Do You Need to Go to a Doctor for Hemorrhoids?

Ah, friends. They’re like family, but cooler. Fully customizable. Fall and one of them will be right there to pick you back up. But as great as friends can be, they also do a lot of really stupid stuff. Stuff that blows your mind. Like, sometimes it seems crazy that you even hang out with people who make such crappy decisions. Stuff that, were it to get out, would be mortifying for anyone with even a shred of self-respect. Lucky for your friends, they’ve got you to ask their deepest, darkest questions for them. And lucky for you, we started this new column to answer those most embarrassing of queries.

The scenario: Your “friend’s” butthole is bleeding, itching, and/or painful, and she hasn’t engaged in anal in, like, a really long time.

The hope: That the universe rewards her for ignoring all recent texts from the guy she met at that Strap On Jo workshop—and the hemorrhoids go away on their own.

The reality: Hemorrhoids are swollen veins on your rectum or anus that get jacked up usually as a result of constipation (but pregnancy can do it too, as can spending long spells sitting on the toilet, which your friend almost definitely does now that the VICE app is so rad). So if your pal developed them after a weeklong tour of France’s cheesemaking region, they might in fact magically disappear when she goes back to eating kale salad every day.

What to do: If said hemorrhoids came on out of the blue—or she just can’t imagine not being proactive where regular bleeding out of a second orifice is involved—she might want to jump on the home-remedy bandwagon before getting worried about upsetting possibilities like cancer (that comes later—see below).

“Increasing your fiber and fluid intake leads to less straining and softer stool, which is effective for a lot of patients,” Benjamin Lebwohl, a Columbia University gastroenterologist, told VICE. And an over-the-counter cream containing an anesthetic and steroid can reduce inflammation. If you’d rather go to hell than put Preparation H in your handbasket, Lebwohl recommends taking a sitz bath, which is a fancy way of saying “soak your ass in a bathtub filled with a few inches of warm water,” two or three times a day. This can ease the discomfort and possibly hurry along the recovery process.

If your symptoms don’t start to improve after a week, make an appointment with a gastroenterologist, who may recommend shrinking your hemorrhoids the professional way—i.e., cutting off blood supply with a rubber band, zapping them with a laser, or cutting them out.

The worst thing that can happen: “Left untreated, hemorrhoids can lead to anemia [iron deficiency],” Lebwohl said. That’s pretty rare, unless you’re bleeding heavily. Another fun possibility: blood clots, which can cause nearby tissue to die and might require surgery to remove. “But my biggest concern is that you think the bleeding is due to hemorrhoids when it’s actually a symptom of colon cancer,” Lebwohl explained. (You probably don’t have cancer, but if you did, you’d likely be bleeding without itching or pain, and you might have unexplained weight loss, fatigue, or any of these symptoms.) Friends don’t let friends run that risk.