Why Do My Haemorrhoids Keep Coming Back?

Introduction

If this sounds familiar — you manage things for a while with creams and dietary changes, they settle, and then a few months later the symptoms are back — you're in very common company. Many people go years cycling through flares before anyone sits down with them to talk about why it keeps happening and what can actually be done about it.

The most useful thing to understand is that different treatments have very different rates of recurrence. Dietary changes alone — without treating the haemorrhoids themselves — address the contributing factors but leave the existing disease in place. Rubber band ligation is effective but treats one haemorrhoid at a time and has a meaningful long-term recurrence rate. Surgical haemorrhoidectomy is the most definitive option and has the lowest recurrence rate of all. Understanding this helps you have a much more useful conversation with your surgeon about what "treated" actually means in your situation.

What are haemorrhoids — and why do they recur?

Haemorrhoids are cushions of tissue inside the anal canal that enlarge, slide down (prolapse), or bleed when subjected to too much pressure — from hard stools, straining, or weakened connective tissue support. When treated with banding or other non-surgical options, the targeted tissue shrinks and scars away. But the underlying factors that caused the enlargement in the first place are still there. If nothing changes, the remaining tissue in the anal canal tends to enlarge over time and produce the same symptoms again.

It's also worth knowing that there are three main haemorrhoidal columns in the anal canal — roughly at the 3, 7, and 11 o'clock positions. Banding typically treats one column per session. Even if one column is effectively treated, the other two may remain symptomatic or develop problems later. Surgery removes all three columns at once, which is a big part of why its recurrence rate is much lower.

Symptoms that suggest recurrence

When haemorrhoids return, the symptoms tend to look similar to what you had before — though sometimes worse, since the underlying condition has often progressed a little further each time:

• Bright red rectal bleeding coming back after a period where things had settled
• Prolapse returning — tissue coming down that wasn't doing so before
• Increasing itching or mucous discharge around the back passage
• Discomfort or the feeling of something present at the anal opening
• Having to push tissue back in with your finger again

Common causes of recurrence

Ongoing dietary factors

This is the most common — and most overlooked — driver of recurrence. Haemorrhoids that have been treated, even surgically, will come back if you continue eating a low-fibre diet, staying dehydrated, and passing hard stools that require straining. Dietary change isn't optional; it's the foundation that any treatment needs to sit on. Getting to a consistent daily intake of 25–35g of fibre and 1.5–2 litres of water makes a genuine, clinically meaningful difference to stool consistency and how much you're straining.

Toilet habits

Spending a long time on the toilet — especially with your phone or something to read — significantly increases the pressure on the tissue inside the anal canal. Ideally that area is kept closed; sitting on an open seat with nothing pushing back allows the cushions to slide downward under their own weight. Limiting toilet time to what's actually necessary, not straining, and using a small footstool (to get a more natural squatting position) all reduce that downward pressure.

Incomplete treatment

If you had banding for one or two haemorrhoid columns but the third was left untreated, those remaining cushions will often enlarge over time — especially if dietary factors haven't been addressed. A common pattern is: one banding session, things feel better, assume it's resolved — then returning symptoms 12–18 months later from the columns that were never treated.

Treatment choice — recurrence rates vary significantly

The data here is worth knowing. Approximate recurrence rates at five years for common treatments are:

• Dietary management alone: very high recurrence if the haemorrhoids themselves aren't treated
• Rubber band ligation: approximately 25–30% recurrence at 5 years
• Surgical haemorrhoidectomy: approximately 5% recurrence at 5 years

This isn't an argument that everyone needs surgery — for many people, repeat banding is a completely reasonable approach to managing things long-term. But if you've had multiple rounds of banding and keep coming back, the conversation about surgery is genuinely worth having.

Ageing and connective tissue weakening

As we get older, the connective tissue that keeps the haemorrhoidal cushions in their proper position becomes less elastic and less supportive. This is why haemorrhoidal disease tends to progress over decades — prolapse becomes more prominent, and symptoms develop more easily. Surgery tends to become more appropriate in older patients with recurrent or progressive disease for exactly this reason.

Pregnancy

Pregnancy causes haemorrhoids to enlarge quickly because of the increased pressure in the pelvic veins and hormonal changes that loosen the connective tissue. Many women who were successfully treated before pregnancy find their haemorrhoids return or worsen during pregnancy and after delivery. If you're planning future pregnancies, the timing of any definitive surgical treatment is worth discussing with your surgeon.

When to worry about "recurrence"

Not everything that looks like a recurrence actually is one. Before putting returning symptoms down to haemorrhoids, it's worth asking:

• Has the bleeding changed? If it's heavier than before, mixed through the stool, or comes with a change in your bowel habits — don't assume it's haemorrhoidal, even if you have a history of them
• If you're over 50 and haven't had a colonoscopy in the past 5 years, a new episode of rectal bleeding warrants investigation rather than reassurance
• If there are other symptoms alongside the bleeding — unexplained weight loss, abdominal pain, or fatigue suggesting anaemia — those need proper assessment

Treatment options for recurrent haemorrhoids

Reinforce the dietary foundation

Before considering further procedures, be honest with yourself about whether fibre intake, hydration, toilet time, and straining habits have actually been consistently sorted out. For many people, recurrence happens because dietary changes were made during the symptomatic episode and then quietly abandoned once things felt better. A daily fibre supplement (psyllium husk, Metamucil, or similar) taken consistently every day — not just when you're flaring — is one of the most effective long-term tools available.

Further rubber band ligation

If previous banding treated one column effectively, the remaining columns can be banded in follow-up sessions. If you've now had two or three sessions and keep recurring from the same spots, that starts to suggest either the disease is too advanced for banding alone, or a more definitive approach is needed.

Surgical haemorrhoidectomy

For recurrent symptomatic haemorrhoids that haven't responded durably to banding — particularly Grade III or IV disease — surgical haemorrhoidectomy gives the most definitive and longest-lasting result. The recovery is more involved than a clinic procedure, but the much lower recurrence rate means it's often the most practical option in the long run, both for quality of life and to stop the cycle of repeated appointments and procedures.

When surgery is the right answer

The decision to go ahead with surgery after multiple recurrences is ultimately a quality-of-life decision, and it should be made together with your surgeon. Most surgeons will raise it when you've had two or more courses of banding with meaningful recurrence, when haemorrhoids are Grade III–IV, or when the impact on your day-to-day life — blood on your clothes, difficulty keeping clean, pain, or the ongoing anxiety of it — has become disproportionate to anything conservative management can offer.

Haemorrhoidectomy is performed under general anaesthetic as a day procedure. The first week is the most uncomfortable; most people describe the pain as significant but manageable with regular pain relief and warm sitz baths (soaking the area in warm water). The majority are back to desk work within 2 weeks and fully recovered by 4–6 weeks.

Frequently asked questions