What to do when
you experience pain or bleeding etcEmergency
treatment
you can
do by yourself

Dealing with hemorrhoidal
symptoms such as pain,
bleeding, and itching

The hemorrhoidal symptoms on this page are merely examples, and the emergency treatment is meant as a temporary measure until you can get to a hospital. If you have any of the following symptoms, make sure to go to a hospital. If multiple symptoms occur at once, such as pain and bleeding, try a treatment method for stronger symptoms.

Overall supervision: Dr. Junichi Iwadare
Supervision: Dr. Akio Kurokawa
Supervision: Dr. Rikisaburo Sahara

Dealing with hemorrhoid symptoms such as pain, bleeding, and itching

If a sudden
pain occurs
If something
sticks out
If you have
sudden bleeding
If you have
an itch

If a sudden pain occurs

If you experience a sudden pain, you should immediately lie down and relax. We tend to stiffen when experiencing pain, which can cause tension in the anus, making the pain much worse.

How to relieve pain

1. First, lie down.

First, lie down on your side in bed with your knees slightly bent.
Relax your entire body to make sure that your anus is not tense. Once you have relaxed, stay lying down in the same position for a while.
Simply doing this can relieve even intense pain in most cases.
Once you have relaxed, try the pain relief method in step 2 below.

2. Relieve the pain.

First you need to identify what kind of hemorrhoid is causing the pain. Is it hemorrhoids (piles), an anal fissure, an anal abscess, or an anal fistula? Identifying the type of hemorrhoid helps you choose the right treatment method.
Refer to the following table and try a method that fits your symptoms to relieve the pain.

Symptoms	Possible type of hemorrhoid
Pain, piles coming out of anus, or swelling outside the anus	Hemorrhoids (piles)
Tearing pain during bowel movements	Anal fissure
How to care
Warming your anus and promoting circulation can often relieve symptoms. Instead of just a shower, soak the bottom half of your body in a bath to warm the affected area in warm water. Remember to soak in lukewarm water. If it hurts too much even to get into the bath, hold a warm, wet towel against the affected area or place a disposable heating pad on top of your underpants.

Symptoms	Possible type of hemorrhoid
Area around the anus is hot, red, and swollen, and throbbing with pain	Anal abscess・Anal fistula
How to care
Lie on your side and cool the affected area. If the area is leaking pus, warming it can have the opposite effect, making symptoms worse. Because anal fistulas cannot be treated at home, you must go to a hospital.

Symptoms	Possible type of hemorrhoid	How to care
Pain, piles coming out of anus, or swelling outside the anus	Hemorrhoids (piles)	Warming your anus and promoting circulation can often relieve symptoms. Instead of just a shower, soak the bottom half of your body in a bath to warm the affected area in warm water. Remember to soak in lukewarm water. If it hurts too much even to get into the bath, hold a warm, wet towel against the affected area or place a disposable heating pad on top of your underpants.
Tearing pain during bowel movements	Anal fissure
Area around the anus is hot, red, and swollen, and throbbing with pain	Anal abscess・Anal fistula	Lie on your side and cool the affected area. If the area is leaking pus, warming it can have the opposite effect, making symptoms worse. Because anal fistulas cannot be treated at home, you must go to a hospital.

Furthermore, incarcerated hemorrhoids and external thrombosed hemorrhoids can cause severe pain.

Incarcerated hemorrhoids
and
external thrombosed
hemorrhoids

If you have sudden bleeding

The type of bleeding differs depending on the type of hemorrhoid and how degree it has progressed. It could be a sign of colon cancer, so make sure to go to a hospital after emergency treatment at home.

How to deal with bleeding

Slow the bleeding

If you experience sudden bleeding, first clean yourself, and then place some toilet paper or cotton in your underpants to keep them clean, follow the instructions in the "If a sudden pain occurs" section, and lie down for a while.

Type of bleeding	Possible type of hemorrhoid, etc.
Small amount on toilet paper	This could be the initial stage of an anal fissure or internal hemorrhoids . In most cases, pain means it is an anal fissure.
Droplets of blood in the toilet	In most cases, this means that internal hemorrhoids have progressed and are somewhat large.
Blood coming out quickly	This could mean that internal hemorrhoids have gotten even larger.
How to care
Take a bath, etc. to clean yourself, and place some toilet paper, cotton, or other soft material against your anus to keep your underpants clean. Follow the instructions in the "If a sudden pain occurs" section and lie down.

