The best sleeping position for hemorrhoids

The best sleeping position for hemorrhoids, for most people in a flare, is on your side with a pillow between your knees. That keeps a sore external lump from being pressed straight into the mattress. No clinical trial has tested sleep position for hemorrhoid pain. A PubMed search on sleeping position and hemorrhoids does not turn up that trial. What follows is the closest research: pregnancy sleep studies, vein-compression studies at the end of pregnancy, and papers on why itch gets worse at night.

If the lump is on the outside and it hurts when you sit or roll over, the symptom guide is external hemorrhoids. The night-itch piece has its own page too: why hemorrhoids itch more at night.

The most comfortable position during a flare

Lie on your side, left or right. Bend your knees a little and put a normal bed pillow between them so the top leg has somewhere to rest. If lying on your back or your stomach presses the sore spot, turn onto your side. If one side hurts and the other does not, use the side that lets you sleep.

That is comfort advice. We did not find a study that assigned people with hemorrhoids to side, back, or stomach sleep and then counted pain scores. External hemorrhoids hurt because the swelling is under skin that has nerve endings. Internal hemorrhoids usually bleed or slip out and hurt less, unless a clot forms. The AGA says hemorrhoids cause significant pain when they are acutely thrombosed, meaning a small clot has formed, and that sharp pain during a bowel movement is more likely an anal fissure ⁹. Position changes will not empty a clot. They can make the night less miserable while it settles. A sudden hard lump is covered in thrombosed hemorrhoid.

Seat cushions, including donut pillows, are made for chairs and cars. We did not find a trial of sleeping on one. For daytime sitting, the options are on the best hemorrhoid pillows page. At night, use the bed pillow you already own.

What research exists on sleep position

No trial has measured hemorrhoid pain in different sleep positions. The studies below are the nearest neighbors: stillbirth and vein flow in late pregnancy, and night itch in skin disease. None of them counted hemorrhoid symptoms.

Side sleeping in pregnancy

Hemorrhoids are common late in pregnancy, which is why sleep advice and hemorrhoid advice get mixed together. The AGA says hemorrhoids occur in up to two-thirds of women during pregnancy, and that treatment should stay conservative: fiber, care of constipation, and topical ointments ⁹. In a Lithuanian cohort of 280 pregnant women examined through pregnancy and the first month after birth, 114 (40.7%) were diagnosed with hemorrhoids. Of the 123 women who developed a perianal problem, 61% of those problems showed up in the third trimester. Constipation was a strong predictor (odds ratio 18.98) ⁸. A short pregnancy review says most symptoms settle after birth, and that the main tools are fiber, stool softeners, fluids, and toilet habits ¹⁰. The week-by-week practical guide is hemorrhoids during pregnancy.

What the stillbirth studies actually compared

From 28 weeks, the position you fall asleep in has been studied for late stillbirth, not for hemorrhoids. A 2019 individual-participant meta-analysis pooled five case-control studies (851 stillbirths and 2,257 ongoing pregnancies). Going to sleep on the back was linked with higher odds of late stillbirth than going to sleep on the left side (adjusted odds ratio 2.63, 95% confidence interval 1.72 to 4.04). The right side was similar to the left (adjusted odds ratio 1.04, 95% confidence interval 0.83 to 1.31). The authors estimated that back sleeping accounted for about 5.8% of late stillbirths in these data ¹. The paper is the pooled analysis of going-to-sleep position and late stillbirth.

One study inside that pool, from New Zealand, looked at the last night before a stillbirth was thought to have happened. Back sleeping that night had an adjusted odds ratio of 3.67 (95% confidence interval 1.74 to 7.78). The estimate was higher for term stillbirths (adjusted odds ratio 10.26) than for preterm (3.12), and the term confidence interval was very wide, from 3.00 to 35.04, so that single number is unstable ². The pooled 2.63 figure is the better summary.

A different design asked the question forward in time. In a U.S. cohort, 8,706 of 10,038 women had sleep questionnaires and pregnancy outcomes. They reported sleep in the first trimester and again around 22 to 29 weeks. Going to sleep on the back or the right side did not come with a higher risk of the combined outcome of stillbirth, a small baby, or a blood-pressure disorder of pregnancy (adjusted odds ratios 1.00 at the first visit and 0.99 at the third). One stillbirth comparison at the later visit went the other way (adjusted odds ratio 0.27, 95% confidence interval 0.09 to 0.75), which the paper noted as an apparent exception. The prospective study of sleep position through 30 weeks concluded that back or right-side sleep, measured before any bad outcome and only through about 30 weeks, did not show those harms ³.

Put the two designs next to each other. Case-control studies of late pregnancy, especially the last night, find higher stillbirth odds with back sleeping, and they find left and right similar ¹. A large prospective study through 30 weeks does not find that harm ³. The practical instruction that matches the late-pregnancy signal is: from 28 weeks, settle to sleep on your side. You do not have to stay locked on the left. If you wake up on your back, roll onto a side again.

The vein studies, and what they do not prove

At the end of pregnancy the uterus can press on the inferior vena cava, the large vein that returns blood from the lower body to the heart, when you lie flat. In 20 women before a planned cesarean, an ultrasound measure of how much that vein collapsed with breathing was higher when they lay flat (mean 19.5%) than when the table was tilted 15 degrees to the left (mean 15.0%). The difference was modest (mean difference 4.5, 95% confidence interval 0.1 to 8.9). After spinal anesthesia and a phenylephrine infusion, the gap was no longer significant ⁴.

