Patient Education · Forest Hills, Queens
How to Sleep With Hemorrhoids: The Best Positions and a Pre-Bed Routine for Relief
There is no single best sleeping position for hemorrhoids, because pressure on the swollen tissue can hurt from almost any angle. For most people, side-lying with a pillow between the knees is the most tolerable, since it keeps direct weight off the anal area. Stomach sleeping with a thin pillow under the hips is the backup. Sleeping flat on your back is usually the least comfortable. A warm sitz bath and an over-the-counter numbing cream before bed help you actually fall asleep.
(718) 261-0900Medically reviewed by Dr. Yuriy Israel, MD, Board-Certified Gastroenterologist | 10+ Years Experience | Last Updated: September 2026
As Dr. Yuriy Israel of Gastroenterology & Nutrition, P.C. explains, "Hemorrhoidal pain comes from external hemorrhoids when they get thrombosed. Unfortunately, there is no best position. Sometimes just touching the hemorrhoid may hurt, so sleeping on your back may not be the greatest. You might try sleeping on your belly or side. If you cannot see your proctologist or gastroenterologist soon, you can use over-the-counter numbing creams like lidocaine to reduce pain and ensure a good night's sleep."
Why Hemorrhoids Hurt More at Night Than During the Day
Most people with hemorrhoids notice the pain peaks right when they lie down to sleep. A few things line up at night to make that happen:
- Lying flat sends more blood to the pelvis. Gravity no longer pulls blood down toward your legs, so more of it pools in the rectal veins. Vessels that are already swollen get more pressurized.
- Fluid from the day redistributes. Swelling fluid that settled in your lower legs during the day shifts back when you go horizontal, which can worsen swelling around existing hemorrhoids.
- Warm bedding widens surface blood vessels. Heat under a heavy comforter dilates the small vessels near the skin, including the hemorrhoidal cushions.
- A quiet room makes pain louder. The same flare you managed to ignore all day feels sharper once there are no distractions.
- Stool can sit in the rectum overnight. Slower gut movement during sleep can leave stool in place, adding pressure against a tender hemorrhoid.
Knowing which of these is driving your pain tells you what to fix. The sections below cover position, bed setup, and a short pre-bed routine that targets each one.
The Best Sleeping Position for Hemorrhoids Is the One That Keeps Weight Off the Swollen Tissue
There is no position that works for everyone, especially with a thrombosed external hemorrhoid where even light contact hurts. The goal is simple: keep direct weight and pressure off the anal area. Ranked from most to least tolerable for most people:
- Side-lying with a pillow between your knees. First choice for most.
- Stomach with a thin pillow under your hips. Second choice, and often better if side-lying still puts pressure on the tender spot.
- Flat on your back. Usually the least comfortable, because it presses external hemorrhoids into the mattress.
Side-Lying With a Pillow Between Your Knees Works for Most People
Lying on your side keeps your body weight off the anal area entirely. A medium-firm pillow between your knees keeps your hips level and your pelvis open, so nothing twists or presses on the rectal area. A memory-foam knee pillow or a folded standard pillow both do the job. Either side is fine; pick whichever hurts less.
Stomach Sleeping With a Thin Pillow Under Your Hips Is the Backup
If side-lying still presses on the sore spot, try your stomach with a thin pillow under your hip bones. That small lift takes weight off the anal area. Keep the pillow thin, since a thick one arches your lower back and trades one ache for another.
Sleeping Flat on Your Back Puts Direct Pressure on External Hemorrhoids
Back sleeping is usually the least comfortable option with hemorrhoids, because it presses external hemorrhoids straight into the mattress. If back sleeping is the only way you can fall asleep, place a pillow under your knees to tilt your pelvis and reduce some of that pressure.
Set Up Your Bed to Take Pressure Off the Area
Small changes to your bedding make the positions above easier to hold all night:
- Knee pillow for side sleepers. Keeps hips aligned and stops your top leg from rolling forward and twisting the pelvis.
- Hip pillow for stomach sleepers. A thin pillow under the hip bones lifts weight off the anal area.
- Donut cushion for the evening. If daytime sitting feeds your nighttime pain, a donut cushion with a hole in the middle keeps weight off the anal cushions while you read or watch TV. Use it for an hour or two before bed, then move to side-lying in bed.
- Cool, breathable cotton sheets. Heavy down comforters and synthetic sheets trap heat, which dilates surface blood vessels and worsens swelling. Cotton or bamboo sheets and a lighter blanket keep the area cooler.
A 20-Minute Pre-Bed Routine That Calms Hemorrhoid Pain Before Sleep
Position matters, but a short routine before you lie down does more to get you to sleep.
