Hemorrhoids (almoranas): home care, medicines and when bleeding needs a doctor

Almoranas is the Filipino word for hemorrhoids, also called piles. Everyone has veins and soft tissue in and around the anus. When too much pressure makes them swell, they are called hemorrhoids.

• Internal hemorrhoids are inside the anus. They are usually painless but can bleed. Sometimes they slip out through the anus (a prolapse).
• External hemorrhoids are under the skin around the anus. They can itch and hurt, especially when you sit.

It is very common, affecting about half of adults over 50 in the United States. It is not a sign of being dirty.

Almoranas can cause:

• bright red blood after you poo, on the toilet paper or in the bowl
• itching around the anus
• one or more lumps at the anus, from pea-sized to grape-sized
• pain or aching, often worse when sitting
• mucus (slime) on your underwear, or feeling you still need to poo

For many people, external hemorrhoid symptoms go away within a few days. A sudden, hard, very painful lump may be a blood clot in an external hemorrhoid (a thrombosed hemorrhoid) and needs a check the same day.

Almoranas is the most common cause of bleeding from the bottom, but not every bleed is almoranas. Other causes include a small tear in the anus (anal fissure), which hurts sharply when you poo; gut infections with bloody diarrhea; bowel inflammation; sexually transmitted infections; blood thinners and aspirin (do not stop a prescribed medicine on your own); and polyps or colorectal (bowel) cancer. Our blood in stool guide explains the other causes.

PhilHealth notes that colorectal cancer is the third most common cancer among Filipinos. The WHO says the risk rises sharply after age 50. Get checked soon if you have:

• blood in your poo (poo that is dark red or black needs a check the same day)
• looser, harder or thinner poo than usual, or a change in how often you go, for 3 weeks or more
• tummy pain, a tummy lump, bloating that does not go away, or weight loss without trying
• tiredness, weakness, shortness of breath or paler skin than usual

The last group can be signs of anemia (low red blood cells) from slow bleeding. A blood test can check. Red foods such as beets and tomatoes can make poo look red, and iron tablets can make it dark. If you are not sure, get checked.

Almoranas forms when there is too much pressure on the veins around the anus, from:

• constipation (hard, dry poo) and straining on the toilet
• sitting on the toilet for a long time, for example scrolling on your phone
• long-term diarrhea
• a low-fibre diet: lots of processed, instant and snack food such as chips, and few vegetables and fruit
• pregnancy and childbirth
• getting older, being overweight, or liver disease such as cirrhosis
• often lifting heavy things, as in construction, farm or warehouse work

"Galing sa pag-upo sa mainit o malamig na upuan." The health sources we checked do not list hot or cold seats as a cause. Straining and long sitting on the toilet are what matter.

"Bawal ang maanghang." Spicy food is not listed as a cause. If chili makes it sting when you poo, eat less. Fibre matters more.

"Normal lang ang dugo." Bleeding can also be a sign of other problems, including cancer. Have new bleeding checked.

"Itulak, talian o hiwain sa bahay." You may gently push a soft lump back in if it goes easily. Never tie, cut or squeeze a hemorrhoid, and do not let anyone massage it (hilot). Banding should only be done by a doctor.

Garlic, kalamansi, toothpaste, alcohol or tawas on the area. No source we checked recommends these, and they can sting or burn delicate skin. Boiled guava leaves (dahon ng bayabas) are not mentioned in our sources either. Plain warm water is enough. If you still use a leaf wash, let it cool to warm and stop if it stings.

Most almoranas gets better with home care. The goal is soft poo that passes without straining.

1. Eat more fibre: vegetables such as malunggay, kangkong and okra, fruits such as papaya and saging, kamote, monggo and other beans, oatmeal, and brown rice. Add it slowly to avoid kabag.
2. Drink enough water, and cut down on alcohol.
3. Do not strain or sit long. Go when you feel the urge, and leave your phone outside. Resting your feet on a low stool, knees above hips, makes pooing easier.
4. Take a sitz bath: sit in a basin (palanggana) of warm, not hot, water for 10 to 15 minutes, several times a day and after you poo.
5. Clean gently. Washing with plain water from a tabo or bidet is fine. Do not scrub or use strong soap, and pat dry.
6. Cool the swelling with an ice pack wrapped in a towel. Wear cotton underwear and try not to scratch.

