Most hemorrhoids improve with simple changes you can start today: more fiber, warm soaks, and over-the-counter creams. These measures resolve the majority of cases within a week or two. For hemorrhoids that persist or cause significant pain, office procedures and surgical options can provide longer-lasting relief.
Start With Fiber and Fluids
The single most effective long-term strategy is softening your stool so it passes without straining. Straining during bowel movements is the primary force that swells hemorrhoidal tissue, and reducing that pressure lets inflamed veins shrink back down. The target is 25 to 34 grams of fiber per day, depending on your age and sex. Most Americans fall well short of that.
You can get there through food (beans, whole grains, vegetables, fruits with skin) or a fiber supplement like psyllium husk. Start slowly, adding a few grams per day over a week or two, and drink more water as you increase fiber. Jumping straight to high doses often causes bloating and gas. Bulk-forming fiber supplements are safe to use daily and work by absorbing water in the gut, making stool softer and bulkier so it moves through more easily.
If fiber alone isn’t enough, a lubricant like mineral oil (one tablespoon with a meal) can help stool pass with less friction, which is especially useful if you have painful external hemorrhoids. Don’t use mineral oil for more than a few days, though, because it interferes with vitamin absorption. Osmotic laxatives are another option but should be used at recommended doses and not as an everyday solution, since they can disrupt your body’s electrolyte balance over time.
Sitz Baths for Quick Relief
A sitz bath is a shallow warm soak that covers your hips and buttocks. Fill a bathtub with a few inches of water, or use a plastic basin that fits over your toilet seat. Aim for about 104°F (40°C), which is warm but not hot enough to burn sensitive skin. Soak for 15 to 20 minutes, up to three or four times a day when symptoms are active. The warmth increases blood flow to the area, which helps reduce swelling and eases itching and pain. Pat dry gently afterward rather than rubbing.
Over-the-Counter Creams and Pads
Hemorrhoid creams typically combine several ingredients, each tackling a different symptom. A local anesthetic numbs the area to relieve pain and itching. A vasoconstrictor shrinks swollen blood vessels, which reduces the size of the hemorrhoid. Protectants like glycerin and petrolatum form a barrier over irritated skin, preventing further friction and moisture loss.
Witch hazel pads are a gentler alternative. They have a mild astringent effect that soothes itching and can be applied directly after bowel movements. Hydrocortisone creams (available in low-strength formulations without a prescription) reduce inflammation effectively, but you shouldn’t use them for more than about a week because prolonged use thins the skin.
Bathroom Habits That Matter
How you use the toilet matters as much as what you eat. A few specific habits make a real difference:
- Go when you feel the urge. Waiting causes stool to back up, dry out, and become harder to pass, which means more straining.
- Limit your time on the toilet. Sitting for extended periods (scrolling your phone, reading) keeps constant pressure on the veins around your anus. Get up if nothing is happening after a few minutes.
- Set a regular schedule. Sitting on the toilet at the same time each day, such as after a meal, helps train your bowel into a predictable rhythm.
- Use a cushion when sitting for long periods. A donut-shaped or soft cushion reduces pressure on existing hemorrhoids and helps prevent new ones.
- Walk regularly. Brisk walking for 20 to 30 minutes a day stimulates bowel function and reduces the constipation that feeds the cycle.
Office Procedures for Persistent Hemorrhoids
When home measures aren’t enough, rubber band ligation is the most common next step. A doctor places a small rubber band around the base of an internal hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. Studies find this procedure is 70% to 80% effective. You can usually return to normal activities the same day, though some people need a day or two to recover. Avoid heavy lifting for at least two weeks afterward. Complications like bleeding, infection, or severe pain are rare.
Other in-office options include infrared coagulation, which uses heat to shrink the tissue, and sclerotherapy, which involves injecting a chemical solution that causes the hemorrhoid to collapse. These are typically used for smaller internal hemorrhoids and generally involve minimal downtime.
Surgery for Severe Cases
Large hemorrhoids or those that haven’t responded to banding may need surgery. The two main approaches differ in recovery and long-term results.
Traditional hemorrhoidectomy surgically removes the hemorrhoid tissue. It’s the most thorough option with the lowest chance of hemorrhoids returning, but recovery is more painful and takes longer. Most people need one to two weeks before returning to normal activities, and the post-surgical pain can be significant.
Hemorrhoidopexy (sometimes called stapled hemorrhoidopexy) repositions the tissue rather than removing it. Many people experience less pain afterward and return to light activities sooner than with traditional surgery. The tradeoff is a higher chance of hemorrhoids coming back over time. Your doctor can help weigh these options based on the severity and location of your hemorrhoids.
Hemorrhoids During Pregnancy
Pregnancy increases the risk of hemorrhoids because of the added pressure on pelvic veins and hormonal changes that relax blood vessel walls. Witch hazel pads are generally considered a safe topical option during pregnancy. For fiber supplements, stool softeners, or hemorrhoid creams, it’s worth confirming with your prenatal care provider which specific products are appropriate, since some active ingredients may not be recommended during pregnancy. Sitz baths and dietary changes are safe and effective first-line strategies throughout pregnancy.
Signs That Need Prompt Attention
A thrombosed hemorrhoid occurs when a blood clot forms inside an external hemorrhoid. It causes severe pain, swelling, and a hard, discolored lump near the anus. While not dangerous, it can be extremely painful and sometimes needs to be drained by a doctor, especially within the first 48 to 72 hours when the procedure provides the most relief.
Large amounts of rectal bleeding, lightheadedness, dizziness, or faintness warrant emergency care. Rectal bleeding can also be a sign of other conditions, so persistent or unexplained bleeding should be evaluated even if you suspect hemorrhoids are the cause.