Each person with multiple sclerosis (MS) experiences the condition differently. Because of this, it can be difficult to tell whether new symptoms are related to the condition or if they could be caused by something else entirely. If you have developed hemorrhoids (swollen veins in or around the anus), you may be wondering whether MS is to blame.

Although MS does not directly cause hemorrhoids, its symptoms can indirectly cause hemorrhoids to form. Read on to learn more about hemorrhoids in MS, including what they are, why they occur, and how they can be managed. As always, talk to your neurologist if you develop a new symptom.

What Are Hemorrhoids?

Hemorrhoids (also known as piles) occur when blood vessels or veins in your anus or rectum swell. These swollen veins can be either inside your anal canal (internal hemorrhoids) or outside it, right around the anus (external hemorrhoids).

The symptoms accompanying hemorrhoids can vary. Some may be itchy and mildly annoying, while others can cause significant pain and discomfort. When hemorrhoids break open (rupture) or protrude from the anus from the inside (prolapse), they can bleed. It can be worrying to see blood in the toilet bowl or on toilet paper. Other possible symptoms of hemorrhoids include swelling around the anus or visible prolapsed hemorrhoids.

Any time you have rectal pain or rectal bleeding, you should see a doctor. They will be able to identify the cause and help you find a solution.

How Can Hemorrhoids Affect Life With MS?

A number of MyMSTeam members have experienced hemorrhoids. “Has anyone had issues with hemorrhoids?” one member asked. “I am only 28 years old, and mine are pretty bad. I don’t want to eat.”

Other members have reported experiencing significant pain with hemorrhoids. “I have been woken from sleep (a precious commodity!) with stabbing pain in my rectum,” one explained. “It happens during the day also. It has nothing to do with needing to use the bathroom, just horrible, stabbing pain.”

Another member wrote, “I’m in so much pain it’s unbearable. I have left two voicemails for my primary care doctor/nurse. I have an appointment Thursday, but I can no longer wait. I went to the ER, but all they could do was pack the hemorrhoids, and that is not what I want. I just want them gone in the worst way.”

What Causes Hemorrhoids in MS?

MS does not directly cause hemorrhoids, but it can cause bowel problems that then lead to hemorrhoids.

Multiple sclerosis is characterized by demyelination, or damage to the protective coating surrounding the nerve cells in the central nervous system. When demyelination causes MS lesions to form on the parts of the brain that control bowel function, messages between the brain and the bowel can become disrupted.

When these messages are disrupted, it can cause problems with the sensations and muscle control in the back and bottom of the anus. This can result in bowel problems like incontinence (lack of control over the bowels), diarrhea, or constipation. Some people may find that they alternate between constipation and diarrhea.

Constipation and diarrhea, especially when lasting for long periods of time, can lead to hemorrhoids. As one member wrote, “I have hemorrhoids and not really being able to go to the bathroom makes them worse.”

Note that MS is not always responsible for bowel problems like constipation or diarrhea. Certain medications, infections, dehydration, and dietary issues (like lack of fiber) can all contribute, as well. It is also possible to have another health condition in addition to MS that affects your bowels.

Managing Hemorrhoids

Managing hemorrhoids effectively can improve your quality of life, and there are many treatment options available for doing so. Your health care provider can help you find a treatment that works for you and is compatible with any MS treatments that you are already using.

Treat Constipation or Diarrhea

Since hemorrhoids in people with MS are usually caused by diarrhea and constipation, getting these problems under control may give your hemorrhoids a chance to heal.

Treating Constipation

There are a number of things you can do to help with chronic constipation. Your doctor may suggest making certain lifestyle changes or trying home treatments first, as these can often be effective while having minimal side effects.

Lifestyle changes or home remedies that help constipation include:

• Making dietary changes to add more fiber to your diet, usually in the form of fruits, whole grains, and vegetables or fiber supplements
• Training your body to empty your bowels at a certain time each day
• Adding physical activity to your routine to the extent that you are comfortable
• Drinking water, at least 48 ounces per day, preferably more
• Using a sitz bath with warm water and witch hazel
• Applying ice packs to the tender area

If those solutions don’t work, your doctor may recommend suppositories, enemas, or stool softeners.

One MyMSTeam member found a combination of these methods to be effective at treating her constipation. “I have that problem chronically, but take stool softeners twice daily along with Miralax. Works pretty well.”

You may also find that sitting in a crouching position when you have a bowel movement makes it easier and takes away your need to strain. One member wrote, “I had hemorrhoid surgery. I’m still using my stool — no problems since.” (Stools to prop your feet up while using the toilet are commonly available online.)

Treating Diarrhea

Diarrhea tends to trouble people with MS less than constipation. When it does occur, however, it can still cause hemorrhoids. If you experience chronic diarrhea, your doctor may perform a physical exam and test you for other conditions that cause persistent diarrhea, like an infection, inflammatory bowel disease (like Crohn’s disease, for example), a parasite, and more.

If your diarrhea is caused by overactive bowel functioning due to MS, your doctor may prescribe medications to manage it. Otherwise, they may prescribe a “bulk former,” like Metamucil, which can help bulk up your stool, making it more substance and less water.

Over-the-Counter Hemorrhoid Treatments

If you have aggravated hemorrhoids and want to alleviate your pain while you try the treatments above, there are a number of over-the-counter options that can help. These come in many forms, including wipes, suppositories, pads, ointments, and creams. These don’t always offer lasting help, but they can lessen the severe pain of hemorrhoids, which makes them easier to deal with until you can effectively address the root cause. As with any over-the-counter treatment, talk to your doctor before trying any new product for hemorrhoids.

One member has found these treatments effective: “I have had hemorrhoids before. I just used over-the-counter Tucks wipes and they went away.”

Hemorrhoid Surgery

If you cannot alleviate your hemorrhoids by treating the underlying cause or using the management methods above, your doctor may recommend one of several surgical treatments to deal with them.

Many of these are highly effective, minimally invasive, and may only require a local anesthetic. One member shared their experience with surgery: “At 22 or 23, I had hemorrhoid surgery. Fixed them pretty much until I had kids — now just little ones. Get the surgery — I think mine was laser treatment (right in the office and really easy). WELL worth it.” A rubber band ligation — a procedure in which a doctor wraps small bands around hemorrhoidal tissue to cut off its blood flow, causing it to eventually drop off — also falls into this category.

In some rare cases, hemorrhoids might involve more invasive surgery, like a hemorrhoidectomy. This is usually the last option, though, because the other treatments tend to be highly effective.

Find Your Team

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 185,000 members come together to share their support and experiences living with MS.

Are you dealing with hemorrhoids on top of multiple sclerosis? Share your story or tips in the comments below or by posting on MyMSTeam.