A fibre supplement such as psyllium, or a stool softener, can help: ask a pharmacist and follow the label. See a doctor if you are not better after 1 week.

Creams, ointments and suppositories (a suppository is a small medicine pushed gently into the anus) may contain a numbing medicine, a soothing ingredient, or a mild steroid such as hydrocortisone. Some need a prescription, so ask the pharmacist which suits you and follow the label.

• Use them for no more than about 1 week unless a doctor says otherwise. Longer use can make the skin thin or sensitive.
• Stop and see a doctor if the skin gets more red, swollen or sore. A steroid can make an infection worse.
• Witch hazel dabbed on with a cotton swab may ease itching.

For pain, paracetamol is a common choice: follow the label. Do not take ibuprofen or aspirin for pain if you are bleeding, and avoid painkillers with codeine, which cause constipation.

Ask a doctor or pharmacist before buying tablets sold as gamot sa almoranas. If you are pregnant, breastfeeding or treating a child, ask a doctor before using any cream, suppository or tablet.

If almoranas keeps bleeding, keeps slipping out or does not improve, a surgeon may suggest:

• Rubber band ligation: a band cuts off the blood supply and the hemorrhoid falls off, usually within a week.
• Sclerotherapy (an injection) or coagulation (heat or a mild current) to shrink it.
• Hemorrhoidectomy (cutting the hemorrhoids out) or stapling, under anesthesia, for large or stubborn ones.

The first two are usually done awake, and you go home the same day. A very painful clot can be removed through a small cut. Almoranas can return if straining continues: see How to prevent almoranas.

Start at your barangay health station, rural health unit (RHU) or city health center: find one near you. For procedures you may be referred to a surgeon. The health worker will look at the area and may check inside with a gloved finger (you can ask for someone to stay with you). Some people need a colonoscopy, a camera test of the large bowel.

PhilHealth YAKAP. As of July 2025, check-ups at your YAKAP clinic are free (a private one may charge up to ₱900 a year), and if you need a colonoscopy, your YAKAP doctor can refer you to an accredited facility that should not charge you for it. GAMOT, the YAKAP medicines benefit, covers up to ₱20,000 of medicines a year (July 2025). Its June 2026 list includes paracetamol and iron tablets for anemia when your YAKAP doctor prescribes them, but not hemorrhoid creams or fibre supplements. See our PhilHealth YAKAP guide.

Screening. PhilHealth's 2025 standards offer colorectal cancer screening to adults aged 45 to 75 and to people whose parent, sibling or child had colorectal cancer, starting with a yearly stool test for hidden blood (FIT). If you already have symptoms, do not wait for screening: tell your doctor now. See our annual check-up guide.

Procedures and surgery. PhilHealth's case-rate list (adjusted in 2024, the newest we found) pays accredited facilities from ₱15,639 to ₱23,634 depending on the procedure, with ₱23,634 for most hemorrhoidectomies. If you are admitted to a ward bed, its no co-payment policy says you may have nothing more to pay. Ask the billing office first, and the Malasakit Center for help with any balance. See what PhilHealth covers.

Not sure? Ask our symptoms assistant or book a nurse call.

Pregnancy and after birth. Almoranas is common then. Fibre, water, gentle exercise, not standing or sitting for long, and a cloth wrung out in cold water are safe first steps. Ask your doctor or midwife before using any cream or medicine, for example at your prenatal check-ups.

Children. Small tears at the anus (anal fissures) are common in young children, often after hard poo. Any blood in a child's poo needs a doctor's check.

The habits that treat almoranas also keep it away:

• eat vegetables, fruit, beans and whole grains every day, and fewer low-fibre snacks and fast food
• drink water through the day, more in hot weather
• go when you feel the urge, and do not strain or linger on the toilet
• walk or move every day, and avoid regular heavy lifting
• treat constipation early, and see a health worker if it keeps happening (see our stomach pain guide)