Internal hemorrhoids can shrink with a combination of dietary changes, at-home treatments, and over-the-counter products. For most people with early-stage hemorrhoids, these measures bring noticeable relief within a week or two. More advanced hemorrhoids that bulge out of the anal canal may need an in-office procedure, but even those are typically quick and don’t require surgery.
Know What You’re Dealing With
Internal hemorrhoids are graded on a scale from I to IV based on how much they protrude. Grade I hemorrhoids stay inside the anal canal and usually just cause painless bleeding. Grade II hemorrhoids push out during a bowel movement but slide back in on their own. Grade III hemorrhoids protrude and have to be pushed back in manually, often causing itching and moisture around the anus. Grade IV hemorrhoids are permanently prolapsed and can’t be pushed back in at all.
This grading matters because it shapes your options. Grade I and II hemorrhoids respond well to home treatment. Grade III hemorrhoids often improve with home care but may eventually need a procedure. Grade IV hemorrhoids almost always require medical intervention.
Fiber Is the Single Most Effective Change
Straining during bowel movements is the main force that engorges and enlarges internal hemorrhoids. Soft, bulky stools pass with minimal effort, which reduces pressure on the swollen tissue and allows it to gradually shrink. The most reliable way to get there is increasing your fiber intake.
Current dietary guidelines recommend about 14 grams of fiber per 1,000 calories you eat. On a typical 2,000-calorie diet, that works out to 28 grams a day. Most people fall well short of that number. Good sources include beans, lentils, whole grains, berries, pears, broccoli, and avocados. If you can’t get enough through food alone, a fiber supplement (like psyllium husk) works too.
Increase fiber gradually over a week or two rather than all at once, and drink plenty of water alongside it. A sudden jump in fiber without enough fluid can cause gas, bloating, and even constipation, which defeats the purpose. Aim for at least six to eight glasses of water a day.
Sitz Baths for Swelling and Discomfort
A sitz bath is a shallow soak that immerses just your hips and buttocks in warm water. The warmth increases blood flow to the area, which helps reduce swelling and relax the muscles around the anus. You can buy a small plastic basin that fits over your toilet seat, or simply use a clean bathtub.
Fill it with water at roughly 104°F (40°C), which should feel comfortably warm but not hot enough to scald. Soak for 15 to 20 minutes. Two to three times a day is a reasonable frequency, especially after bowel movements when the tissue is most irritated. Pat the area dry afterward rather than rubbing.
Over-the-Counter Products That Help
Two main types of products target hemorrhoid swelling directly. Phenylephrine, a vasoconstrictor found in many hemorrhoid creams and suppositories, works by temporarily tightening the blood vessels in the swollen tissue. This physically reduces the size of the hemorrhoid for a few hours. It’s safe for both internal and external use, applied up to four times a day.
Hydrocortisone, a mild steroid available in creams and suppositories, primarily relieves itching and irritation rather than shrinking the tissue itself. It’s useful when itching is a major symptom, but it shouldn’t be used for more than a week without a doctor’s guidance. Prolonged steroid use can thin the skin in the anal area and create new problems.
Witch hazel pads and wipes can soothe the tissue after a bowel movement. They have a mild astringent effect that some people find helpful for reducing that swollen, irritated feeling. None of these products cure the underlying hemorrhoid, but they reduce symptoms while dietary and lifestyle changes do the longer-term work.
Habits That Speed Up Shrinking
Beyond fiber, a few daily habits make a real difference. Don’t sit on the toilet longer than necessary. Scrolling your phone for 15 minutes while bearing down, even lightly, puts continuous pressure on the veins in your rectum. Go when you feel the urge, finish, and get up.
Physical activity helps too. Regular movement promotes healthy bowel function and reduces the time stool sits in the colon, which keeps it softer. Even a 20- to 30-minute daily walk can be enough. If you sit at a desk all day, standing or walking periodically takes pressure off the rectal area. Some people find that a small cushion or donut pillow helps during long stretches of sitting, though the main goal is to sit less, not to sit more comfortably.
When Home Treatment Isn’t Enough
If you’ve spent two to three weeks eating more fiber, using sitz baths, and applying topical treatments without meaningful improvement, an in-office procedure is the next step. The most common one is rubber band ligation. A doctor places a tiny rubber band around the base of the internal hemorrhoid, cutting off its blood supply. The tissue shrivels up and falls off on its own, usually within about a week. You won’t feel or notice when it happens.
Rubber band ligation is 70% to 80% effective and doesn’t require anesthesia or recovery time. Some people feel pressure or mild discomfort for a day or two afterward. Other in-office options include infrared coagulation, which uses heat to shrink the tissue, and sclerotherapy, which involves injecting a solution that causes the hemorrhoid to scar and collapse. All of these are outpatient procedures that take just a few minutes.
Surgical removal is reserved for Grade III or IV hemorrhoids that haven’t responded to less invasive treatments, or for hemorrhoids that are unusually large. Recovery from surgery takes two to four weeks and involves more significant pain, so doctors generally try banding or coagulation first.
Bleeding: What’s Normal and What’s Not
Small amounts of bright red blood on toilet paper or in the bowl after a bowel movement are the hallmark symptom of internal hemorrhoids and aren’t dangerous on their own. But bleeding that continues over weeks or months, even in small amounts, can lead to iron-deficiency anemia. This kind of slow, ongoing blood loss is sometimes hard to notice because the quantities are small enough to be hidden in stool.
If you feel unusually fatigued, lightheaded, or short of breath alongside rectal bleeding, those are signs your blood count may be dropping. Heavy bleeding that drips steadily or fills the toilet bowl warrants prompt medical attention. And any rectal bleeding in someone over 45 who hasn’t had a recent colonoscopy should be evaluated to rule out other causes.