Most internal hemorrhoids resolve with simple at-home measures within a few days to a week. Small ones often clear up on their own, while larger or more persistent ones may need an office procedure or, in severe cases, surgery. The right approach depends on how far the hemorrhoid has progressed, which ranges from mild (bleeding but staying inside the rectum) to advanced (permanently bulging outside the anus).
How Internal Hemorrhoids Are Graded
Internal hemorrhoids are classified into four grades based on how much they protrude from the anal canal. Understanding where yours falls helps explain why some respond to fiber and sitz baths while others need a procedure.
- Grade I: The hemorrhoid bleeds but doesn’t drop below the anal opening. You might notice bright red blood on toilet paper or in the bowl.
- Grade II: The tissue pushes out during a bowel movement but slides back in on its own afterward.
- Grade III: The hemorrhoid protrudes and has to be manually pushed back in.
- Grade IV: The tissue stays outside the anus permanently and can’t be pushed back in.
Grades I and II, along with some grade III cases, can usually be managed without surgery. Grade IV hemorrhoids almost always require a surgical procedure.
At-Home Treatments That Work
For grade I and II internal hemorrhoids, conservative treatment is the standard first step. Most people see improvement within a few days, though you should expect to maintain these habits long-term to prevent recurrence.
Increase Your Fiber Intake
Fiber softens stool and reduces the straining that worsens hemorrhoids. 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 get enough through food, a fiber supplement (like psyllium husk) can fill the gap. Increase your intake gradually over a week or two to avoid bloating, and drink plenty of water alongside it.
Take Sitz Baths
Sitting in a few inches of warm water relaxes the muscles around the anus, improves blood flow to the area, and eases pain and itching. Aim for water around 104°F (40°C), warm enough to be soothing but not hot enough to burn. Soak for 15 to 20 minutes at a time, up to three or four times a day when symptoms are active. You can use a small plastic basin that fits over your toilet seat or simply use a clean bathtub.
Use Over-the-Counter Products
Topical creams and suppositories can provide temporary symptom relief. Products containing phenylephrine (a vasoconstrictor found in Preparation H) work by narrowing blood vessels in the tissue, which temporarily shrinks swelling. Hydrocortisone creams reduce itching and inflammation but shouldn’t be used for more than about a week, since prolonged use can thin the skin. These products treat symptoms, not the underlying hemorrhoid, so they work best alongside dietary changes.
Adjust Your Bathroom Habits
Go when you feel the urge rather than waiting. Avoid sitting on the toilet longer than necessary, since extended time on the seat increases pressure on the veins in your rectum. If you’re in the habit of scrolling your phone on the toilet, that’s worth changing. A small footstool to elevate your knees above your hips can also reduce straining by putting your body in a more natural position.
Office-Based Procedures
If your symptoms haven’t improved after a week of home care, or if you have grade II or III hemorrhoids that keep coming back, an office procedure is the next step. These are done without general anesthesia, typically in a doctor’s office, and you go home the same day.
Rubber Band Ligation
Banding is considered the most effective office-based treatment for internal hemorrhoids, backed by strong recommendations from the American Society of Colon and Rectal Surgeons. During the procedure, 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, usually without you noticing. You may feel pressure or mild discomfort for a day or two afterward. Most people return to normal activities the same day.
Infrared Coagulation
This technique uses a burst of infrared light to create a small scar on the hemorrhoid tissue, which cuts off blood flow and causes it to shrink. It’s typically used for grade I and II hemorrhoids and is less effective than banding for larger ones. The procedure is quick, causes minimal discomfort, and is sometimes preferred for smaller hemorrhoids or for patients on blood-thinning medications where banding carries more risk.
Sclerotherapy
A doctor injects a chemical solution directly into the hemorrhoid, causing the tissue to scar and shrink. Like infrared coagulation, sclerotherapy works best for grade I and II hemorrhoids. It’s a fast procedure with little recovery time, though it may need to be repeated if the hemorrhoid returns.
When Surgery Is Necessary
Surgery is reserved for large, prolapsed hemorrhoids (grade III that don’t respond to other treatments and grade IV) or hemorrhoids that keep recurring despite office procedures. There are two main surgical options, and they differ in important ways.
Hemorrhoidectomy
This is the traditional surgical removal of hemorrhoid tissue. It’s the most thorough option and has the lowest recurrence rate, but it comes with more pain and a longer recovery. Most people need one to two weeks off work, and full healing can take several weeks. Pain management after the procedure is a significant part of recovery.
Stapled Hemorrhoidopexy
Instead of removing the hemorrhoid, this procedure uses a surgical stapler to reposition the prolapsed tissue back into the anal canal and cut off its blood supply. Recovery is generally faster and less painful than a traditional hemorrhoidectomy, with most people returning to light activities sooner. The trade-off is a higher chance of the hemorrhoids coming back over time.
Recovery Timelines
Small internal hemorrhoids treated with dietary changes and sitz baths often improve within a few days. After rubber band ligation, the banded tissue typically falls off within a week, with full healing over the following one to two weeks. Surgical recovery takes longer: expect one to two weeks of restricted activity after a stapled procedure and two to four weeks after a traditional hemorrhoidectomy. Regardless of the treatment, maintaining high fiber intake and good bathroom habits is essential to keep hemorrhoids from returning.
Signs That Need Prompt Attention
Bleeding during bowel movements is the most common hemorrhoid symptom, but it shouldn’t be dismissed without evaluation. If you notice large amounts of rectal bleeding, feel lightheaded or dizzy, or experience faintness, seek emergency care. Rectal bleeding can also be a sign of other conditions, including colorectal cancer, so it’s important not to assume hemorrhoids are the cause, particularly if you notice changes in your bowel habits or stool consistency. Any hemorrhoid symptoms that persist beyond a week of home treatment warrant a visit to a healthcare professional.