Warning! Graphic detail ahead!
As a general rule, once you get piles, they don't go away. But that can and do shrink a bit, if you can remove whatever-it-is that was bringing them on in the first place.
In my case it was pregnancy. Especially the end bit, the childbirth. If you think about it, all that straining coupled with a body loaded with progesterone (which relaxes ligaments and blood vessel walls) means you're a cert for piles.
mother in law used to be a hospital midwife. She said they had a great treatment for the women on the ward who got piles during delivery - they got those surgical gloves, the flexible rubbery ones, and cut off the fingers. They filled them with water and put them in the freezer. To treat a girl's piles they would get a finger out of the freezer (still inside the glove finger) and tell her to literally stick it - well, where the sun don't shine.
If your piles have prolapsed, try to push them back in. If they are painful and/or bleeding considerably, see the doctor. If you only have a spot of blood (especially after straining) check to see if it really is piles or merely a small tear or fissure.
Prevention is the best management. I've had a few of these ever since I gave birth to easy child. I did see a proctologist way back then, he said he could get rid of them surgically for me (probably using a rubber band, like we used to dock corgis' tails when I was a kid and RSPCA hadn't put a stop to tail docking; like we still dock lambs' tails in Australia because it's still more humane than fly strike). But there was no point, having more kids would have just given me more piles, like as not. May as well wait until I've finished having kids, he told me. Only since then, they haven't got any worse. If anything, they have improved especially as my diet improved. Occasionally they prolapse, but they go back in easily.
So, prevention - eat as much fibre as your body can tolerate. Make sure you drink at least 2 litres of water a day. Don't overdo it though. Cut back on fat, sugar and simple carbs. Switch to wholegrain everything where it's an option and exercise regularly. No need to be ridiculous about exercise, merely keeping active will help. And push the darn things back in at the first sign of prolapse, because if you leave them out they rapidly get more inflamed and strangulated.
Creams etc that can help - you can get those over-the-counter things form the pharmacy. I haven't used them in decades. I ended up making my own herbal brew and mixed it into a fairly standard oil and beeswax base. Frankly, I think what did the trick with that, was the oil in the ointment base. These days if there is any trouble in that area (I get the darndest itch) I just use pure coconut oil. I keep it in a special bottle or jar and if I want to I can add a bit of essential oil to perfume it. If you want something herbal that is also therapeutic, try a little lavender oil, or ti-tree (melaleuca) oil, or sandalwood oil. To get a cheap supply of coconut oil, go to the fridge at the supermarket and look for Copha. In Australia we use it to make chocolate crackles - do you get chocolate crackles in the US? Very unhealthy, but a must-have at kids birthday parties.
As for avoiding too much "strain at stool" as the old textbooks used to call it, GoingNorth said,
Despite it feeling natural to us Westerners; we are really designed to SQUAT when doing our business.
I just have to tell you - we have a term for that too in Australia - it's called "kangarooing the dyke".
Dyke is a fairly rough word for toilet. So is dunny. Shouse.
Before you try that method, make sure of two things:
1) you have good balance.
2) Your toilet pedestal is strong enough.
To not have one or the other could prove very embarrassing!
If the problem seems too severe for any of the above to make any difference then see the doctor. You do this if they can't stay back inside, if you can't push them back in at all, if they're bleeding a lot, if they're painful or any other problem that you find is really interfering with your lifestyle. Or if you just want to be sure.
Marg