In 22 women, also before a cesarean, the vein’s maximum width was larger with a left tilt, and with the uterus lifted toward the left, than when they lay flat. The widest measurement was with the lift in 11 women (55%), with the tilt in 7 (35%), and while lying flat in 2 (10%) ⁵. So a left tilt helps many people at term and does not rank first in every person.

These ultrasound studies are about blood flow at the end of pregnancy. They did not ask anyone about hemorrhoid pain. It is reasonable to think that less pressure on the big vein is one reason side lying feels better late in pregnancy. That is a hypothesis. It is not a result from a hemorrhoid trial.

Pillows, including a pillow between the knees

Use one pillow between the knees so the top leg has a place to rest. In late pregnancy, many people add a second pillow under the belly. We did not find a trial of either pillow for hemorrhoids. Try the setup for two or three nights. Keep it if you wake up less sore. Drop it if it leaves your back sore and your sleep worse.

Two findings from other research still change the night:

• Constipation in the pregnancy cohort had an odds ratio of 18.98 for perianal problems ⁸. A softer stool the next morning matters more than the pillow angle. Fiber, fluids, and toilet habits are the tools named for pregnancy hemorrhoids ¹⁰.
• Long toilet sits and straining are on the NIDDK home-care list ¹¹. Cutting the evening sit is part of that home plan.

Why itching often gets worse at night

Itch that ramps up at bedtime is a known pattern in many skin diseases. A 2007 review of night itch says it is common, that it disturbs sleep, and that the mechanisms are not well understood. The authors point to the daily rhythm of the chemicals involved in itch, and to changes in skin temperature and skin-barrier function across the day. They also say specific treatments for night itch are scarce ⁶. A 2016 review adds that night scratching can show up in any sleep stage and is most often recorded in light sleep, stages N1 and N2 ⁷. Neither paper enrolled people with hemorrhoids.

A review of pruritus ani, the medical name for anal itch, says most treatment recommendations rest on low-level evidence. The plan it describes is to remove irritants, stop scratching, use general comfort measures, and then add active treatment. The authors say symptoms and skin changes often settle when that is done ¹⁴. Scratching is the part you can change tonight. It feels useful for a few seconds and leaves the skin more irritable for the next cycle.

A simple night routine

Use this order on a bad night. The soak, the one-week product limit, and the cold-pack trial have sources. The side-sleeping step does not.

1. Sit in warm water for about 10 minutes, at a temperature you can stay in without discomfort. In a 1993 study of warm baths and anal pressure, 18 healthy volunteers and 28 people with fissures or hemorrhoids sat for 10 minutes at 40, 45, or 50 degrees Celsius. Internal-sphincter activity dropped during the bath and drifted back over 25 to 70 minutes. Pain relief was stronger after the hotter baths ¹³. Those hotter settings were a lab protocol. Keep home water warm, not hot. Setup steps are in how to take a sitz bath. The AGA says sitz baths are often advised and that the data are limited ⁹.
2. Pat the skin dry. If the outside itches, a witch hazel pad is the usual cooling option, with the limits described in does witch hazel work for hemorrhoids. The NIDDK says doctors most often recommend over-the-counter products for 1 week, then a follow-up if you are no better or if the skin gets dry or a rash starts ¹¹. If the product contains a steroid, the AGA cap is 2 weeks ⁹.
3. If the area throbs, use a wrapped cold pack while you are still awake. After hemorrhoid surgery, ice packing produced lower pain scores in the first 16 hours than warm sitz baths, and less swelling at 24 hours ¹². That trial is about the hours after an operation, not a home flare. Packs made for this spot stay cold for about 15 to 20 minutes. Wrap the pack. A bare pack from the freezer can feel too cold, and hard seams can scratch. When to pick cold or warm is in ice or heat for hemorrhoids, and the product notes are on the best ice packs.
4. Lie on your side with the pillow between your knees. From 28 weeks of pregnancy, settle to sleep on your side ¹.
5. Keep your hands off the itch. The pruritus ani review treats scratching as something to stop, and it is honest that most of this advice rests on weak evidence ¹⁴.

Hemorrwedge (Cold pack)

Hemorrwedge Hemorrhoid Ice Pack (2 pack)

Best for: Swelling and throbbing when you want relief without medicine

ReusableTwo packsStorage case

A contoured, reusable cold pack shaped for the area. It is not inserted. It rests against the outside while you sit or recline.

What recent buyers say

Most reviewers who mention results call it a lifesaver for pain and swelling. The cold lasts about 15 to 20 minutes, which matches the usual advice anyway. The common complaints are hard seams that can scratch and packs that split after a while. Wrap it in a thin cloth, since some find it too cold straight from the freezer.

What buyers like

• Real relief from swelling and pain
• One pack freezes while you use the other
• Case keeps it separate from food

Common complaints

• Hard seams can dig in
• Some split at the seam over time
• Too cold without a cloth

Skip it if you want long cold sessions. Each pack stays cold for about 15 to 20 minutes.

Price $$$mid-rangeAmazon reviews checked September 2026

Check price on Amazon

The next 48 hours of home care, including the soak and the stool plan, are in how to get rid of hemorrhoids fast. Where pads and soaks sit next to office procedures is in hemorrhoid treatment.

If side sleeping and a 10-minute soak have not made the nights bearable after several days, book a visit. Average-risk adults should be up to date on colon cancer screening from age 45 ¹⁵.