Most prolapsed hemorrhoids, particularly those that slide out during a bowel movement but can still be pushed back in, respond well to a combination of home measures, medications, and minimally invasive office procedures. The key factor is the degree of prolapse. Hemorrhoids that retract on their own or that you can gently push back into place have a strong track record of improving without an operating room, while those that remain permanently outside the anal canal are harder to manage conservatively. Getting the grade right is where treatment starts.
Why the Grade of Prolapse Matters
Doctors classify internal hemorrhoids using a four-tier system originally described by Goligher. Grade I hemorrhoids bulge into the anal canal but don’t come out at all. Grade II hemorrhoids prolapse during straining but slide back in on their own. Grade III hemorrhoids prolapse and stay out until you manually push them back. Grade IV hemorrhoids are permanently prolapsed and can’t be reduced.
1PubMed Central. Is the Goligher classification a valid tool in clinical practice and research for hemorrhoidal disease?This grading matters because it shapes every treatment decision. Grade II and III hemorrhoids are the sweet spot for non-surgical approaches. Grade I hemorrhoids rarely need much beyond dietary changes. Grade IV hemorrhoids, and any prolapsed hemorrhoid that becomes thrombosed or strangulated (meaning its blood supply gets cut off), almost always require more aggressive intervention. If your hemorrhoid is out all the time, deeply painful, and bluish-purple in color, that’s an urgent situation where conservative measures alone are unlikely to help.
2International Journal of Ayurvedic Medicine. Effect of Leech application in Prolapsed Thrombosed Hemorrhoid: A case studyFiber, Fluids, and Toilet Habits
The foundation of every non-surgical hemorrhoid plan is making bowel movements easier. Straining is one of the primary forces that pushes hemorrhoidal tissue downward, so softer stools that pass without effort can let swollen tissue gradually shrink. Fiber supplements and high-fiber foods work by holding water in the stool, creating bulk that moves through the colon more smoothly. Research has long supported the idea that passing a softer stool helps hemorrhoids and related conditions like anal fissures.
3PubMed. Drug therapy reviews: dietary fiber and fiber supplements in the therapy of gastrointestinal disordersAim for roughly 25 to 30 grams of fiber a day from a mix of whole grains, fruits, vegetables, and legumes. If your current intake is low, increase gradually over a week or two to avoid gas and bloating. Psyllium husk is a common supplement that bridges the gap. Drink enough water alongside the fiber so it can do its job; fiber without adequate fluid can actually make constipation worse.
Time on the toilet also plays a role. Sitting for extended periods, especially while straining or scrolling through a phone, increases pressure on the hemorrhoidal cushions. Research has found a direct relationship between prolonged toilet sitting time and hemorrhoid severity. Squatting postures, or at least elevating your feet on a small stool to mimic a partial squat, can reduce the effort needed to evacuate and shorten time spent on the toilet.
4PubMed Central. Sitting vs. squatting: a scoping review of toilet postures and associated health outcomesTopical Treatments and Warm Soaks
Over-the-counter hemorrhoid creams and ointments containing ingredients like hydrocortisone, lidocaine, or witch hazel can reduce itching, pain, and swelling. These don’t fix the underlying prolapse, but they make the day-to-day experience far more manageable, which matters when you’re waiting for dietary changes to take effect. One clinical investigation of a combination ointment containing hydrocortisone found no adverse reactions over a median treatment period of about 20 days, suggesting short courses are generally well tolerated.
5PubMed Central. A Clinical Investigation into the Long-term Use and Safety of Killed Escherichia coli Suspension-Hydrocortisone Combination Ointment for the Treatment of HemorrhoidsHydrocortisone-containing products should not be used for more than about a week at a time without medical guidance, because prolonged steroid use can thin the skin around the anus and cause its own problems. Alternating with a non-steroidal barrier cream or plain petroleum jelly during flare-free stretches is a reasonable approach.
Warm sitz baths, where you sit in a few inches of plain warm water for 10 to 15 minutes, remain a staple of hemorrhoid self-care. The warmth relaxes the anal sphincter, improves blood flow to the area, and provides temporary pain relief. Some people add Epsom salts, though there’s no strong evidence that the salt itself adds a measurable benefit beyond what plain warm water provides. Two to three sitz baths a day during a flare-up is a standard recommendation.
Cold therapy is another option. A small randomized trial found that topical cold application performed as well as or better than standard proctology ointment for reducing pain and bleeding from uncomplicated hemorrhoids.
6PubMed Central. Treatment of uncomplicated hemorrhoids with a Hemor-Rite® cryotherapy device: a randomized, prospective, comparative studyAlternating warm soaks with brief cold application can address both pain and swelling. Wrap ice or a cold pack in a cloth rather than applying it directly to the skin.
