Most hemorrhoids heal on their own within one to two weeks with simple home care: more fiber, warm soaks, and less straining on the toilet. The key is reducing pressure on the swollen blood vessels so they can shrink back to normal. For hemorrhoids that don’t respond to home treatment, office procedures and surgery offer reliable long-term solutions. Here’s what actually works at each stage.
What’s Happening Inside
Hemorrhoids are cushions of blood vessels that everyone has in and around the anal canal. They only become a problem when those vessels swell from too much pressure, usually due to straining during bowel movements, sitting on the toilet too long, or chronic constipation.
Internal hemorrhoids sit inside the rectum and are covered by a mucous lining. Their most common symptom is painless bleeding: bright red blood on toilet paper or dripping into the bowl. They generally don’t hurt unless they’ve prolapsed (pushed outside the body) and become trapped. External hemorrhoids develop under the skin around the anus. These are the ones that tend to itch, swell, and cause pain, especially if a blood clot forms inside them (thrombosis). Large hemorrhoids of either type can also create a feeling of incomplete evacuation or fullness in the rectum.
Home Treatments That Speed Healing
Sitz Baths
A sitz bath is one of the most effective things you can do at home. Fill your bathtub or a plastic basin (sold at most pharmacies) with 3 to 4 inches of warm water, around 104°F (40°C). Sit in it for 15 to 20 minutes, letting the warm water soak the affected area. This increases blood flow, relaxes the surrounding muscles, and eases pain and itching. For active flare-ups, three to four sitz baths per day provides the best relief. Make sure the water isn’t hot enough to burn.
Over-the-Counter Products
Hemorrhoid creams, ointments, and suppositories contain a few active ingredients worth understanding. Products with a local anesthetic (like lidocaine) numb the area to relieve pain. Those with a vasoconstrictor (like phenylephrine) temporarily shrink the swollen tissue. Hydrocortisone creams reduce itching and inflammation. These products manage symptoms while healing happens, but they aren’t designed for long-term use. Hydrocortisone in particular can thin the skin if used for more than a week at a time.
Cold Packs
Applying a cold pack wrapped in a cloth for 10 to 15 minutes can reduce swelling and numb sharp pain, especially with thrombosed external hemorrhoids. Alternate with sitz baths throughout the day for the best combination of relief.
Dietary Changes That Make the Biggest Difference
Fiber is the single most important dietary factor. Soft, bulky stool passes easily without straining, which takes pressure off hemorrhoidal blood vessels and lets them heal. The recommended daily intake is about 14 grams of fiber per 1,000 calories you eat. On a typical 2,000-calorie diet, that’s 28 grams per day. Most people fall well short of this.
Good sources include beans, lentils, whole grains, berries, pears, broccoli, and avocados. If you struggle to get enough from food alone, a fiber supplement (psyllium husk is the most studied) can bridge the gap. Increase your fiber intake gradually over a week or two to avoid gas and bloating, and drink plenty of water alongside it. Fiber without adequate fluid can actually make constipation worse.
Toilet Habits That Reduce Pressure
How you sit on the toilet matters more than most people realize. The standard sitting position on a Western toilet creates a bend in the lower bowel that forces you to strain. Research consistently shows that a squatting posture straightens this angle, allowing faster and more complete evacuation. Studies have found that squatting reduces the time spent defecating to roughly one minute compared to 4 to 15 minutes in a standard sitting position, and significantly cuts down on straining. You don’t need to rebuild your bathroom. A small footstool placed in front of the toilet that raises your knees above your hips mimics the squatting position effectively.
Beyond posture, limit your time on the toilet. Sitting there scrolling your phone for 15 minutes keeps constant pressure on the hemorrhoidal vessels. Go when you feel the urge, and if nothing happens within a few minutes, get up and try again later. Never strain or push forcefully.
When Home Treatment Isn’t Enough
If your symptoms haven’t improved after about a week of consistent home care, or if you’re experiencing rectal bleeding, it’s time to see a healthcare provider. Bleeding can also be a sign of other conditions that need to be ruled out. Your provider can confirm the diagnosis, grade the severity, and discuss next steps.
Office Procedures for Persistent Hemorrhoids
Several minimally invasive procedures can be done in a doctor’s office without general anesthesia. These are typically used for internal hemorrhoids that keep bleeding or prolapsing despite lifestyle changes.
Rubber band ligation is the most widely used option. A small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. The cumulative success rate is around 80%, and the procedure can be repeated for recurrences. Each session treats one hemorrhoid at a time. You may feel pressure or mild discomfort for a day or two afterward, but it’s generally well tolerated.
Infrared coagulation uses a probe that delivers a brief pulse of infrared light to the hemorrhoid tissue, causing it to scar and shrink. It’s quick (about 1.5 seconds per application) and works well for smaller, bleeding internal hemorrhoids.
Sclerotherapy involves injecting a chemical solution directly into the hemorrhoid, which causes it to scar and shrivel. It’s sometimes combined with rubber band ligation for better results. This approach works best for smaller hemorrhoids (grade I through III).
Surgery for Severe Cases
Surgery is reserved for hemorrhoids that are large, prolapsing, or haven’t responded to office-based procedures. This generally means grade III or IV hemorrhoids, where the tissue protrudes from the anus and either requires manual pushing back in or can’t be pushed back at all.
A conventional hemorrhoidectomy, where the hemorrhoid tissue is surgically removed, remains the gold standard for long-term results. It has the lowest recurrence rate of any treatment. The tradeoff is a more difficult recovery. Most people report that pain resolves within about two weeks, with full recovery taking two to four weeks on average. It can be six to eight weeks before you’re ready for strenuous exercise or heavy physical work.
A stapled procedure is an alternative that repositions the hemorrhoid tissue rather than removing it. Recovery is generally faster and less painful, but recurrence rates are higher compared to conventional excision. Your surgeon can help weigh the tradeoffs based on the severity of your case.
Preventing Recurrence
Hemorrhoids tend to come back if the underlying causes aren’t addressed. The same habits that help them heal are the ones that prevent future flare-ups: hitting your daily fiber target, staying well hydrated, keeping toilet sessions short, using a footstool to elevate your knees, and avoiding straining. Regular physical activity also helps by promoting healthy bowel function and reducing the time stool sits in your colon.
If you have a job that involves long periods of sitting, take breaks to stand and move around. Prolonged sitting increases pressure on the pelvic blood vessels. Even brief movement every hour makes a difference over time.