Hemorrhoids are swollen and enlarged veins that develop in the anus and lower rectum. They are categorized as internal if they form within the rectum or external if they develop under the skin surrounding the anal opening. This condition arises from increased pressure on the veins in the lower rectum. Primary causes include straining during bowel movements, chronic constipation or diarrhea, and sitting on the toilet for extended periods. Other contributing factors are a low-fiber diet, pregnancy, and obesity. While they can cause significant discomfort, most mild cases of hemorrhoids shrink and resolve on their own.
Natural Resolution and Timelines
The body’s healing process is typically effective in reducing the swelling and inflammation that characterizes a flare-up. When the underlying cause of increased pressure is removed, the distended vascular cushions begin to contract, leading to a reduction in size. This natural resolution is most common in smaller, milder cases where tissue damage is minimal.
The timeline varies depending on the type and severity. Small internal hemorrhoids may resolve within a few days. External hemorrhoids, which can be more painful, tend to subside within about a week in mild instances with appropriate home care.
If the hemorrhoid is more severe, such as a large external one or a thrombosed hemorrhoid, the resolution process is significantly longer. A thrombosed hemorrhoid may take several weeks for the body to reabsorb the clot and for the swelling to disappear. If symptoms persist beyond a week of focused at-home care, or if pain is severe, medical assistance may be needed.
Lifestyle Changes That Promote Healing
Taking specific steps can significantly accelerate the shrinking process by addressing the root causes of vascular swelling. The most effective measure involves softening the stool to minimize strain during defecation. This is achieved by increasing daily intake of dietary fiber (25 to 38 grams for most adults) through sources like whole grains, fruits, and vegetables.
Hydration is important, as drinking plenty of fluids helps keep the stool soft. During a bowel movement, avoid straining, which puts excessive pressure on the anal veins. Also, limit the time spent sitting on the toilet to prevent prolonged vascular congestion.
Several supportive measures can ease symptoms and promote healing:
- Soaking the anal area in warm, shallow water (Sitz baths) for 10 to 20 minutes increases blood flow.
- Proper hygiene, including gently cleaning the perianal area with water or pre-moistened wipes, prevents irritation.
- Over-the-counter topical treatments, such as creams, ointments, or suppositories, provide temporary relief.
- Ingredients like witch hazel, hydrocortisone, or mild anesthetics such as lidocaine can reduce pain, itching, and swelling.
Medical Treatments for Persistent Hemorrhoids
A medical evaluation is necessary when hemorrhoids do not shrink after a week or two of consistent at-home treatment, or if severe pain or significant bleeding occurs. For internal hemorrhoids that are not severe (Grades I, II, and some Grade III), several minimally invasive procedures can be performed in an office setting:
- Rubber band ligation places a tiny band around the base of the hemorrhoid, cutting off its blood supply.
- Sclerotherapy involves injecting a chemical solution into the hemorrhoid to induce scarring and shrinkage.
- Infrared coagulation uses heat or light energy to cause the small, bleeding hemorrhoid to harden and shrivel.
For the most advanced cases, such as prolapsed internal hemorrhoids (Grade IV) or large, recurrent hemorrhoids, surgical options are often necessary. A hemorrhoidectomy involves the complete removal of the excess tissue causing the bleeding or prolapse. A less invasive method is stapled hemorrhoidopexy, which repositions the tissue and blocks its blood flow, generally resulting in less pain and a quicker recovery.