The Bummed Guide to Hemorrhoids, Anal Fissures & Anal Itching
August 20, 2025
This blog was created using an AI model of Carmen’s book, Constipation Nation.
Hemorrhoids
What Are Hemorrhoids, Really?
If you’ve ever Googled “Why does it feel like I’m sitting on a grape?”—you’re probably familiar with hemorrhoids.
But here’s the truth: everyone has hemorrhoids.
Hemorrhoids are not a disease. They’re part of your normal anatomy—vascular cushions located in your anal canal. Their job is to help keep your poop in. They provide bulk and seal. They’re like little air pillows that expand and contract with pressure.
So what’s the problem?
They become symptomatic when they swell, bleed, or prolapse. This usually happens when you strain to poop, sit on the toilet too long, or ignore the urge to go. Once irritated, they can:
- Bleed with wiping or stool passage
- Protrude outside the anus
- Cause discomfort, itching, or a “full” sensation
There are two main types:
- Internal hemorrhoids: painless bleeding or protrusion
- External hemorrhoids: painful, swollen lumps at the anal opening
Understanding this anatomy helps you understand that hemorrhoids aren’t an infection, cancer, or a punishment for eating poorly. They’re your body’s own structures, just angry.
Why You Keep Getting Hemorrhoids (and How to Make Them Stop)
Let’s talk about patterns. If your hemorrhoids flare up after every vacation, every stressful deadline, or every week you eat less fiber—there’s a reason.
Here are the usual suspects:
- Straining: Whether it’s constipation or habit, pushing increases rectal pressure.
- Sitting too long: Especially on the toilet. Those 10-minute scrolls? They press on the vessels.
- Dehydration: Hard stools are harder to pass. The harder you push, the more irritated your hemorrhoids become.
- Low-fiber diet: Without enough fiber, your poop stays small, dry, and reluctant to exit.
What makes it worse?
- Ignoring the urge to go
- Frequent diarrhea (yes, too much wiping causes irritation too)
- Pregnancy, where increased pressure and hormones collide
The 6 Types of Hemorrhoid Treatments—From Creams to Surgery
If you’ve tried every cream in the pharmacy aisle and your hemorrhoids still won’t quit, it may be time to explore other options. The right treatment depends on what kind of hemorrhoid you have and how severe it is.
Here are your options:
- Lifestyle changes: Hydration, fiber, bathroom habits, and movement. Still the first line of defense.
- Topical creams & suppositories: These may help with symptoms, especially if there’s inflammation or itching, but they won’t fix the hemorrhoid itself.
- Custom compounded prescription creams: Bummed’s prescription treatments are uniquely formulated to target the inflammation, swelling and irritation, providing immediate relief as well as longer-term results. Our prescriptions use more than just active ingredient, and so they are often more effective than out-of-the-box prescriptions that may only include lidocaine or hydrocortisone.
- Rubber band ligation (RBL): Office-based. A tiny band cuts off blood flow to an internal hemorrhoid so it shrivels and falls off.
- Sclerotherapy or infrared coagulation: Injection or light-based options to shrink internal hemorrhoids. Less common, but effective.
- Surgical excision: Used for large external hemorrhoids, persistent bleeding, or protruding skin tags that interfere with hygiene.
No one wants surgery, but when hemorrhoids interfere with your life, you deserve relief. The good news? Most people never need it if they intervene early.
Do I Really Need Hemorrhoid Surgery?
Short answer: Probably not.
Most hemorrhoids improve with basic changes—diet, water, not sitting too long. But here’s when it might be time to talk about surgery:
- You have persistent bleeding despite trying everything.
- You’ve developed skin flaps that trap stool or make wiping difficult.
- Your hemorrhoids protrude constantly and cause hygiene issues.
- You’re in pain that’s not improving.
Surgical options include:
- Hemorrhoidectomy: removal of the hemorrhoid tissue
- Stapled hemorrhoidopexy: pulling the tissue back up, often for prolapsing internal hemorrhoids
- Excision of thrombosed external hemorrhoids (done early for sudden painful lumps)
- Surgery isn’t for everyone. But if your quality of life is suffering—talk to a colorectal surgeon.
Sitting Is the New Pooping Problem: How Your Toilet Habits Cause Hemorrhoids
Let’s talk about your relationship with your toilet.
If your bathroom break includes 15 minutes of scrolling TikTok, you’re not just wasting time—you’re stressing out your anus.
Here’s the physiology:
Sitting with your hips flexed increases pressure in the rectal veins. Over time, that pressure distends the hemorrhoidal cushions, weakening their support and leading to swelling or prolapse.
Mammals poop in about 12 seconds. That includes elephants. If you’re there longer, something’s wrong—or nothing’s ready to come out.
The 12-second rule:
- Feel the urge → go
- Sit for a few minutes
- If nothing happens, get up
The longer you sit, the more likely your hemorrhoids are to get squeezed. Don’t bring your phone. Bring your awareness.
You just birthed a human being. Your body is healing. But now there’s a painful bump at your anus that bleeds, itches, or makes sitting unbearable.
Welcome to postpartum hemorrhoids.
During pregnancy:
- Hormonal changes soften vessels
- The growing uterus adds pressure on pelvic veins
- Constipation is common (thanks, progesterone and iron)
During labor:
- Pushing increases pelvic floor strain
- Blood vessels stretch or rupture
- External hemorrhoids may appear suddenly
After delivery:
- Internal hemorrhoids often resolve on their own
- External skin flaps may persist
- Pain and swelling typically improve in 1–2 weeks with:
- Sitz baths
- Ice packs
- Stool softeners
- Witch hazel pads (sparingly)
If a skin flap remains and causes hygiene issues, a surgical excision may be needed later—but there’s no rush. You’ve done enough.
