Haemorrhoids are a common and often frustrating condition. While in most cases, they clear up completely after treatment, there are cases where they reoccur.
Haemorrhoids are closely linked to pressure within the lower rectum, and unless the underlying causes of that pressure are addressed, recurrence is always a possibility. Understanding what causes haemorrhoids, and when to consider further treatment, can make a significant difference in breaking that cycle.
Here we’ll explore why some haemorrhoids keep coming back, and the things you can do to prevent recurrence.
Why do haemorrhoids come back?
Haemorrhoids are swollen blood vessels in the lower rectum or around the anus. They tend to develop when there is repeated strain or pressure in this area. One of the most common triggers is constipation. When stools are hard or difficult to pass, straining becomes more likely, increasing pressure on the rectal veins and causing them to enlarge.
Diet plays a central role here. A low-fibre diet, inadequate fluid intake, and irregular eating patterns, can all contribute to sluggish bowel movements. Over time, this creates the perfect environment for haemorrhoids to form and reoccur.
Frequent diarrhoea can also be a trigger. While it may seem counterintuitive, repeated irritation and inflammation of the anal canal can weaken supporting tissues, making haemorrhoids more likely to come back.
Other contributors include prolonged sitting, particularly on the toilet, and lifestyle factors such as inactivity or carrying excess weight. In some cases, there may also be a genetic predisposition.
Breaking the cycle with lifestyle changes
Preventing recurrence often starts with reducing strain on the bowel. Regular, soft bowel movements are key. This usually involves a combination of dietary fibre, hydration, and routine.
Increasing fibre intake gradually through foods like whole grains, fruit, vegetables, and pulses, can help create bulkier, softer stools that are easier to pass.
Hydration is equally important. Fibre works best when it absorbs water, so drinking enough fluid throughout the day helps maintain the right consistency.
Responding promptly to the urge to go, rather than delaying, can prevent stools from becoming harder and more difficult to pass. Spending prolonged periods on the toilet, particularly with straining, should also be avoided where possible.
Despite best efforts, some haemorrhoids continue to return or fail to settle completely. Symptoms such as persistent bleeding, discomfort, itching, or prolapse (where haemorrhoids protrude), may indicate that further assessment is needed.
Modern treatment options and recurrence rates
Two commonly used treatments are rubber band ligation and haemorrhoidal artery ligation (HAL). Rubber band ligation involves placing a small band around the base of the haemorrhoid, cutting off its blood supply so it shrinks and falls away. It’s a relatively quick procedure and works well for many patients, particularly in earlier stages.
HAL is a more targeted approach. Using ultrasound guidance, the surgeon identifies and ties off the arteries supplying the haemorrhoids, reducing blood flow and allowing them to shrink. This technique addresses the underlying blood supply issue, rather than just the visible swelling.
A 2025 systematic review and meta-analysis comparing these approaches found that while both offered similar short-term relief, HAL was associated with lower recurrence rates over time. This suggests that for patients experiencing repeated episodes, a more targeted intervention may provide longer-lasting results.
At the Warwick Bowel and Hernia Clinic, we focus on understanding why haemorrhoids keep returning and tailor treatment accordingly. For some patients, small adjustments are enough to restore comfort. For others, a procedural approach may offer a more durable solution.
If you’re dealing with persistent, recurring haemorrhoids, book an appointment with Mr Stellakis at the Warwick Bowel and Hernia Clinic.
