…tub baths several times a day in plain, warm water for about 10 minutes
…application of a hemorroidal cream or suppository to the affected area for a limited time

Preventing the recurrence of hemorrhoids will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fiber and fluids in the diet. Eating the right amount of fiber and drinking six to eight glasses of fluid (not alcohol) result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding.

Good sources of fiber are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
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The diet should be modified to increase fibre and bulk. This may be achieved using pharmacological bulking agents.

This approach may also prevent deterioration in patients who already have piles.

The time spent defecating should be minimised.
Bulk-forming laxative agents include:

bran
ispaghula husk
methylcellulose
sterculia granules
Bulk-forming laxatives:

have been shown to decrease abdominal pain and improve stool consistency
bulk-forming laxatives they are only required if dietary fibre cannot be increased sufficiently – an effective bulk-forming preparation is unprocessed wheat bran (taken with food or fruit juice)
not appropriate for acute relief, as they may take several days to work, but they are a good option for long-term control
bulk-formng agents increase stool bulk. The increased stool bulk then stimulates peristalsis. Clearly to prevent obstruction, fluid intake must be maintained
it is essential to drink adequate amounts of fluid when using bulk-forming laxatives to avoid intestinal obstruction.
flatulence and abdominal distension are the most common side effects.
Bulk forming laxatives are contraindicated in patients with existing bowel obstruction or faecal impaction.
Laxatives are agents which promote bowel evacuation.

They may be overused and abused. In excess, they may cause diarrhoea, dehydration, hypokalaemia, atonic bowel and weight loss.
Most authors agree that low-fiber diets cause small-caliber stools, which result in straining with defecation. This increased pressure causes engorgement of the hemorrhoids, possibly by interfering with venous return. Pregnancy and abnormally high tension of the internal sphincter muscle can also cause hemorrhoidal problems, presumably by means of the same mechanism. Decreased venous return is thought of as the mechanism of action. Prolonged sitting on a toilet (eg, while reading) is believed to cause a relative venous return problem in the perianal area (a tourniquet effect), resulting in enlarged hemorrhoids. Aging causes weakening of the support structures, which facilitates prolapse. Weakening of support structures can occur as early as the third decade of life.

Straining and constipation have long been thought of as culprits in the formation of hemorrhoids. This may or may not be true. Patients who report hemorrhoids have a canal-resting tone that is higher than normal. Of interest, the resting tone is lower after hemorrhoidectomy than before. This change in the resting tone is the mechanism of action of Lord dilatation, which is most commonly performed in the United Kingdom.

Pregnancy clearly predisposes women to symptoms from hemorrhoids, although the etiology is unknown. Notably, most patients revert to their previously asymptomatic state after delivery. The relationship between pregnancy and hemorrhoids lends credence to hormonal changes or direct pressure as the culprit.

Portal hypertension has often been mentioned in conjunction with hemorrhoids. Hemorrhoidal symptoms do not occur more frequently in patients with portal hypertension than in those without. Massive bleeding from hemorrhoids in these patients is unusual. Bleeding is very often complicated by coagulopathy. If bleeding is found, direct suture ligation of the offending column is suggested.

Anorectal varices are common in patients with portal hypertension. Varices occur in the mid rectum, at connections between the portal system and the middle and inferior rectal veins. Varices occur more frequently in patients who are noncirrhotic, and they rarely bleed. Treatment is usually directed at the underlying portal hypertension. Emergent control of bleeding can be obtained with suture ligation. Portosystemic shunts and, more recently, transjugular intrahepatic portosystemic shunts (TIPS) have been used to control hypertension and, thus, the bleeding.

Attention to regular and soft bowel movements is important. Bulk agents (eg, psyllium seed) and oral fluids are important. Bathing in tubs for comfort and hygiene is part of the routine. Judicious narcotic administration relieves pain
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