Bummed also provides pregnancy-safe treatment options for pregnant and post partum women, including our Long-Acting Hemorrhoid & Fissure Rx Cream.
Anal Fissures
What’s That Sharp Pain When I Poop?
If it feels like you’re pooping shards of glass—or like something ripped on the way out—you may have an anal fissure.
A fissure is a tiny tear in the skin of your anus, usually caused by a hard or large stool. It sounds minor, but the pain can be excruciating. You may see bright red blood on the toilet paper, feel a stinging spasm after wiping, or start dreading your next bowel movement.
The injury itself isn’t dangerous—but it can become a cycle of pain and fear. The more you tense up to avoid hurting, the harder it becomes to relax and go. And that tension? It slows blood flow to the tear, delaying healing.
Fissures are common, treatable, and more about muscle tone than hygiene. The key is to break the cycle before it becomes chronic.
The Difference Between Hemorrhoids and Anal Fissures
Both fissures and hemorrhoids can cause blood and discomfort—but the experience is very different.
- Fissure = sharp, cutting pain during or right after a bowel movement. May include bleeding.
- Hemorrhoid = pressure or swelling, sometimes with blood, but usually not painful unless thrombosed.
Dr. Fong’s tip:
“If it feels like a paper cut on your butthole, it’s probably a fissure.”
Fissures are more likely to hurt with each poop. Hemorrhoids tend to come and go in waves, often related to straining or sitting too long. Getting the diagnosis right helps you get the right treatment—and relief.
Why You Got a Fissure (and How to Prevent the Next One)
Let’s be blunt: hard poop tears your anus.
That’s how most fissures start. A bulky, dry stool stretches the anal canal too fast, and something gives—right at the midline, where the skin is thinnest. But that’s not the only cause:
- Constipation → hard stool + straining = injury
- Diarrhea → frequent wiping + acidic stool = irritation
- Tight pelvic floor → tension increases risk
- Delaying the urge to poop → stool dries and hardens
Preventing future fissures means changing the behavior that caused the first one:
- Hydrate
- Eat fiber, and add in a fiber supplement
- Go when you feel the urge
- Take your time, but not too much time (12-second rule!)
The Silent Saboteur: How Holding in Poop Causes Anal Fissures
We’re taught not to poop in public. To hold it until we’re home. But every time you ignore that natural urge, your colon continues to absorb water from the stool—making it harder.
By the time you’re ready to go, that stool has turned into a rock. And the anus? It tightens in response to stress or shame. Then you strain. Then it tears. Hello, fissure.
Dr. Fong’s one rule:
“Go when you have to go. Don’t go when you don’t.”
Bathroom shame is deeply ingrained, especially for women. But the consequences are real—and avoidable.
Treating a Fissure Without Surgery
Good news: most anal fissures heal without surgery.
Treatment is all about reducing pressure and soothing the tissue:
- Warm sitz baths: 10–15 minutes, 2–3 times daily
- Stool softeners: to keep bowel movements gentle
- Topical creams: prescription ointments that relax the anal sphincter (e.g., nifedipine, nitroglycerin). Check out Bummed’s custom compounded prescription creams here.
- Fiber and hydration: to prevent recurrence
Only chronic fissures—those lasting more than 6 weeks or resistant to treatment—require surgical evaluation. And even then, it’s a minor procedure with high success.
Pruritus Ani (Anal Itching)
Why Your Butt Itches (And Why Wipes Might Be to Blame)
Anal itching (also called pruritus ani) isn’t just annoying—it’s often misunderstood. Most people think it’s caused by being “dirty.” So they wipe more. Use scented wipes. Add creams. And the itch? Gets worse.
Here’s why:
- Wipes and soaps strip away your natural skin barrier
- Steroid creams used long-term thin the skin
- Overwashing leaves your butt dry, raw, and vulnerable
You don’t have to clean your anus with industrial strength. Your butt isn’t broken—it’s over-loved.
Don’t Do Anything to Your Butt You Wouldn’t Do to Your Mouth
Dr. Fong puts it simply:
“Would you rub a scented wipe on your gums three times a day?
Would you scrub your tongue with a washcloth?”
Of course not. The skin around your anus is just as delicate. It’s not meant for frequent abrasion or chemicals. So when in doubt, treat your anus like your lips: gently, respectfully, and with minimal friction.
The Perpetual Itch: Understanding Pruritus Ani
The most frustrating part of anal itching? The itch-scratch cycle. It goes like this:
- You feel itchy → you wipe/scratch
- Skin barrier weakens → more irritation
- You feel even itchier → more scratching
This feedback loop leads to chronic inflammation, especially if you’re also dealing with:
- Hidden hemorrhoids
- Fungal or bacterial imbalance
- Allergies to laundry detergent, soap, or diet
Breaking the cycle starts with stopping the over-cleaning. The skin needs time and space to heal.
Stop the Scratch: How to Actually Treat Anal Itching
Let’s talk treatment:
- Step 1: Stop using wipes or soaps. Water only. Pat dry, don’t rub.
- Step 2: Wear cotton underwear. Avoid synthetic fabrics.
- Step 3: If needed, try a bland barrier cream—like zinc oxide or petroleum jelly.
- Step 4: If you suspect infection (especially if moist, weeping, or foul-smelling), see a provider. We recommend Bummed’s Anti-Itch Pruritus Ani Rx Cream, which includes clotrimazole for its antifungal properties and hydrocortisone to calm inflammation.
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Bummed content is for general education and should never replace professional medical advice that considers your individual health. If you think you’re experiencing a medical emergency, call 911 or head to the nearest emergency department.
