i have been having hemorrhoids problems on/ off the last 12m or so ... i have fairly healthy diet. i have had history of UTIs .. antibiotics that made constipation real bad. when hemorrhoid problem lead to more bowel accidents ,and was told i was probably straining to hard when on the loo . i decided to change my bowel time slightly , by trying to avoid to use the commode chair over the loo , and doing my bowel evacuation on the bed and relearn to relax without straining , gradually my hemorrhoids heal up and i thus i having fewer bowel accidents .
For context, I'm an incomplete, and also no longer have a Gallbladder (so no bile storage device). I don't have sensation, but can (somewhat) bear down (albeit often completely ineffective). Bearing down (or the attempt to do so) exacerbates my hemorrhoids. I use a warm water enema, and it results in not having to bear down or to only lightly bear down. Hemorrhoids are a much smaller (pardon the pun) problem for me since switching to a warm water enema.