Hemorrhoids aren’t exactly dinner-party conversation, but you or someone you know has likely dealt with them. In fact, there’s a good chance they’re sitting beside you at that proverbial dinner table: it’s estimated that roughly 50% of all people will have hemorrhoids by age 50.

Despite their ubiquity, there are lots of misconceptions about treating hemorrhoids. And since many people feel self-conscious about seeing a doctor for hemorrhoids, they don’t always get the help they need.

[time-brightcove not-tgx=”true”]

Several treatment options and lifestyle practices can make troublesome hemorrhoids go away. Here’s what colorectal surgeons want you to know.

What are hemorrhoids?

Technically, everyone has hemorrhoids. “Hemorrhoids in and of themselves are actually part of normal anatomy, so [they’re] nothing to be embarrassed about. We’re born with hemorrhoidal tissue,” says Dr. Titi Adegboyega, chief of colorectal surgery at South Shore University Hospital in Long Island, N.Y. “When people say they ‘have hemorrhoids,’ what they’re really saying is, ‘This thing that is normal is now acting abnormally or bothering me.’”

Sometimes called “piles,” they’re cushions of veins in the anal canal that help with fecal continence. Hemorrhoids are typically caused by straining from constipation or anything that increases intra-abdominal pressure leading to straining, such as pregnancy and childbirth, says Dr. David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital.

Hemorrhoids may cause symptoms when they become swollen or dilated. They can either be internal (inside the anal canal) or external. “External hemorrhoids often feel like a bump, whereas internal hemorrhoids cannot be seen unless they prolapse outside the anal opening,” he says. Common symptoms of hemorrhoids include itching, bleeding, and rectal pain.

Read More: The Best Way to Treat Insomnia

Internal hemorrhoids can be uncomfortable but aren’t typically very painful. “External hemorrhoids, on the other hand—they’re a pain in the butt,” says Adegboyega. “You feel them, they’re itchy, they irritate.” For small external hemorrhoids, those symptoms don’t tend to last past a few days. However, when people have a thrombosed external hemorrhoid—which is when a blood clot forms—severe pain can last for three to five days, with symptoms gradually subsiding over three weeks, says Adegboyega.

If you’re having intense, around-the-clock pain (especially after bowel movements), the more likely culprit is an anal fissure, which refers to tears in the lining of your anus. “It’s a cut, and just like when you have a wound, there is a pain associated with that wound all the time,” says Adegboyega. 

An anal abscess, which is typically caused by a local infection, is another potential diagnosis for anorectal discomfort and may be accompanied by symptoms like fever or chills.

That’s why seeing a colorectal surgeon is essential if you’re having these kinds of issues. Reviewing your history can help point doctors toward the most likely diagnosis.

How to treat hemorrhoids

Hemorrhoids often improve on their own. Plus, “there are a variety of management options that are not related to surgery or any procedures that can relieve your hemorrhoid symptoms,” Adegboyega says.

Here is what docs recommend you do if you have hemorrhoids.

Soften your stool

Constipation is one of the main causes. “Hemorrhoids are blood vessels, and they’re very fragile,” says Dr. Albert Chung, a colorectal surgeon in private practice in Orange County, Calif., and founder of the YouTube channel “Your Friendly Proctologist.”

When these blood vessels swell up, symptoms may ensue. That’s why Chung’s first line of attack is to implement a lifestyle routine to ensure soft stools 90-95% of the time. “It’s impossible to have 100%, because life is just like that,” he says. But Chung says you can promote mostly soft stools that are easy to pass by focusing on getting enough fiber, water, and exercise.

Read More: Are Dates Actually That Good for You?

Greenwald also endorses lifestyle remedies to address constipation: Aim for at least 25 grams of fiber per day, ensure adequate fluid intake (typically defined as 64 ounces or more of fluid each day), and engage in regular exercise of 30 minutes or more daily. Unfortunately, Greenwald says, doctors regularly see patients rely on over-the-counter medications for symptomatic relief of hemorrhoids without addressing the root cause of the problem, which is often straining and constipation. Just making these lifestyle changes can be “effective at preventing hemorrhoids” in the first place.

Some people may also benefit from adding a stool softener, fiber supplement, or both to their routine. Here are a few popular options:

• Docusate sodium (Colace) is a helpful stool softener if constipation is provoking your hemorrhoids, says Adegboyega.
• Psyllium husk fiber (which you can buy in unflavored powder form or under brand names like Metamucil), works as a sponge, helping to pull water into your GI tract and move things along, Adegboyega explains. When you take psyllium husk you need to increase your water intake, she says; not doing so could make stools even bulkier.
• Polyethylene glycol (MiraLAX), an osmotic laxative, and senna, a stimulant laxative, are other medications doctors may recommend. 

Talk to your doctor about which of these—if any—is the best option for you.

Getting your stool softer can happen in a variety of ways, says Adegboyega, but don’t overlook the simplest: “Some people just need to drink more water,” she says.

Use a pooping stool

Though we take bowel movements for granted, having one is a complex process that requires coordination of multiple body parts and processes, explains Chung. “Pelvic musculature needs to completely relax, which involves the pelvic floor lowering into the toilet bowl and the internal anal sphincter opening up,” so stool comes out uninhibited, he says. 

