At a glance
Hemorrhoids are one of the most common colorectal conditions, and one of the most frustrating aspects is their tendency to return. Even after successful treatment — whether self-care, banding, or surgery — many people experience recurrence. Understanding why helps you take practical steps to reduce the risk.
Why they recur
Hemorrhoids are swollen blood vessels in and around the anal canal. They develop when pressure on these vessels causes them to stretch, swell, and sometimes prolapse. The key insight is that treatment addresses the symptoms and the existing swollen vessels, but it does not remove the underlying causes.
The factors that drive recurrence
Straining during bowel movements
This is the single most significant factor. Straining increases pressure in the rectal veins, which is exactly the mechanism that causes hemorrhoids in the first place. If the straining continues after treatment, new hemorrhoids will develop.
Straining is usually caused by:
- Hard stools from inadequate fibre or hydration
- Spending too long on the toilet
- The habit of pushing rather than allowing natural evacuation
Constipation
Hard, infrequent stools mean more straining. Chronic constipation is one of the strongest predictors of hemorrhoid recurrence. Managing stool consistency is the foundation of prevention.
Prolonged sitting
Sitting — particularly on the toilet — increases pressure on the anal cushions. People who sit for extended periods for work, or who read or scroll on their phone while on the toilet, are at higher risk.
Pregnancy and childbirth
The increased abdominal pressure during pregnancy, combined with hormonal changes that affect blood vessels, makes hemorrhoids common during and after pregnancy. They may resolve postpartum but can recur with subsequent pregnancies.
Ageing
The supportive tissues around the anal canal naturally weaken with age. Hemorrhoids become more common and more prone to recurrence as these tissues lose their elasticity.
Genetics
Some people are simply more susceptible. If hemorrhoids run in your family, you may have a greater tendency to develop them regardless of lifestyle factors.
Heavy lifting
Regular heavy lifting — whether occupational or recreational — increases intra-abdominal pressure. This pressure is transmitted to the rectal veins and can contribute to hemorrhoid development and recurrence.
What people do to prevent recurrence
Diet and stool management
- High-fibre diet — 25 to 30 grams per day from fruit, vegetables, wholegrains, and legumes
- Adequate hydration — two to three litres of water per day
- Fibre supplements — psyllium husk or similar to top up dietary intake
- Stool softeners when needed — better to use them proactively than to strain
Toilet habits
- Do not sit on the toilet longer than necessary — if the bowel movement is not happening within a few minutes, get up and try again later
- Do not strain — if the stool is not passing easily, the issue is stool consistency, not effort
- Respond to the urge — delaying bowel movements leads to harder stools
- Consider a footstool — elevating the feet changes the angle of the rectum and can make evacuation easier with less straining
Activity
- Regular exercise — promotes healthy bowel function
- Avoid prolonged sitting — take breaks every 30 to 60 minutes
- Moderate heavy lifting — use proper breathing technique and avoid Valsalva manoeuvres
When to seek further treatment
If hemorrhoids keep returning despite good lifestyle management, clinical options for longer-term management include:
- Rubber band ligation — effective for internal hemorrhoids, can be repeated
- Injection therapy (sclerotherapy) — shrinks the hemorrhoid tissue
- Hemorrhoidectomy — surgical removal, which has the lowest recurrence rate but the most significant recovery
- Stapled hemorrhoidopexy — repositions prolapsing tissue
Your doctor can assess which option is appropriate based on the type, grade, and frequency of your hemorrhoids.