Most internal hemorrhoids heal with simple changes to diet, bathroom habits, and daily routines. Grade I and II hemorrhoids, which account for the majority of cases, typically respond well to conservative measures at home. More advanced hemorrhoids that prolapse and won’t retract on their own usually need an in-office procedure or surgery, but even then, recovery is relatively straightforward.
How Internal Hemorrhoids Are Graded
Internal hemorrhoids sit inside the anal canal where you can’t see or feel them directly. They’re classified into four grades based on how much they protrude:
- Grade I: Swollen blood vessels that may bleed but don’t prolapse outside the anus.
- Grade II: Tissue that pushes out during a bowel movement but slides back in on its own.
- Grade III: Tissue that protrudes and needs to be manually pushed back in.
- Grade IV: Permanently prolapsed tissue that can’t be pushed back in, sometimes with blood clots or strangulation.
Grade I and II hemorrhoids are the most common and the most responsive to home treatment. Grade III and IV hemorrhoids generally require a procedure.
Fiber and Fluid: The Foundation
The single most effective thing you can do is soften your stools so they pass without straining. The 2024 American Society of Colon and Rectal Surgeons guidelines strongly recommend increasing fiber and fluid intake as the first step, noting it improves both prolapse and bleeding.
The federal Dietary Guidelines recommend 14 grams of fiber per 1,000 calories you eat. On a standard 2,000-calorie diet, that works out to about 28 grams per day. Most people fall well short of this. You can close the gap with fruits, vegetables, legumes, whole grains, and a fiber supplement like psyllium husk if food alone isn’t enough. Increase your intake gradually over a week or two to avoid bloating and gas.
Water makes fiber work. Without enough liquid, extra fiber can actually make constipation worse. Aim to drink water throughout the day, and include other fluids like clear soups and fruit juices. The right amount varies by your body size, activity level, and climate, but if your urine is pale yellow, you’re generally on track.
Bathroom Habits That Reduce Pressure
How you sit on the toilet matters more than most people realize. A small footstool placed under your feet raises your knees above your hips, mimicking a squat position. This straightens the path through your lower colon and reduces the amount of pushing needed. Place your feet hip-width apart on the stool, lean slightly forward, and rest your elbows on your knees. The gentle pressure of your thighs against your lower belly helps, too.
A few other habits make a real difference:
- Keep your heels flat. Lifting them tightens the pelvic floor muscles and makes it harder to go.
- Breathe and relax. Take slow breaths and consciously relax your belly, face, and pelvic floor instead of bearing down. Holding your breath while straining spikes pressure in the hemorrhoidal veins.
- Limit your time. Sitting on the toilet for extended periods (scrolling your phone, reading) puts sustained pressure on the anal cushions. If nothing is happening after a few minutes, get up and try again later.
- Go when you feel the urge. Delaying bowel movements dries out the stool and makes straining more likely.
Topical Relief for Symptoms
While you’re waiting for dietary changes to take effect, a few things can ease discomfort. Warm sitz baths, where you soak your lower body in a few inches of warm water for 10 to 15 minutes, increase blood flow and relax the muscles around the anus. You can do this two to three times a day and after bowel movements.
Over-the-counter creams and suppositories containing ingredients like witch hazel or hydrocortisone can temporarily reduce itching, swelling, and pain. Hydrocortisone products shouldn’t be used for more than about a week, since prolonged use thins the skin. These treatments manage symptoms but don’t shrink the hemorrhoid itself.
Oral Supplements That Help
Flavonoid supplements, plant-based compounds that strengthen blood vessel walls and reduce inflammation, have solid evidence behind them for hemorrhoid symptoms. The most studied formulation combines diosmin and hesperidin. Research shows these supplements reduce bleeding, pain, and swelling, with noticeable improvement within the first 4 to 10 days. They’re available over the counter in many countries and are worth considering as an addition to fiber and fluid therapy, not a replacement.
When Home Treatment Isn’t Enough
If your symptoms haven’t improved after a week or two of consistent home care, an in-office procedure is the next step. These are minimally invasive, done without general anesthesia, and don’t require significant downtime.
Rubber band ligation is the most widely recommended option. Your 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 few days. It’s 70% to 80% effective, and the most common side effect is mild discomfort or pressure for a day or two. Serious complications like bleeding or infection are rare.
Infrared coagulation uses a burst of infrared light to scar the hemorrhoidal tissue, causing it to shrink. It works about as well as banding and tends to cause less pain, though hemorrhoids are slightly more likely to come back afterward.
Sclerotherapy involves injecting a chemical solution into the hemorrhoid to cause it to scar and shrink. Its effectiveness and recurrence rates are similar to infrared coagulation. It’s most often used for smaller, Grade I or II hemorrhoids.
Surgical Options for Advanced Hemorrhoids
Grade III and IV hemorrhoids, or cases that don’t respond to office procedures, may need surgery. The two main approaches differ in recovery and effectiveness.
Excisional hemorrhoidectomy, where the hemorrhoid tissue is surgically removed, has the highest long-term success rate but comes with more pain. Expect soreness and a feeling of fullness in the anal area for the first week, with full recovery taking a few weeks. It’s typically reserved for large or combined internal and external hemorrhoids.
Doppler-guided hemorrhoidal artery ligation is a newer alternative. Using ultrasound, the surgeon locates and ties off the arteries feeding the hemorrhoid. It causes less postoperative pain than traditional surgery and can be a good option for internal hemorrhoids specifically. Stapled hemorrhoidopexy, another technique, is no longer recommended as a first-line surgical treatment because of a higher risk of complications and lower long-term effectiveness.
How Long Healing Takes
With consistent fiber intake, adequate fluids, and good bathroom habits, mild internal hemorrhoids often improve within one to two weeks. Bleeding is usually the first symptom to resolve. Swelling and discomfort take a bit longer.
After rubber band ligation, most people feel back to normal within a few days, though complete tissue healing happens over one to two weeks. After a full hemorrhoidectomy, the first week involves the most discomfort, and you should plan on limiting strenuous activity for two to three weeks.
Regardless of which treatment path you follow, the dietary and habit changes described above are what keep hemorrhoids from coming back. Procedures fix the immediate problem, but fiber, fluids, and avoiding straining are what prevent recurrence.
Signs That Need Prompt Attention
Rectal bleeding during bowel movements is common with hemorrhoids, but don’t assume that’s the cause without a proper evaluation, especially if your bowel habits have changed or your stool looks different in color or consistency. Rectal bleeding can also be a sign of colorectal or anal cancer.
Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness, or faintness. These could indicate significant blood loss. In rare cases, a prolapsed hemorrhoid can become strangulated, meaning its blood supply is cut off, causing severe pain and swelling that requires immediate treatment. Chronic low-level bleeding from hemorrhoids can also lead to anemia over time, so persistent bleeding that doesn’t respond to treatment is worth investigating.