or a foreign body sensation in the rectum
5. Small lumps or swellings around the anus (with external hemorrhoids)

In later stages, discomfort becomes more pronounced. Pain intensifies — especially when sitting, walking, or during bowel movements. Bleeding may become heavier. Nodes prolapse — first only during straining, then permanently. Swelling and irritation appear in the perianal area.

It's important to understand: blood in the stool is always a reason to see a doctor, even if you're certain it's hemorrhoids. Rectal bleeding can be a discomfort of more serious conditions, including colorectal cancer. Only a doctor can make the right assessment.

When You Need Urgent Supportive Attention

There are situations where self-support is not an option and you should see a proctologist as soon as possible.

Warning signs that require urgent consultation:

• Heavy rectal bleeding (blood flowing in a stream or steady drops)
• Severe pain that doesn't respond to standard pain support products
• Sudden pain and a bluish discoloration of a node (signs of thrombosis)
• Prolapsed nodes that cannot be pushed back
• Fever accompanying hemorrhoid discomfort
• Discomfort that persists or worsens over more than a week despite support

It's also worth remembering that not every problem in the rectal area is hemorrhoids. Similar discomforts can be caused by anal fissures, polyps, irritation bowel condition, or tumors. That's why rectal bleeding — especially for the first time — always warrants a consultation and proper examination.

Types of Hemorrhoid Products and How They Work

Supporting hemorrhoids almost always requires a combined approach. A single product is rarely enough. Typically, you need both systemic products and topical ones (suppositories, creams). Let's break down the main categories and how they work.

Venotonics: Strengthening the Vessels from Within

Venotonics — also called phlebotonic agents — are products taken orally as pieces. They work systemically, affecting the condition of veins throughout the body, including the pelvic region.

The mechanism of action of venotonics in hemorrhoid support includes several effects. They strengthen vein walls, making them more resistant to stretching. They improve microcirculation in the small blood vessels. They reduce capillary permeability, which decreases swelling. They reduce blood pooling in the hemorrhoidal nodes. And they have a soothing effect.

Venotonics are most effective during an acute flare-up, when the priority is to quickly reduce irritation and swelling. They're also recommended in courses to prevent recurrences in chronic cases.

One important note: venotonics don't produce instant results. Improvement typically begins after 2–3 days of regular use. Support during an acute episode usually runs 7–10 days; for avoidance, courses of 2–3 months are taken several times a year.

Fitomucil Norm Plus 180 g

Tormentilla Root 50 g

Aspen bark crushed 50 g

Detralex 500 mg 30 pcs

Procto Help Blend 50 g

Upland Queen Herbs 50 g

Rectal Suppositories: Targeted Action Right at the Source

Suppositories are one of the primary forms of topical hemorrhoid support. They're inserted into the rectum, where the key ingredients are released and act directly on the irritated nodes.

The advantage of suppositories is that the active substance reaches exactly where it's needed, bypassing the gastrointestinal tract. This reduces the risk of side effects and ensures a faster onset of action.

Suppositories are especially effective for internal hemorrhoids and anal fissures. They coat the mucosa, soften the tissue, and ease bowel movements.

By their action, suppositories fall into several categories:

Soothing suppositories reduce irritation and mucosal swelling. Supportive suppositories contain local anesthetics and provide fast pain relief. Hemostatic suppositories help manage bleeding from the nodes. Recovery suppositories accelerate the recovery of damaged mucosa. Combination suppositories deliver several effects at once — pain relief, soothing, and recovery.

Phytosuppositories rectal for hemorrhoids and prostatitis

Vaginal rectal phyto-suppositories for prostatitis, hemorrhoids, thrush 10 pcs

Anestezol 5 suppositories

Sea buckthorn oil suppositories (rectal or vaginal) 10 pcs

Relief Ultra rectal suppositories 10 pcs

Agaric Brazilian suppositories 2.2 g 10 pcs

Tykveol suppositories from Prostatitis 500mg 10 pcs

Dorogov's phytosuppositories ASDCLASSIC with ASD-2 10 pcs

Relief rectal suppositories 12 pcs

Dorogov's phytosuppositories with ASD-2 fraction 14 pcs

Belladonna Extract 10 suppositories

Balms and Creams for External Use

Balms are preferred for external hemorrhoids, where the nodes are located outside, around the anus. They're also used for skin irritation in the perianal area.