In this modern era, Adegboyega says, people are spending time on their phones while sitting on the toilet for a lengthy duration, which isn’t good for hemorrhoids. While toilet-reading is an age-old habit, limit your time on the toilet bowl to a few minutes. “You can also use a step stool to help to position you in a more squatting position, which alleviates the need to strain as much,” adds Adegboyega. If you don’t want to buy a stool designed for use during bowel movements like the Squatty Potty or Tushy Ottoman, you can try a footstool or even a yoga block or two.

Read More: 6 Health Myths About Oils

Following bowel movements, doctors also recommend “sitz baths” for people struggling with hemorrhoids. These are over-toilet vessels that you fill with warm water to sit in after a bowel movement to help soothe your anal region. Or you can just take a warm bath for 10–15 minutes. “This generally helps to relax the area and helps with the swelling,” says Adegboyega. Some people also find it helpful to put an ice pack on the area, which can have a numbing effect.

Try an over-the-counter medication

If it sounds too good to be true, it probably is. “Potions” sometimes advertised on the internet to cure hemorrhoids should be avoided, says Greenwald.

Stick to creams and suppositories doctors trust, like Preparation H, “which can really offer a good amount of relief,” says Adegboyega, and temporarily shrink hemorrhoidal tissue. Lidocaine, a numbing agent, is another good option, she says, because its direct goal is to help the pain and itchiness. Witch hazel pads also help relieve symptoms.

When you see a physician for hemorrhoids, they most frequently prescribe hydrocortisone, a steroid medication to help with inflammation, says Adegboyega. You can buy it over the counter in 1% strength, but “most of the time when we’re giving it as a prescription, it’s 2.5%,” in either a cream form or suppository version.

See a doctor

If your hemorrhoid symptoms haven’t resolved themselves in two to four weeks with at-home remedies, Chung says it’s time to see a doctor.

Adegboyega similarly points to the need to see a health care provider if your hemorrhoids are persistent: either your primary care physician, a gastroenterologist, or a colorectal surgeon. (Lots of women also confide in their ob-gyn.) That’s because telling a doctor you have anal pain doesn’t confirm any diagnosis without a comprehensive exam, which will include a review of your patient history and onset of symptoms, as well as a digital examination.

“It’s important for that area to be evaluated to make sure that what we’re calling ‘hemorrhoids’ are indeed hemorrhoids that are causing those symptoms,” says Adegboyega. Follow-up tests such as a flexible sigmoidoscopy or colonoscopy may also be recommended to rule out more serious gastrointestinal conditions, polyps, or colorectal cancers.

Read More: What to Expect at a Colonoscopy

Chung estimates that 90% of his patients come to him with hemorrhoids, and of the 14 million views on his YouTube channel, among his most popular videos are hemorrhoid-related ones such as “external hemorrhoid treatment” and “how to build a routine and avoid surgery.”

In advance of your appointment, do your homework. Research, go on Reddit, visit online forums to get more information, advises Chung. “People think that Dr. Google is horrible. In my opinion, Dr. Google is helpful, because it gives you more questions to ask the doctor when you finally see them.”

Surgical interventions and other treatment approaches

The treatment approaches discussed above—from dietary tweaks to ointments—are often effective quickly, generally within five to seven days, says Greenwald. However, some hemorrhoids will not respond to topical anti-inflammatory suppositories and creams and may need additional therapy including the application of thermal therapies, a rubber-band ligation technique which removes blood flow to internal hemorrhoids, and even surgery (hemorrhoidectomy), he says.

Some doctors prefer only to intervene surgically as a last resort. “Hemorrhoids are rarely life-threatening and never turn into cancer,” says Chung. As long as you aren’t losing so much blood that you’re severely anemic, or you don’t have painful prolapsed hemorrhoids, Chung prefers to avoid surgery on his patients. “The big thing is the coaching. I coach them with soft pooping so they can be successful,” without more invasive procedures, he says.

Should you be worried about blood in your stool?  

As Chung bluntly puts it, “bleeding from your arm bothers no one, but if it comes from your butthole, people are already jumping to the phone, jumping to the internet to find a solution.”

For many people, that’s because they’re worried about colorectal cancer, a disease that has been rising among young people. But doctors stress that considering the context—such as your age, family history of colon cancer,_, and when you’ve had your most recent colonoscopy—is key. “Rectal bleeding is one of the most common signs of colorectal cancer, but it is the most common sign, too, of hemorrhoidal symptoms,” says Adegboyega. This is why seeking medical attention matters, since it’s hard to tease out what is causing the bleeding episode without evaluating the bigger picture.

Of course, it’s natural to feel worried when you see blood in your stool. “Most of the time, that bleeding is not going to be from something more sinister like a cancer; it’s usually going to be from hemorrhoids,” says Adegboyega. When you have hemorrhoidal bleeding, the blood will be bright red, since hemorrhoids are at the end of the anal canal. “The bleeding in and of itself is just a very small fraction of the puzzle.” 

When in doubt, err on the side of caution and book that appointment. “It is important for people not to be embarrassed about seeking help for anal and rectal problems,” says Greenwald. “As I always say, don’t die of embarrassment.”