Most hemorrhoids can be treated at home with a combination of dietary changes, warm soaks, and over-the-counter products. Mild cases often improve within a week or two. For hemorrhoids that persist or worsen, a range of office-based and surgical procedures can provide longer-lasting relief, with the right option depending on the severity.
Start With Fiber and Fluids
The single most effective long-term change you can make is increasing your fiber intake. Fiber softens stool and adds bulk, which means less straining during bowel movements. Straining is one of the primary forces that engorges and irritates hemorrhoidal tissue. Federal dietary guidelines recommend 14 grams of fiber per 1,000 calories you eat, which works out to about 28 grams a day on a standard 2,000-calorie diet. Most people fall well short of that number.
Good sources include beans, lentils, whole grains, fruits, and vegetables. If you struggle to hit the target through food alone, a fiber supplement (like psyllium husk) can fill the gap. Increase your intake gradually over a week or two to avoid bloating and gas, and drink plenty of water alongside it. Fiber without adequate fluid can actually make constipation worse.
Sitz Baths for Immediate Relief
A sitz bath is a shallow warm soak that targets just your anal area. You can use a small basin that fits over your toilet seat or simply sit in a few inches of warm water in a bathtub. The Cleveland Clinic recommends a water temperature around 104°F (40°C), soaking for 15 to 20 minutes per session. For active flare-ups, three to four sitz baths a day can help reduce pain, itching, and swelling. The warmth improves blood flow to the area and relaxes the surrounding muscles, which eases discomfort noticeably.
Pat the area dry gently afterward rather than rubbing. Keeping the skin around your anus clean and dry between baths helps prevent further irritation.
Over-the-Counter Products
Hemorrhoid creams, ointments, and suppositories available at any pharmacy typically contain one or two types of active ingredients. Some include a vasoconstrictor like phenylephrine, which temporarily narrows the swollen blood vessels to reduce puffiness and discomfort. Others contain a topical anesthetic like pramoxine, which blocks pain and itch signals in the skin. Many combination products include both.
You can also find creams with hydrocortisone, a mild steroid that reduces inflammation and itching. These work well for short-term flare-ups, but you shouldn’t use steroid-based products for more than a week without guidance, since prolonged use can thin the skin. Medicated wipes containing witch hazel offer a gentler option for soothing irritation after bowel movements. Cold packs applied for 10 to 15 minutes can also reduce swelling during an acute episode.
Change How You Sit on the Toilet
Your posture on the toilet matters more than most people realize. Standard sitting positions create a kink in the rectum that forces you to strain. When you shift into more of a squatting position, the anorectal angle opens to about 100 to 110 degrees, straightening the rectal canal and letting stool pass with significantly less effort.
You don’t need to squat over the toilet. A simple footstool placed in front of the toilet that raises your knees above your hips achieves much of the same effect. One study found that using a footstool cut average bowel movement time roughly in half (about 56 seconds versus 113 seconds in a standard seated position) and reduced self-reported straining from a rating of 2.5 to 1.4. Participants also reported feeling more completely emptied. It’s a small change with a real payoff, especially if you’re prone to constipation or prolonged time on the toilet.
On that note, avoid sitting on the toilet longer than necessary. Reading or scrolling on your phone extends the time you spend with gravity and pressure bearing down on your hemorrhoidal veins.
Office-Based Procedures
When home treatment isn’t enough, several minimally invasive procedures can be performed in a doctor’s office without general anesthesia. These are most commonly used for internal hemorrhoids that bleed or prolapse mildly.
Rubber band ligation is the most widely used office procedure. A small elastic band is placed around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. It’s effective, but recurrence rates are notable. A 2025 randomized trial in Diseases of the Colon & Rectum found that about 48% of patients with grade III hemorrhoids experienced recurrence within 12 months after banding, and 54% eventually needed further treatment. For smaller, less advanced hemorrhoids, the success rate is considerably better. Multiple banding sessions are common.
Infrared coagulation uses a burst of infrared light to scar hemorrhoidal tissue, causing it to shrink. A comparative analysis found that infrared coagulation produced fewer and less severe complications than rubber band ligation, though slightly more patients needed follow-up treatment. For grade I hemorrhoids (the mildest), one study reported bleeding resolved in 78% of patients. That number dropped to 52% for grade II and 22% for grade III. It tends to be a good fit for smaller hemorrhoids where comfort during treatment is a priority.
Sclerotherapy involves injecting a chemical solution into the hemorrhoid, which causes the tissue to shrink and scar. It’s another option for mild internal hemorrhoids and produces similar symptom relief to infrared coagulation at the 12-month mark, though, like infrared treatment, it may require repeat sessions.
When Surgery Makes Sense
Surgery is reserved for hemorrhoids that haven’t responded to other treatments or that have become too advanced for office procedures. The American Society of Colon and Rectal Surgeons recommends excisional hemorrhoidectomy primarily for patients with external hemorrhoids or combined internal and external hemorrhoids graded III or IV.
The specific situations where surgery is typically recommended include:
- Prolapse that won’t stay in. Grade III hemorrhoids (those you have to push back in manually) and grade IV hemorrhoids (those that can’t be pushed back in at all) are strong candidates for surgical removal.
- Blood clots (thrombosis). A thrombosed hemorrhoid is intensely painful. If you’re within the first 72 hours, surgical removal of the clot offers fast relief. After that window, the clot typically starts resolving on its own.
- Strangulation. A hemorrhoid that has prolapsed and gotten trapped outside the anus can lose its blood supply. This is a medical emergency.
- Repeated recurrence. If hemorrhoids keep returning after less invasive treatments, surgery offers the most durable solution. The recurrence rate after hemorrhoidectomy is around 6%, far lower than the roughly 48% seen with rubber band ligation for advanced hemorrhoids.
Recovery from hemorrhoidectomy takes time. You can expect significant pain for the first week or two, managed with pain medication and sitz baths. Light daily activities can resume fairly quickly, but strenuous exercise or heavy lifting typically requires six to eight weeks of recovery.
Habits That Prevent Flare-Ups
Treating an active hemorrhoid is only half the equation. Prevention comes down to minimizing the pressure and irritation that cause hemorrhoids to swell in the first place. Keep your fiber intake consistently high, stay well hydrated, and respond to the urge to have a bowel movement promptly rather than delaying it. Holding it in leads to harder stool and more straining.
Regular physical activity helps keep your digestive system moving. Even daily walking makes a difference. If your job requires long periods of sitting, take breaks to stand and move throughout the day. Prolonged sitting, especially on hard surfaces, increases pressure on the veins around the anus. And if you tend to strain or spend more than a few minutes on the toilet, a footstool and a conscious effort to relax rather than push can meaningfully reduce your risk of recurrence.
Bleeding That Needs Attention
Small amounts of bright red blood on toilet paper or in the bowl are common with hemorrhoids and usually not dangerous. But rectal bleeding should never be automatically chalked up to hemorrhoids. If bleeding persists beyond a week of home care, or if you notice changes in your bowel habits, stool color, or stool consistency, those are reasons to get evaluated. Large amounts of rectal bleeding, or bleeding accompanied by lightheadedness, dizziness, or faintness, requires emergency care.