Type of bleeding	Possible type of hemorrhoid, etc.
Blackish blood found in stool	This could indicate bleeding in the colon, etc. However, you should not let your guard down if it is not blackish. Fresh red blood also can indicate bleeding in the colon.
How to care
Go to a hospital immediately.

Type of bleeding	Possible type of hemorrhoid, etc.	How to care
Small amount on toilet paper	This could be the initial stage of an anal fissure or internal hemorrhoids. In most cases, pain means it is an anal fissure.	Take a bath, etc. to clean yourself, and place some toilet paper, cotton, or other soft material against your anus to keep your underpants clean. Follow the instructions in the "If a sudden pain occurs" section and lie down.
Droplets of blood in the toilet	In most cases, this means that internal hemorrhoids have progressed and are somewhat large.
Blood coming out quickly	This could mean that internal hemorrhoids have gotten even larger.
Blackish blood found in stool	This could indicate bleeding in the colon, etc. However, you should not let your guard down if it is not blackish. Fresh red blood also can indicate bleeding in the colon.	Go to a hospital immediately.

If something sticks out

If you feel like something is coming out of your anus, the most likely candidate is internal hemorrhoids. When pushing during bowel movements, the piles on the inside can come out. Usually, this does not cause pain. If there is no pain even when touching the piles, you can use your hand to push them back inside the anus.

How to push piles back inside

Do not push forcibly

If piles have come out of the anus after a bowel movement, first clean yourself, then, while sitting on the toilet seat, slowly push them back inside with your fingers. Then, stand up while holding them in to ensure they go back in smoothly.
If it is difficult to push piles back in, use a warm water washing toilet seat or a warm shower to warm the anus to make it easier. However, make sure not to use warm water for too long.
If the piles still will not go back in, go to the hospital instead of trying to force them in.
Note that prolapse of rectum can be mistaken for internal hemorrhoids that have come out of the anus, so make sure to go to a hospital instead of trying to diagnose the illness yourself.

If you have an itch

Stool can cling to the anus, causing inflammation and a clammy, itchy feeling, and washing the anus for too long with a warm water washing toilet seat can result in a dry itchy feeling. The hemorrhoids that have come out of the anus can rub against underpants and rectal mucus can stick to your bottom, causing a rash and itchiness.
These symptoms are collectively called pruritus ani.

How to relieve itching

Keep clean

The way to deal with itching differs slightly depending on the type of itching. Please check the following table. Once you have finished, make sure to wear underwear made of cotton or some other breathable fabric. Synthetic fibers can be got stuffiness. It is also important to review how you usually wipe after bowel movements.

Types of itchiness	Possible causes
Dry itchiness	Washing the anus for too long with a warm water washing toilet seat.
Clammy itchiness	Soft stool is stuck in the wrinkles of the anus, which creates unsanitary conditions.
How to care
Wipe thoroughly after bowel movements. Later, it may be good to use an anti-itch ointment or other ointment for delicate areas. Make sure not to wash too much with a warm water washing toilet seat.

Types of itchiness	Possible causes
Other	Hemorrhoids prolapsed out of the anus are rubbing on underpants, or the mucus is traveling along the hemorrhoids, sticking to your bottom and causing a rash.
How to care
Wipe thoroughly after bowel movements. If it is difficult to clean well, use a warm water washing toilet seat for a light wash, then thoroughly dry the area around the anus.

Types of itchiness	Possible causes	How to care
Dry itchiness	Washing the anus for too long with a warm water washing toilet seat.	Wipe thoroughly after bowel movements. Later, it may be good to use an anti-itch ointment or other ointment for delicate areas. Make sure not to wash too much with a warm water washing toilet seat.
Clammy itchiness	Soft stool is stuck in the wrinkles of the anus, which creates unsanitary conditions.
Other	Hemorrhoids prolapsed out of the anus are rubbing on underpants, or the mucus is traveling along the hemorrhoids, sticking to your anus and perianal and causing a rash.	Wipe thoroughly after bowel movements. If it is difficult to clean well, use a warm water washing toilet seat for a light wash, then thoroughly dry the area around the anus.

What to do when you experience pain or bleeding etcEmergency treatment you can do by yourself

Dealing with hemorrhoidal symptoms such as pain, bleeding, and itching