Most hemorrhoids can be treated at home with a combination of dietary changes, better bathroom habits, and over-the-counter products. Mild cases often improve within a week. For hemorrhoids that keep coming back or have started to prolapse, office procedures and surgery offer more lasting solutions. The right treatment depends on the severity of your symptoms and how long you’ve been dealing with them.
Understanding Hemorrhoid Severity
Internal hemorrhoids are graded on a scale from I to IV based on how far they’ve dropped from their normal position inside the anal canal. Grade I hemorrhoids are small and stay inside, usually causing no symptoms beyond occasional painless bleeding. Grade II hemorrhoids bulge out during a bowel movement but slide back in on their own. Grade III hemorrhoids push out and need to be manually pushed back in, often with itching and irritation. Grade IV hemorrhoids stay outside permanently and can’t be pushed back in at all.
This grading matters because it largely determines your treatment path. Grade I and II hemorrhoids almost always respond to home treatment. Grade III and IV hemorrhoids are more likely to need a procedure or surgery.
External hemorrhoids sit under the skin around the anus and can become extremely painful if a blood clot forms inside them (a thrombosed hemorrhoid). These feel like a hard, tender lump and typically peak in pain over the first 48 to 72 hours.
Home Treatments That Work
Sitz baths are one of the most effective and simplest ways to relieve hemorrhoid pain and itching. Fill a bathtub or a basin that fits over your toilet seat with warm water, around 104°F (40°C). Soak for 15 to 20 minutes, up to three or four times a day when symptoms are active. The warm water increases blood flow to the area and relaxes the muscles around the anus, which eases discomfort.
Over-the-counter hemorrhoid creams and ointments can also provide meaningful short-term relief. The most common formulations contain a vasoconstrictor like phenylephrine (which shrinks swollen tissue), a local anesthetic like pramoxine (which numbs the area), and protectants like glycerin or petrolatum that form a barrier over irritated skin. Apply these after bowel movements and before bed for the best results. Hydrocortisone creams reduce inflammation but shouldn’t be used for more than a week without guidance, since prolonged use can thin the skin.
Ice packs wrapped in a cloth and applied for 10 to 15 minutes at a time can reduce swelling from external hemorrhoids. Alternating between ice and sitz baths works well for many people.
Fiber, Water, and Stool Quality
Hard stools and straining are the primary drivers of hemorrhoid symptoms. The single most important long-term change you can make is getting enough fiber. The recommended intake is about 14 grams per 1,000 calories you eat, which works out to roughly 28 grams a day on a standard 2,000-calorie diet. Most people fall well short of that.
Good sources include beans, lentils, whole grains, berries, pears, broccoli, and ground flaxseed. If you can’t get enough through food, a fiber supplement like psyllium husk works well. Increase your fiber gradually over a week or two, because jumping in too fast causes bloating and gas. Drinking six to eight glasses of water a day helps fiber do its job by keeping stools soft and easy to pass.
Bathroom Habits That Reduce Strain
Spending too long on the toilet puts sustained pressure on the veins in your rectum. Try to limit your time to five to ten minutes. If nothing is happening, get up and come back later. Scrolling your phone on the toilet is one of the most common, and most overlooked, contributors to hemorrhoid problems.
Go when you feel the urge rather than holding it, since delaying bowel movements leads to harder, drier stools. A footstool that raises your knees above your hips mimics a squatting position, which straightens the angle of the rectum and allows stool to pass with less straining. Never bear down forcefully.
When Home Treatment Isn’t Enough
If your hemorrhoids haven’t improved after a week of consistent home care, or if they keep coming back, it’s time to consider office-based procedures. The most common is rubber band ligation, where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply. The tissue shrinks and falls off within a few days. Studies find it to be 70% to 80% effective, and most people return to normal activities right away, though some need a day or two to recover.
Other office procedures include infrared coagulation, which uses heat to shrink the hemorrhoid, and sclerotherapy, which involves injecting a chemical solution that causes the tissue to shrivel. These are generally used for smaller, grade I or II hemorrhoids and have similar recovery profiles to banding.
Minimally Invasive Surgery Options
For hemorrhoids that don’t respond to banding or that are too advanced for office procedures, two minimally invasive surgical options exist: hemorrhoidal artery ligation and stapled hemorrhoidopexy.
Hemorrhoidal artery ligation uses a small ultrasound probe to locate and tie off the arteries feeding the hemorrhoid, cutting off blood flow so it shrinks. The procedure avoids removing tissue, which generally means less pain. However, recurrence rates tend to be higher, around 10% for grade III hemorrhoids and potentially higher in some studies.
Stapled hemorrhoidopexy uses a circular stapling device to reposition prolapsed hemorrhoid tissue back into the anal canal and cut off blood supply. Recurrence rates in comparative studies range from 4% to 9%, generally lower than artery ligation, though the difference isn’t always statistically significant. Both procedures carry similar overall complication rates of roughly 24% to 26%, mostly minor issues like temporary pain and bleeding.
Traditional Hemorrhoidectomy
A full surgical hemorrhoidectomy, where the hemorrhoid tissue is cut away entirely, is the most definitive treatment. It’s typically reserved for grade III or IV hemorrhoids that have failed other treatments, hemorrhoids with complications like chronic prolapse, or cases where someone simply wants them gone for good.
The tradeoff is a tougher recovery. Healing takes between two and eight weeks, and the first week or two can involve significant pain, especially during bowel movements. Stool softeners and pain management are standard parts of the recovery plan. Despite the harder recovery, hemorrhoidectomy has the lowest recurrence rate of any treatment, making it the best option for severe or repeatedly problematic hemorrhoids.
Red Flags to Take Seriously
Rectal bleeding during bowel movements is common with hemorrhoids, but you should never assume that’s the cause without confirmation. Changes in bowel habits, stools that look different in color or consistency, or bleeding that doesn’t match your usual pattern can signal other conditions, including colorectal or anal cancer. If you experience large amounts of rectal bleeding, lightheadedness, dizziness, or faintness, that requires emergency medical attention.