Oral Venoactive Drugs
In many countries outside the United States, doctors prescribe a class of plant-derived medications called venoactive drugs, the most studied being micronized purified flavonoid fraction (MPFF). These work from the inside to strengthen vein walls, reduce inflammation, and improve lymphatic drainage. A systematic review and meta-analysis found that MPFF provided significant benefits for bleeding, discharge, and overall patient-reported improvement.
7PubMed Central. Micronized Purified Flavonoid Fraction in Hemorrhoid Disease: A Systematic Review and Meta-AnalysisMPFF can reduce symptoms including bleeding, pain, anal discomfort, discharge, and itching in acute hemorrhoidal flare-ups.
8PubMed. Micronized purified flavonoid fraction in the treatment of hemorrhoidal diseaseSome clinicians also combine MPFF with topical preparations containing ingredients like sucralfate, calendula, or witch hazel for a dual approach addressing both the internal vascular problem and the surface-level discomfort.
9PubMed Central. Treatment of haemorrhoidal disease with micronized purified flavonoid fraction and sucralfate ointmentMPFF is available over the counter in parts of Europe and Asia under various brand names but isn’t FDA-approved in the United States. If you’re in the U.S. and interested, you can find diosmin-hesperidin supplements (the active flavonoid components) from supplement companies, though quality and dosing can vary since supplements aren’t held to the same manufacturing standards as pharmaceuticals. Discuss this with your doctor before starting.
Gently Pushing a Prolapsed Hemorrhoid Back In
For grade III hemorrhoids that prolapse but can still be reduced, manual reduction at home is a straightforward skill. After a bowel movement, apply a lubricant like petroleum jelly or a water-based gel to your fingertip. Using gentle, steady pressure, push the prolapsed tissue back through the anal opening. Some people find it easiest to do this while lying on their side. Hold gentle pressure for a minute or two until the tissue stays in place, then tighten your pelvic floor muscles (a Kegel contraction) to help keep it inside.
A case report described a hospital technique for acutely swollen, strangulated hemorrhoids: applying granulated sugar to the prolapsed tissue to draw out fluid and reduce swelling before pushing the mass back in. After manual reduction, the patient’s hemorrhoids shrank significantly within two weeks with bed rest and topical ointment alone.
10PubMed Central. Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case ReportThis is a clinical technique, not a home remedy, but it illustrates that even significantly swollen hemorrhoids can sometimes be managed without proceeding to surgery when reduction is successful.
If you try to reduce a prolapsed hemorrhoid at home and it won’t go back in, or if it’s extremely painful and discolored, stop and seek medical attention. Forcing an irreducible hemorrhoid risks damaging the tissue further.
Office-Based Procedures That Avoid the Operating Room
When lifestyle changes, medications, and self-care aren’t enough, several minimally invasive procedures can be done in a doctor’s office without general anesthesia, hospital admission, or the recovery time of formal surgery. These sit in a gray zone: they’re technically “procedures,” but they’re not what most people picture when they think of hemorrhoid surgery.
Rubber Band Ligation
This is the most widely used office procedure for grade II and III internal hemorrhoids. The doctor places a small rubber band around the base of the hemorrhoid using a scope inserted into the anal canal. The band cuts off blood supply, and the hemorrhoid shrivels and falls off within a few days. A large study following over 800 patients found that rubber band ligation succeeded in about 70% of cases across all grades of hemorrhoids, with success defined as no further need for treatment.
11PubMed. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoidsAnother study of endoscopic band ligation found it controlled bleeding in 98% of patients and reduced prolapse in about 83% of patients. The recurrence rate for prolapse climbed slowly over time, reaching roughly 17% at five years.
12PubMed Central. Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoidsThose numbers are respectable for a procedure that typically takes a few minutes, causes mild discomfort for a day or two, and lets you return to normal activities almost immediately. Multiple sessions may be needed if several hemorrhoid columns require treatment.
Sclerotherapy
Injection sclerotherapy involves injecting a chemical agent directly into the hemorrhoidal tissue, causing it to scar and shrink. It’s quick, low-cost, and causes minimal pain because the injection site is above the sensitive nerve-rich zone of the anal canal.
13PubMed Central. Sclerotherapy in HemorrhoidsIn a large comparative study, sclerotherapy using aluminum potassium sulfate and tannic acid eliminated prolapse in 96% of patients with grade II and III hemorrhoids. Postoperative pain requiring intravenous painkillers occurred in fewer than 2% of those patients, compared with 14% after traditional hemorrhoidectomy. The average procedure time was only about 13 minutes.
14PubMed Central. Impact of less invasive treatments including sclerotherapy with a new agent and hemorrhoidopexy for prolapsing internal hemorrhoidsSclerotherapy tends to work best for smaller hemorrhoids and is sometimes used as a first step before considering banding for larger ones. It can also be repeated if symptoms return.
