I have them arise when sitting for a long time, holding in my BMs as a young man. Being very inactive and sitting a lot. I do not know why myself more than some other people. I have a several health issues and they have arisen from time to time throughout my life. Usual conservative therapy worked like upping fiber in my diet and waiting. Keeping clean..(showering and cleansing the rear after each BM)
For the past 12 months they've become more aggressive and the tissue back there gets irritating by both loose and hard stool brought upon by diet change. I have found rinsing after each BM with cool water and avoiding sitting as much as possible being the best recipe. I had a bout in April-May of last year that mostly cleared. Again this year and they've mostly cleared again by merely using cool water repeatedly in the shower...washing out that area.. No soap, just a steady flow of constant rinse. I have bought both essential oils and coconut oil but I'm trying to avoid any other method aside stool softener in Miralax and Metamucil. The only two things I add in. I still cannot sit long without issues and have to be cautious with the spasms from orgasms. Although other than that the tissue back there heals well. Faster than I thought it would... Relaxing and focusing on relaxing is key. I know some people cannot. What a nightmare! Being active and changing sitting positions also seems to help. I hope this continues! Gets better... my health is poor but I don't want another issue!