Internal hemorrhoids improve most reliably with two changes: eating more fiber and spending less time straining on the toilet. These two interventions are now considered the most effective starting point for symptom relief, and they work for the majority of people with lower-grade internal hemorrhoids. Beyond that foundation, a range of home remedies, over-the-counter products, office procedures, and surgical options exist depending on how severe your symptoms are.
How Internal Hemorrhoids Are Graded
Internal hemorrhoids sit inside the rectum, above the point where you can feel pain, which is why they’re often painless even when they bleed. They’re classified into four grades based on how much they protrude:
- Grade I: Swollen tissue that stays inside the anal canal. You might notice blood on toilet paper or in the bowl but feel nothing otherwise.
- Grade II: The hemorrhoid pushes out during a bowel movement but slides back in on its own.
- Grade III: The hemorrhoid protrudes and needs to be pushed back in manually. Itching and mucus leakage are common at this stage.
- Grade IV: The hemorrhoid stays prolapsed and can’t be pushed back in. Chronic irritation and inflammation develop around the area.
Painless bleeding can happen at any grade. The grade matters because it determines which treatments are appropriate. Grades I and II almost always respond to conservative, at-home measures. Grade III may need an office procedure. Grade IV typically requires surgery.
Fiber: The Single Most Effective Change
Fiber softens stool and adds bulk, which means less straining and less pressure on the veins inside your rectum. Federal 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 number.
You can close the gap through food (beans, whole grains, vegetables, fruits with skin) or through a fiber supplement. The options differ in a few practical ways. Psyllium husk (sold as Metamucil or Konsyl) delivers about 10 grams of fiber per dose and is typically taken twice a day. Wheat dextrin (Benefiber) provides around 6 grams per dose. Methylcellulose (Citrucel) gives about 2 grams per dose but is 100% soluble fiber, so it tends to cause less gas, which matters if bloating is a concern for you.
If you’re not used to eating much fiber, increase gradually over a week or two and drink plenty of water alongside it. A sudden jump in fiber without enough fluid can make constipation worse.
Toilet Habits That Reduce Pressure
Straining during a bowel movement is one of the primary forces that engorges hemorrhoidal tissue. Sitting on the toilet for extended periods, even without actively straining, keeps pressure on the anal cushions. The fix is straightforward: go when you feel the urge, avoid pushing hard, and get up when you’re done. Scrolling your phone on the toilet for 15 or 20 minutes is one of the most common, least recognized contributors to hemorrhoid symptoms.
If stools are still hard despite adequate fiber, a stool softener or a gentle osmotic laxative can help. The goal is a soft, formed stool that passes without effort.
Sitz Baths and Topical Relief
A sitz bath is a shallow soak of just the anal area in warm water. Cleveland Clinic recommends a water temperature of about 104°F (40°C), soaking for 15 to 20 minutes, up to three or four times a day when symptoms are active. The warm water increases blood flow, relaxes the sphincter muscles, and eases itching and discomfort. You can use a small plastic basin that fits over your toilet seat or simply sit in a few inches of water in a bathtub.
Over-the-counter creams and suppositories containing hydrocortisone can reduce swelling and itching in the short term. The key word is “short term.” If symptoms haven’t improved within seven days, stop using hydrocortisone. Prolonged use can thin the delicate skin in the area, making it fragile and more prone to irritation. Witch hazel pads and plain petroleum jelly are gentler options for ongoing comfort.
Flavonoid Supplements
A class of plant-based compounds found in citrus peel has shown genuine benefit for hemorrhoid symptoms. These supplements (sold under names like Daflon in many countries) work by strengthening vein walls and improving blood flow. A systematic review and meta-analysis found they significantly reduced bleeding and swelling, with measurable improvement in pain scores within 4 to 10 days and further reduction in swelling after 10 days of use. Doses in the studies ranged from about 1,800 to 2,700 milligrams per day. These supplements are widely available outside the United States and can be found online or in some health food stores in the U.S. They’re not a replacement for fiber and habit changes, but they can be a useful addition.
Office Procedures for Persistent Symptoms
When conservative measures aren’t enough, particularly for Grade II and III hemorrhoids, several minimally invasive procedures can be done in a doctor’s office without general anesthesia. The most common is rubber band ligation, where a tiny elastic band is placed at the base of the hemorrhoid to cut off its blood supply. The tissue shrinks and falls off within a few days. You might feel pressure or mild discomfort for a day or two afterward, but most people return to normal activities immediately.
Other office-based options include infrared coagulation, which uses heat to shrink the tissue, and sclerotherapy, which involves injecting a solution that causes the hemorrhoid to shrink. All of these work best on Grade I through III hemorrhoids and may need to be repeated if symptoms return.
When Surgery Becomes Necessary
Grade IV hemorrhoids, and Grade III hemorrhoids that don’t respond to banding, usually require surgical removal. The two main approaches are traditional excisional surgery (hemorrhoidectomy) and stapled hemorrhoidopexy.
A large randomized trial published in The Lancet compared the two head to head. Stapled hemorrhoidopexy was less painful in the first few weeks, and quality-of-life scores were higher during the initial six-week recovery. But the picture reversed over time: people who had traditional excisional surgery reported better quality of life in the longer term and had lower recurrence rates. Surgical complication rates were similar between the two approaches.
In practical terms, this means the stapled approach gets you back on your feet faster, but the traditional method is more durable. Your surgeon’s recommendation will depend on the size and number of hemorrhoids, whether there are other anal conditions present, and your own priorities around recovery time versus long-term results.
Daily Habits That Prevent Flare-Ups
Once hemorrhoid symptoms improve, the same habits that helped them heal will keep them from coming back. Stay at or above 28 grams of fiber daily. Drink enough water that your urine stays light-colored. Keep toilet visits brief and strain-free. Regular physical activity helps keep bowel movements consistent, though you should avoid heavy lifting with breath-holding (the Valsalva maneuver), which spikes pressure in your pelvic veins.
If you sit for long stretches at work, standing or walking for a few minutes every hour reduces sustained pressure on the anal area. And if you notice occasional bleeding returning, restart sitz baths and check whether your fiber intake has slipped before assuming the problem has worsened.