Most hemorrhoids clear up within a few weeks using a combination of dietary changes, topical treatments, and simple home care. When they don’t, office procedures and surgery can eliminate them more permanently. The right approach depends on how severe your symptoms are and whether you’re dealing with internal or external hemorrhoids.
Fiber: The Single Most Effective Change
Increasing your fiber intake is the foundation of hemorrhoid treatment because it softens stool and reduces the straining that caused the problem in the first place. The recommended target is about 14 grams of fiber per 1,000 calories you eat, which works out to roughly 28 grams per day on a standard 2,000-calorie diet. Most people fall well short of that number.
Good sources include beans, lentils, whole grains, berries, broccoli, and pears. If you can’t hit your target through food alone, a fiber supplement like psyllium husk (the active ingredient in Metamucil) can fill the gap. The key detail most people miss: fiber only works if you’re drinking enough water alongside it. Without adequate fluids, extra fiber can actually make constipation worse. Aim for several glasses of water throughout the day, adjusting for your activity level and climate.
Home Treatments That Relieve Symptoms
A sitz bath is one of the most reliable ways to reduce pain, itching, and swelling. Fill a bathtub or a basin that fits over your toilet with warm water, around 104°F (40°C), and soak your anal area for 15 to 20 minutes. You can do this three to four times a day when symptoms are flaring. Pat the area dry afterward rather than rubbing.
Witch hazel applied to the area with a cotton pad can also help. In a clinical study, patients using witch hazel suppositories saw their symptoms (bleeding, itching, burning, swelling) drop by about 43% after just two days, and nearly all symptoms resolved within about six days. You can find witch hazel pads and wipes at most pharmacies.
Ice packs wrapped in a cloth and applied for 10 to 15 minutes at a time can temporarily numb pain and reduce swelling, particularly with external hemorrhoids.
Over-the-Counter Creams and Ointments
Hemorrhoid creams sold at drugstores typically contain one of two active ingredients. Some use a vasoconstrictor (like phenylephrine) that shrinks swollen blood vessels to reduce the size of the hemorrhoid. Others contain hydrocortisone, a mild steroid that reduces swelling, itching, and pain. Products like Preparation H come in formulations with either ingredient.
Hydrocortisone creams are effective for short-term relief but shouldn’t be used for extended periods. If your symptoms haven’t improved after a few days, it’s worth checking in with a doctor rather than continuing to apply steroid cream, which can thin the skin over time.
Toilet Habits That Make a Difference
How you use the bathroom matters more than most people realize. Sitting on the toilet for long stretches, often while scrolling your phone, puts sustained pressure on the veins around your anus. Gastroenterologists recommend limiting toilet time to no more than five minutes per sitting. If you can’t go by then, get up and come back later.
Straining is the other major culprit. If you’re eating enough fiber and drinking enough water, you shouldn’t need to push hard. Going when you first feel the urge, rather than holding it, also helps because stool dries out and hardens the longer it sits in the colon.
Office Procedures for Persistent Hemorrhoids
When home treatment isn’t enough, doctors can treat internal hemorrhoids with quick, in-office procedures that don’t require general anesthesia.
Rubber band ligation is the most common option. A doctor places a tiny rubber band around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a week or so. Success rates fall between 60% and 80%, though recurrence is possible. In one large trial, about 49% of patients had symptoms return within a year after a single banding session, but that rate dropped to around 37.5% when multiple bandings were performed. Recovery is faster and less painful than surgery.
Infrared coagulation uses a burst of infrared light to scar the tissue and cut off blood flow to the hemorrhoid. It causes fewer and less severe complications than banding, making it a good option for smaller hemorrhoids or patients who want to minimize discomfort. The tradeoff is that more patients need repeat treatments compared to banding.
Sclerotherapy involves injecting a chemical solution into the hemorrhoid to shrink it. Outcomes at 12 months are comparable to infrared coagulation, though again, repeat treatments are more likely than with banding.
Surgery for Severe Cases
Large hemorrhoids, those that have prolapsed significantly, or hemorrhoids that haven’t responded to other treatments may require surgery. Two main surgical approaches exist.
Conventional hemorrhoidectomy surgically removes the hemorrhoid tissue entirely. It’s the most effective long-term solution, with a recurrence rate of only about 1.7% at one year. The downside is a more painful recovery compared to other options.
Stapled hemorrhoidopexy repositions the hemorrhoid tissue back into place and cuts off its blood supply using a circular stapling device. Recovery tends to be less painful than a conventional hemorrhoidectomy, but recurrence rates are significantly higher: about 8.7% overall at one year. For more advanced hemorrhoids (grade three or four), the gap widens dramatically. Recurrence after stapling reaches around 20% compared to less than 4% with conventional surgery.
Thrombosed Hemorrhoids Need Quick Attention
A thrombosed external hemorrhoid is one that has developed a blood clot, causing sudden, intense pain and a firm, bluish lump near the anus. If you can get to a doctor within 72 hours of the pain starting, a simple in-office procedure to remove the clot provides fast relief. After that 72-hour window, the procedure often causes more discomfort than it relieves, and doctors will typically recommend managing symptoms at home while the clot gradually reabsorbs over a few weeks.
Rectal bleeding that doesn’t stop, bleeding that seems excessive, or bleeding accompanied by dizziness or lightheadedness warrants a prompt medical evaluation. While hemorrhoids are the most common cause of rectal bleeding, other conditions can produce similar symptoms and should be ruled out.