Balms are applied in a thin layer to the affected area 2–3 times a day, usually after hygiene procedures. Some balms can also be introduced into the rectum using a special applicator.

Types of balms by primary action:

• Balms with anesthetics — provide fast support, suitable for the acute phase
• Balms with anticoagulants (heparin) — help to avoid clot formation in the nodes and help dissolve existing ones
• Balms with venotonic agents — strengthen the vascular wall locally
• Balms with soothing components — reduce swelling and irritation
• Multi-component balms — combine several effects, convenient for comprehensive support

Hemlock with silver ions balm50 ml

Troxerutin gel for external use 2% 40 g

Antihemor balm 50 g

Fleming's balm 25 g

Vitaon Lux 25 ml

Heparin balm 25 g

How to Choose the Right Product

Choosing the right product depends on several factors: the stage of hemorrhoids, the most bothersome discomfort, the location of the nodes (internal or external), and overall health.

In the early stages, topical products — suppositories or balms— are often sufficient on their own. During a flare-up, a combination of oral venotonics and topical products is usually needed. In the chronic stage, the focus shifts to avoiding recurrences through courses of venotonics.

If pain is the main complaint, products with anesthetics are the right choice. For bleeding — hemostatic agents. For node thrombosis — heparin-based balms. For pronounced irritation — soothing components.

A key principle of hemorrhoid supoort: systemic support (venotonics) works from the inside, improving vein health. Topical products (suppositories, balms) work from the outside, providing fast discomfort relief. For best results, they should be used together.

How to Support Hemorrhoids Effectively: Plans and Recommendations

Effective hemorrhoid support is not just about taking products. It's a comprehensive approach that includes products, lifestyle changes, and diet. Let's look at how to approach different situations.

What to Do During an Acute Flare-Up

An acute hemorrhoid flare-up is an episode of intense pain, irritation, and sometimes bleeding. The nodes enlarge and become painful, and thrombosis may develop.

First steps before seeing a doctor can help ease the discomfort. Cool compresses on the anal area for 10–15 minutes help reduce swelling and pain — cool, not ice-cold. Maximum rest, avoiding prolonged sitting or standing. A gentle diet to prevent constipation and reduce irritation. Careful hygiene after each bowel movement — rinsing with cool water.

The standard supportive plan for an acute flare-up typically includes several components:

1. Oral venotonics (Detralex, Phlebodia, Venarus) — reduce irritation and swelling from within, course of 7–10 days
2. Local anesthetics (suppositories or balms with lidocaine or benzocaine) — for fast comfort
3. Topical soothing products — suppositories or balms to reduce irritation
4. For thrombosis — heparin-based balms to help dissolve the clot

The acute phase typically lasts 3–7 days with proper support. Pain begins to ease within 1–2 days, swelling subsides by days 3–5. Full recovery may take 2–3 weeks.

If there's no improvement after 3 days of self-support or discomfort worsens — see a doctor without delay. More intensive measures may be needed, up to and including a minimally invasive procedure.

Supporting Chronic Hemorrhoids

Chronic hemorrhoids are a long-term condition with periods of flare-ups and remissions. The goal of support here is to extend discomfort-free periods as long as possible and avoid the condition from progressing.

Avoiding flare-ups involves taking courses of venotonics 2–3 times a year for 2–3 months each, especially during higher-risk periods (seasonal transitions, anticipated physical exertion). Lifestyle correction is essential: more physical activity, weight management, proper nutrition. Using topical products at the first sign of discomfort can help head off a full flare-up.

Maintenance support keeps the condition under control. Regular courses of venotonics strengthen the vessels and reduce the likelihood of flare-ups. Products are taken in 1.5–2 month courses with breaks in between.