How Conservative Results Compare Over Time
A fair question with any non-surgical approach is whether you’re just kicking the problem down the road. A meta-analysis comparing surgical and conservative treatments found that surgery achieved higher rates of complete symptom resolution and lower recurrence rates overall. However, conservative treatments were safer and less invasive, with fewer post-treatment complications.
15PubMed Central. Comparison of efficacy and safety between surgical and conservative treatments for hemorrhoids: a meta-analysisIn practical terms, this means many people who go the conservative route will eventually experience a recurrence, sometimes months or years later. But each recurrence can often be managed the same way again, and for plenty of people, periodic flares managed with fiber, sitz baths, and the occasional banding session are preferable to the pain, recovery time, and risks of formal surgery. The choice isn’t always between “cured forever” and “suffering indefinitely.” It’s often between different patterns of management.
A study specifically looking at thrombosed external hemorrhoids (a somewhat different situation from internal prolapse) found that conservative management had a recurrence rate of about 25%, compared to roughly 6% after surgical excision. But the conservative group still avoided the recovery burden of surgery, and most recurrences happened within seven months, allowing patients to reassess their options relatively quickly.
16PubMed. Thrombosed external hemorrhoids: outcome after conservative or surgical managementHemorrhoids During Pregnancy
Pregnancy is one of the most common triggers for hemorrhoid flare-ups and prolapse, thanks to increased pelvic blood volume, hormonal changes that relax vein walls, and the growing uterus pressing on pelvic veins. The good news is that in most women, hemorrhoid symptoms resolve on their own after delivery.
17PubMed Central. Hemorrhoids in pregnancyBecause of this natural resolution, the approach during pregnancy is almost always conservative. Treatment focuses on controlling symptoms rather than eliminating the hemorrhoid. Increasing fiber, using stool softeners, drinking more water, and adjusting toilet habits are the first line. Although topical hemorrhoid preparations containing anesthetics, corticosteroids, and anti-inflammatory agents haven’t been formally studied for safety in pregnancy, they’re considered unlikely to pose a meaningful risk to a third-trimester baby. Surgical procedures should be delayed until a few weeks after delivery unless there’s an acute thrombosis that demands immediate attention.
18Ewha Medical Journal. Treatment of Hemorrhoid in Unusual Condition-PregnancyIf you’re pregnant and dealing with a prolapsed hemorrhoid, gentle manual reduction after bowel movements and consistent fiber intake are your best tools. Sitz baths are safe throughout pregnancy. Most women find that hemorrhoids that seemed alarming in the third trimester become a non-issue within weeks of giving birth.
When You Should Stop Trying to Avoid Surgery
Non-surgical management has real limits, and being honest about those limits prevents unnecessary suffering. You should have a conversation with a colorectal specialist if any of the following apply:
- Grade IV prolapse: The hemorrhoid stays out permanently and can’t be pushed back in. Conservative measures alone rarely resolve this.
- Strangulation: A prolapsed hemorrhoid whose blood supply has been cut off. The tissue turns dark, the pain is severe, and this is a medical emergency.
- Recurrent thrombosis: Repeated episodes of clotting within the hemorrhoid despite lifestyle changes.
- Persistent bleeding: Ongoing blood loss that doesn’t respond to fiber, medications, or banding, especially if it’s causing anemia.
- Failed office procedures: Rubber band ligation or sclerotherapy attempted multiple times without lasting improvement.
In these situations, procedures like hemorrhoidectomy (surgical removal) or stapled hemorrhoidopexy offer more definitive results. The recovery is more involved, typically one to three weeks of significant discomfort, but the recurrence rates are substantially lower. Surgery also isn’t what it was a generation ago; newer techniques produce less postoperative pain than the traditional open approach.
The Quality-of-Life Factor
Hemorrhoids are rarely dangerous, but they can quietly erode your daily life. The itching, the anxiety about bleeding, the discomfort sitting at a desk, the self-consciousness: these add up. Research on hemorrhoid patients has confirmed that quality of life improves significantly after treatment, whether that treatment is conservative or procedural.
19International Journal of Public Health Science (IJPHS). Life quality differences before and after hemorrhoid treatmentPeople often delay seeking help because they’re embarrassed, or because they assume the only option is surgery. In reality, the vast majority of grade II and III prolapsed hemorrhoids can be managed with some combination of the approaches described here, from fiber and sitz baths at the mild end to rubber band ligation at the more involved end. Even for those who eventually do need surgery, starting with conservative measures first establishes the lifestyle habits (adequate fiber, good toilet posture, staying hydrated) that help prevent recurrence after any treatment. Those habits aren’t just a stopgap while you figure out the “real” fix. They are the real fix for keeping hemorrhoids from coming back.