Take a 15-Minute Warm Sitz Bath
A sitz bath is a shallow soak of just your hips and buttocks in 3 to 4 inches of warm water. Use a basin that fits over the toilet rim, or run a few inches of warm water in the tub. Warm water relaxes the anal sphincter and improves blood flow, which eases pain and itching. The National Institute of Diabetes and Digestive and Kidney Diseases recommends soaking the anal area in plain warm water for 10 to 15 minutes a few times a day. Plain water is enough; do not add Epsom salt unless your doctor tells you to.
Use a Cold Compress First for a Fresh, Acute Flare
For the first 24 to 48 hours of an acute flare, a cold compress wrapped in a thin cloth and held on the area for 10 to 15 minutes numbs the pain and calms inflammation. After the first 48 hours, switch to warm sitz baths to encourage healing.
Apply an Over-the-Counter Numbing or Anti-Inflammatory Cream
Right before bed, a topical product buys you a few hours of relief. Options that address different parts of the problem:
- Lidocaine or pramoxine creams numb the pain directly. This is the step Dr. Israel points patients to when they cannot get in to be seen right away.
- Hydrocortisone 1% reduces inflammation and itching. Do not use it more than 7 days in a row without medical guidance.
- Witch hazel pads or spray (Tucks) reduce swelling and irritation and are gentle enough for frequent use.
Take an Oral Pain Reliever Only If Pain Is Blocking Sleep
Short-term ibuprofen or naproxen (one to two nights) reduces both inflammation and pain. Avoid these if your hemorrhoid is bleeding, since they thin the blood, or if you recently had a colonoscopy with polyp removal. Acetaminophen (Tylenol) is the safer choice in those cases.
Wear Loose Cotton Sleepwear
Tight underwear, synthetic fabric, and elastic waistbands all add friction and trap heat against the anal area. Loose cotton sleepwear and clean cotton underwear, with a thin liner in case of overnight bleeding, keep the area cool, dry, and breathable.
Daytime Habits That Stop Nighttime Hemorrhoid Flares
How you sleep tonight partly depends on what you did today. The biggest lever is keeping stool soft so you never strain:
- Build up your fiber slowly. Aim for roughly 25 grams a day for women and 38 grams for men, and increase by about 5 grams per week. Adding it all at once causes gas and bloating that make things worse first. Psyllium husk (Metamucil or generic) is the best-studied fiber for hemorrhoid symptoms.
- Drink water through the day. Eight to ten cups keeps stool soft and easier to pass.
- Do not strain or sit long on the toilet. Prop your feet on a small footstool so you are closer to a squat, which relaxes the rectum.
- Move a little every day. Twenty to thirty minutes of walking keeps things moving and reduces pressure.
- Ease off late, heavy, spicy meals and evening alcohol. Finish dinner about 3 hours before bed, since alcohol and caffeine worsen dehydration and constipation.
When Hemorrhoid Pain at Night Means You Should See a Gastroenterologist
Most hemorrhoid pain settles within a week or two of the routine above. External hemorrhoids usually take about three to four weeks to fully resolve, as long as you avoid straining, heavy lifting, and long periods of sitting. See a gastroenterologist if you notice any of the following:
- Bleeding that lasts more than a few days, or any blood clot
- Severe pain that over-the-counter creams and pain relievers do not control
- A hard, painful lump at the anus, which can be a thrombosed hemorrhoid that is easiest to treat within 48 to 72 hours of onset
- Symptoms that last longer than 7 days despite home care
- Recurring flares, or hemorrhoids during pregnancy or after childbirth
- Fever, pus, or spreading redness, which can signal infection
Rectal bleeding should always be evaluated rather than assumed to be hemorrhoids, since other conditions can cause it. A gastroenterologist can confirm the diagnosis and, when home care is not enough, treat the hemorrhoid directly. For related reading, see our hemorrhoids condition page, our guide on whether hemorrhoids can be removed during a colonoscopy, and our explainer on whether hemorrhoids cause stomach pain.
Get Hemorrhoid Relief at Gastroenterology & Nutrition, P.C. in Forest Hills, Queens
If lost sleep from hemorrhoid pain has gone on more than a week, our team can evaluate you and treat the underlying problem so the nights get easier. Dr. Yuriy Israel, Dr. Samuel Davidoff, and the gastroenterology team at Gastroenterology & Nutrition, P.C. in Forest Hills have treated hemorrhoids in-office since the practice was founded in 2008, including rubber band ligation performed on-site in the AAAASF-accredited suite.
Call (718) 261-0900 to schedule. We offer same-week consultations and Sunday appointments, and our providers speak English, Russian, and Spanish.
Disclaimer: This information is provided for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Please schedule a consultation with our team to discuss your individual needs.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Hemorrhoids: niddk.nih.gov
- Mayo Clinic, Hemorrhoids, Symptoms and Causes: mayoclinic.org
- Cleveland Clinic, Thrombosed Hemorrhoids: my.clevelandclinic.org
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