Doctors fix hemorrhoids through a range of treatments that depend on how severe your symptoms are, from dietary changes and office procedures to surgery. Most people never need an operation. The American Society of Colon and Rectal Surgeons recommends starting with conservative measures and stepping up to more invasive options only when simpler ones fail.
How Doctors Decide Which Treatment You Need
Internal hemorrhoids are classified on a four-point grading scale based on how far they’ve moved out of position. Grade I hemorrhoids bulge into the anal canal but stay inside. Grade II hemorrhoids slide out during a bowel movement but go back in on their own. Grade III hemorrhoids come out and need to be pushed back in manually. Grade IV hemorrhoids are permanently outside and can’t be pushed back in at all.
External hemorrhoids sit under the skin around the anus and are graded differently, mostly by whether they’ve developed a blood clot. Your grade, your symptoms, and whether you’ve already tried simpler treatments all factor into what your doctor recommends.
First-Line Treatment: Diet and Habits
The starting point for nearly every hemorrhoid case is increasing fiber and water intake. Fiber softens stool and reduces the straining that puts pressure on hemorrhoidal tissue. Your doctor will typically recommend 25 to 30 grams of fiber per day through food or a supplement, along with plenty of fluids. Other behavioral changes include not sitting on the toilet for extended periods, avoiding straining, and using stool softeners when needed. For many people with grade I or II hemorrhoids, these changes alone are enough to resolve symptoms.
Office-Based Procedures
When diet and lifestyle changes aren’t enough, the next step is an in-office procedure. These are performed without general anesthesia and don’t require a hospital stay. The area is numbed, and you typically go home the same day.
Rubber Band Ligation
Rubber band ligation is considered the most effective office-based treatment. Your doctor places a small rubber band around the base of an internal hemorrhoid, cutting off its blood supply. Over the following days, the tissue shrinks and falls off. Success rates range from 69% to 97%, with better results for grade II hemorrhoids (about 80% excellent outcomes) than grade III (around 54%). Some people need more than one session. Between 7% and 18% of patients require additional treatments for recurring symptoms.
Doctors can place bands on one hemorrhoid at a time or treat all three common hemorrhoid sites in a single visit. Studies comparing single and triple banding found that treating all sites at once is equally safe and requires fewer total office visits. The main downside compared to other office procedures is more post-treatment pain, though it’s generally manageable.
Sclerotherapy
Sclerotherapy involves injecting a chemical solution directly into the hemorrhoid, which causes the tissue to shrink and scar down. The most commonly used agent today is a foam formulation that has largely replaced older options because of its improved safety profile. It’s used primarily for grade II hemorrhoids, though some doctors extend it to grade III cases, particularly for patients who are at higher risk for other procedures. The injection itself is quick and typically causes less pain than banding.
Infrared Coagulation
In this procedure, a device directs a burst of infrared light at the hemorrhoid, creating a small burn that causes scar tissue to form. The scarring cuts off blood flow and anchors the tissue in place. It’s effective for smaller, lower-grade hemorrhoids but generally has lower long-term success than rubber band ligation and may require more repeat sessions.
Surgical Options for Severe Hemorrhoids
Surgery is typically reserved for grade III and IV internal hemorrhoids, large external hemorrhoids, or cases where office procedures have failed. These are performed under general anesthesia or regional anesthesia (a spinal block), usually as an outpatient procedure.
Excisional Hemorrhoidectomy
Traditional surgical removal remains the gold standard when hemorrhoids are severe or involve both internal and external components. The surgeon cuts out the hemorrhoidal tissue with a scalpel, sometimes closing the wound with stitches and sometimes leaving it open to heal on its own. This approach has the lowest recurrence rate of any treatment, but recovery is the most demanding.
Most people describe the first two weeks as the hardest, particularly the first bowel movement after surgery. The average recovery takes two to four weeks, with pain generally resolving by the two-week mark. Strenuous exercise and physical labor are usually off the table for six to eight weeks. Your doctor will recommend stool softeners, sitz baths, and pain medication to help you through the recovery period.
Stapled Hemorrhoidopexy
Rather than removing hemorrhoidal tissue, this technique uses a circular stapling device to reposition prolapsed tissue back into the anal canal and cut off its blood supply. It’s less painful in the early recovery period and patients return to normal activities sooner than with traditional surgery. Hospital stays tend to be shorter as well.
The trade-off is a significantly higher recurrence rate. A large Cochrane review found that patients who had stapled surgery were more than three times as likely to have hemorrhoids come back compared to those who had traditional excision. In that analysis, 37 out of 479 stapled patients had recurrences versus only 9 out of 476 in the conventional surgery group. For this reason, stapling is sometimes chosen for patients who prioritize a faster recovery, with the understanding that further treatment may be needed down the line.
Doppler-Guided Artery Ligation
This newer technique uses an ultrasound probe inserted into the anal canal to locate the arteries feeding the hemorrhoids. The surgeon stitches each artery closed, starving the hemorrhoid of blood flow, and then sutures the prolapsed tissue back into its normal position. No tissue is removed. Compared to traditional hemorrhoidectomy, this approach causes less postoperative pain and allows a quicker return to daily life. Recurrence rates in follow-up studies hover around 14%, which is higher than excisional surgery but comes with a much easier recovery.
Thrombosed External Hemorrhoids
A thrombosed external hemorrhoid, one that has developed a blood clot, is a special case. It shows up suddenly as a firm, painful lump near the anus. If you see a doctor within the first 24 to 48 hours, they can make a small incision under local anesthesia and remove the clot. This provides nearly immediate relief.
Timing matters. After 48 hours, the body begins breaking down the clot on its own, and the pain starts to improve naturally. At that point, the benefit of surgical removal decreases. Most doctors will recommend conservative management (warm baths, pain relievers, stool softeners) if you’re past that early window, since the worst of the pain is already fading.
What Recovery Looks Like
Recovery varies enormously depending on the procedure. Office-based treatments like rubber band ligation involve mild discomfort for a day or two, and most people return to work within 24 hours. Sclerotherapy and infrared coagulation have even less downtime.
Surgical recovery is a different experience. After a traditional hemorrhoidectomy, expect two to four weeks before you feel close to normal. Pain is most intense in the first week and tends to center around bowel movements. Sitz baths (sitting in a few inches of warm water for 10 to 15 minutes) several times a day help with both pain and healing. Stool softeners are essential to avoid straining at the surgical site. Most people say pain is manageable by the two-week mark, though full healing of the tissue can take longer. Stapled procedures and artery ligation generally allow a return to daily activities sooner, often within one to two weeks.
Regardless of which treatment you have, the dietary and lifestyle changes that form the first line of treatment remain important afterward. Keeping stools soft, staying hydrated, eating enough fiber, and avoiding prolonged straining are the best ways to keep hemorrhoids from coming back.