Hemorrhoids: what helps at home, and when bleeding needs a doctor

• Itching around the anus
• An ache or pain, mostly when sitting
• A soft or tender lump near the anus
• A little bright-red blood on the toilet paper or on the stool after a bowel movement

Not every sign like this is a hemorrhoid. Bleeding from the rectum (the end of the bowel) can have other causes, so tell a doctor about it.

Hemorrhoids come from pressure on the veins near the anus. Straining on the toilet, constipation, sitting on the toilet a long time, pregnancy and heavy lifting can all add pressure.

• Eat more fiber, like fruits, vegetables and whole grains. A fiber supplement, like psyllium, can help too.
• Drink plenty of water and other fluids.
• A stool softener can make bowel movements easier.
• Do not strain, and do not sit on the toilet for a long time.
• Sit in a few inches of warm water (a sitz bath) for 10 to 15 minutes, a few times a day.
• A hemorrhoid cream with hydrocortisone or a numbing medicine, or witch hazel, can ease itching and pain.
• Wear cotton underwear and use plain, unscented toilet paper or wipes.

If store products do not help after 1 week, talk with a doctor.

Call 911 or go to the emergency room if you lose a lot of blood, or if you are bleeding and feel dizzy, lightheaded or faint.

Get care the same day for severe pain near the anus with bleeding, especially if you also have belly pain, diarrhea or a fever. Also get care the same day for a fever with a painful swelling near the anus.

• More than a small amount of blood, bleeding that keeps going, or blood clots
• Black, tarry or maroon stools
• Feeling very tired or short of breath, which can come from losing blood over time
• Severe pain, or a hard and very tender lump. A blood clot in a hemorrhoid may need a quick procedure, so get seen within a day or two.
• A change in your usual bowel habits, or weight loss you cannot explain
• New bleeding from the rectum at age 45 or older. You may need colon cancer screening.
• Fever, pus, or a painful swelling near the anus

If you are in Virginia or West Virginia, you can start a visit online at any time. It is for adults 18 and older with classic signs: itching, discomfort, a soft lump, or a small amount of bright-red blood on the toilet paper.

A board-certified physician reviews your answers. If medicine is right for you, the doctor can send a prescription to your pharmacy. If you need to be seen in person, the doctor will tell you.

It is not for anyone with the emergency signs or the in-person reasons above, or with inflammatory bowel disease (Crohn's disease or ulcerative colitis).

Visits start at $59. You see the price before you pay, and you do not need insurance.