Skip to main content


The pain, itching, or irritation has returned, and you know instantly that you’re having a hemorrhoid flare-up. It’s natural to wonder what your hemorrhoids are caused by, and what makes the condition come back after you’ve gotten rid of it.

The truth is that the causes of flare-ups vary from person to person and there is, unfortunately, often no clear reason for why they occur1.

The bottom line: knowing the different possible causes of hemorrhoids is the first step in learning to manage them. Learn more about what could be causing your piles in this guide.


Hemorrhoidal discomfort is a condition where your hemorrhoids, the blood vessels in your lower rectum and around your anus, are swollen, dilated, and inflamed.

Hemorrhoidal discomfort can include:

  • External itch
  • External pain
  • Internal burning
  • Internal pain
  • Swelling of hemorrhoidal tissue
  • Surface inflammation
  • Painful bowel movements
  • Bleeding

There are several possible causes of hemorrhoids and reasons why you might suffer from recurrent piles flare-ups, but here are some of the most common:

  • Straining during bowel movements
  • Straining due to chronic constipation or diarrhea
  • Sitting or standing for long periods of time
  • Being overweight
  • Pregnancy or childbirth
  • Not eating enough fibre2
  • Exerting yourself with heavy lifting*

* This guide is provided for informational purposes only and is not intended as a substitute of any kind for professional medical advice, diagnosis or treatment of a qualified professional as required. Speak to your healthcare professional before making any changes to your lifestyle or beginning or discontinuing any course of treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this site.

There is not known to be a difference in the causes of external hemorrhoids and internal ones – both can be caused by straining on the toilet, pregnancy, being overweight, heavy lifting, a diet lacking in fibre, and other reasons we’ve covered.

Visit your doctor if your flare-ups happen frequently. If your symptoms become severe, such as heavy bleeding when using the toilet, get medical help immediately1.


Flare-ups can occur at any time with or without warning. They can cause pain, itching, irritation, burning and sometimes bleeding. For some, flare-ups are related to things like stress, diet, and constipation. The length and severity of a flare-up varies by person.

Luckily, there are many options for treating flare-ups and relieving your symptoms – our Preparation H range includes cream, gel, suppositories and soothing wipes to reduce discomfort and help your piles heal. If your hemorrhoid symptoms persist for longer than 7 days after treating them at home, get in touch with your doctor1.


Inadvertently, stress can be a factor in causing piles flare-ups. Since stress can have a strong impact on the digestive system – sometimes causing diarrhea or constipation – piles can appear because of this and the associated straining on the toilet3.

If you feel like stress could be contributing to your hemorrhoidal discomfort, speak to your doctor. They may be able to refer you to counselling to help relieve your stress and can also advise on how to improve your gut health and hemorrhoid issues. Make sure you eat a healthy balanced diet featuring plenty of fibre, and drink lots of water, to help keep digestive problems and piles at bay1.


  1. NHS. Piles (haemorrhoids). Accessed 05/11/2023.
  2. Mayo Clinic. Hemorrhoids. Accessed 05/11/2023
  3. Better Help. Can Stress Cause Hemorrhoids?. Accessed 05/11/2023.