Most hemorrhoids are treated at home with simple measures like warm soaks, over-the-counter creams, and dietary changes. When those don’t work, doctors can perform quick in-office procedures or, for severe cases, surgery. The right approach depends on the type of hemorrhoid you have and how much trouble it’s causing.
Home Treatments That Work for Most Cases
The majority of hemorrhoids improve within a week or two with basic self-care. The cornerstone is the sitz bath: sitting in a few inches of warm water (around 104°F) for 15 to 20 minutes, three to four times a day. This increases blood flow to the area and eases pain, itching, and swelling. You can use a shallow basin that fits over your toilet seat or simply sit in a regular bathtub.
Ice packs wrapped in a cloth and applied for 10 to 15 minutes at a time can also reduce swelling. Keeping the area clean and dry matters, and patting gently with unscented wipes or a soft cloth after bowel movements helps prevent further irritation.
Over-the-Counter Options
Hemorrhoid creams, ointments, and suppositories contain ingredients that target specific symptoms. Phenylephrine, found in many common ointments, works by temporarily shrinking swollen hemorrhoid tissue and relieving burning. Products with hydrocortisone reduce inflammation and itching. Witch hazel pads cool and soothe irritated skin.
These products are meant for short-term use. Hydrocortisone creams in particular can thin the skin if used for more than a week or so. Stool softeners are another useful tool. They draw water into the stool, making bowel movements easier and reducing the straining that aggravates hemorrhoids.
Fiber: The Best Long-Term Prevention
Straining during bowel movements is one of the main causes of hemorrhoids, and the simplest way to prevent it is eating enough fiber. Current dietary guidelines recommend about 14 grams of fiber per 1,000 calories you eat, which works out to roughly 28 grams a day on a standard 2,000-calorie diet. Most people fall well short of that.
Good sources include beans, lentils, whole grains, fruits, and vegetables. If you can’t get enough through food, a fiber supplement like psyllium husk can fill the gap. Increase your fiber intake gradually over a week or two, and drink plenty of water alongside it. Adding too much fiber too quickly can cause gas and bloating.
In-Office Procedures
When home care isn’t enough, doctors can treat internal hemorrhoids with quick, minimally invasive procedures done right in the office, usually without anesthesia.
Rubber Band Ligation
This is the most common office procedure for internal hemorrhoids. A doctor places a tiny rubber band around the base of the hemorrhoid, cutting off its blood supply. The tissue shrivels and falls off on its own, typically within a week. Studies find it effective 70% to 80% of the time. You may feel pressure or mild discomfort for a day or two, but most people return to normal activities quickly.
Infrared Coagulation
This approach uses pulses of infrared light directed at the tissue just above the hemorrhoid. The light creates small areas of scarring that cut off blood flow, causing the hemorrhoid to shrink over the following weeks. It’s FDA-approved for grade I, II, and III internal hemorrhoids (ranging from small hemorrhoids that don’t protrude to ones that bulge out during bowel movements). The procedure takes just a few minutes and causes minimal pain.
When Surgery Becomes Necessary
Surgery is reserved for hemorrhoids that are large, persistent, or complicated. Your doctor may recommend it if hemorrhoids keep coming back after less invasive treatments, if they’ve prolapsed to the point where they can’t be pushed back inside, or if there’s a blood clot causing severe pain.
Traditional Hemorrhoidectomy
This is the most thorough option. The surgeon removes the hemorrhoid tissue entirely under anesthesia. It’s the most effective long-term solution, with the lowest recurrence rates, but it comes with a tradeoff: recovery is more involved. The average recovery time is two to four weeks, and it can take six to eight weeks before you’re able to return to strenuous exercise or manual labor. Post-operative pain is significant for the first several days, managed with pain medication, sitz baths, and stool softeners.
Stapled Hemorrhoidopexy
Instead of removing the hemorrhoid, this procedure uses a circular stapling device to reposition prolapsed tissue back into place and cut off blood supply. It’s less painful than a traditional hemorrhoidectomy in the short term, and surgical complication rates are similar between the two. The downside is a somewhat higher chance the hemorrhoid will come back over time. For people prioritizing a quicker, less painful recovery, it can be a reasonable option to discuss with a surgeon.
Thrombosed Hemorrhoids Need Fast Attention
A thrombosed hemorrhoid is an external hemorrhoid that develops a blood clot inside it. It typically appears as a hard, painful lump near the anus that may look blue or purple. If you get to a doctor within 72 hours of symptoms starting, a small incision to remove the clot can provide significant relief. After that three-day window, the pain from the procedure itself may not be much better than the pain you’re already in, and the clot will usually start to resolve on its own over one to two weeks.
Signs That Need Medical Attention
Rectal bleeding during bowel movements is common with hemorrhoids, but it shouldn’t be dismissed automatically. Changes in bowel habits, differences in stool color or consistency, or bleeding that persists beyond a week of home care all warrant a visit to your doctor. These symptoms can overlap with more serious conditions, including colorectal cancer.
Large amounts of rectal bleeding, lightheadedness, dizziness, or feeling faint call for emergency care. In rare cases, chronic blood loss from hemorrhoids leads to anemia, where your body doesn’t have enough healthy red blood cells. Ongoing fatigue and weakness alongside hemorrhoid symptoms could point to this complication.