Hemorrhoids During Pregnancy and After Childbirth

Pregnancy is one of the leading risk factors for hemorrhoids in women. The growing uterus presses on the pelvic veins, disrupting blood flow. Constipation, which frequently affects pregnant women, makes things worse. And pushing during labor can trigger an acute flare-up.

Supporting hemorrhoids during pregnancy comes with safety-related limitations on products. Most venotonics are contraindicated in the first trimester. In the second and third trimesters, some products are permitted — but only after consulting an OB-GYN.

The foundation of support during pregnancy is topical products. Plant-based suppositories and balms (sea buckthorn, calendula) and certain products with an approved safety profile. Particular attention should be paid to hygiene and preventing constipation.

Products generally considered safe during pregnancy (typically from the 2nd trimester):

• Natalsid (suppositories based on seaweed)
• Sea buckthorn suppositories
• Posterisan
• Relief (with caution, after consultation)

Postpartum hemorrhoids often flare up in the first weeks after delivery due to the intense pressure during pushing. During breastfeeding there are also product restrictions, though they are somewhat less strict than during pregnancy.

Safe options while nursing are mainly topical products. Many venotonics can be taken during lactation, but a doctor's consultation is advisable. Combining support with pelvic floor exercises is especially important during this period.

Lifestyle and Diet as the Foundation of Successful Support 

Even the most effective products won't deliver lasting results if the underlying causes are not addressed. Lifestyle changes are not a supplement to support — they're an essential part of it.

The diet for hemorrhoids focuses on normalizing bowel movements and avoiding constipation. Fiber is the cornerstone of the diet. Vegetables, fruits, whole grains, and bran help form soft, easy-to-pass stools. Fluid intake matters too — at least 1.5–2 liters of water per day keeps stools soft.

What to limit or avoid:

• Spicy seasonings and condiments — irritate the intestinal mucosa
• Alcohol — dilates blood vessels and increases blood flow to the nodes
• Smoked, salted, and pickled foods — promote irritation
• White bread, pastries, sweets — contribute to constipation
• Strong tea and coffee — have a binding effect

Meal timing also matters. Eating smaller portions 4–5 times a day promotes regular, effortless bowel movements.

Physical activity is critical for avoiding blood pooling in the pelvic area. Walking is the simplest and most accessible option — 30–40 minutes a day significantly improves circulation. Swimming is an ideal form of exercise, engaging all muscle groups without excessive strain. Targeted exercises for the perineal muscles can also improve venous drainage.

What to avoid: heavy lifting, strength training with straining, prolonged sitting or standing in one position. If your job is sedentary — get up every hour and take a short walk or stretch.

Proper hygiene helps prevent irritation. After each bowel movement, rinsing with cool water is preferable to using toilet paper. If that's not possible — use soft, unscented paper or specially designed moist wipes for intimate hygiene.

Avoid harsh soaps and scented shower gels in the anal area. Plain water or intimate hygiene products with a neutral pH are the better choice.

When Balms and Suppositories Are No Longer Enough

Conservative support is effective for stages 1–2 hemorrhoids. At stages 3–4, when nodes are permanently prolapsed or prolapse is combined with other complications, a surgical procedure is typically required.

Signs that surgery may be needed:

1. Nodes remain outside permanently and cannot be reduced
2. Frequent flare-ups (3–4 times a year or more) despite proper support
3. Node thrombosis that doesn't respond to conservative support
4. Heavy, recurring bleeding leading to anemia
5. Hemorrhoids combined with anal fissures or fistulas

Modern proctology offers not only traditional surgery but also minimally invasive options. Rubber band ligation — a small band is placed around the node, cutting off its blood supply until it detaches. Sclerotherapy — a substance is injected into the node to seal its walls together. Infrared coagulation — the node is supported with infrared light.

These methods are less invasive than traditional surgery, performed on an outpatient basis, and recovery takes just a few days. However, they're not effective for all stages or all forms of hemorrhoids. The choice of method is made by a proctologist after a thorough examination.

The golden rule: the earlier support begins, the better the chances of managing it without surgery. Don't endure it, don't be embarrassed, don't wait for it to "go away on its own." Hemorrhoids don't resolve by themselves — they progress.