The best treatment for hemorrhoids depends on how severe they are, but for most people, the answer starts with simple changes at home. Higher fiber intake alone cuts the risk of persistent symptoms by about 53%, and the majority of hemorrhoid flare-ups resolve without any procedure. Here’s what works at each stage, from first-line home care to office procedures and surgery.
Fiber and Fluids Come First
Increasing your fiber and fluid intake is the single most effective starting point. A Cochrane review of seven trials found that people who added fiber to their diet were 53% less likely to have ongoing symptoms compared to those who didn’t. Bleeding specifically dropped by about 50%. Most adults should aim for 25 to 35 grams of fiber per day through a mix of whole grains, fruits, vegetables, and a supplement like psyllium husk if needed.
The goal is softer, bulkier stools that pass without straining. Straining during bowel movements is one of the main drivers of hemorrhoid pressure, so anything that makes stools easier to pass directly reduces symptoms. Drink enough water throughout the day to keep your stool soft, especially if you’re adding a fiber supplement (which can cause constipation if you don’t hydrate alongside it).
Bathroom Habits That Matter
How you use the toilet matters almost as much as what you eat. Prolonged sitting on the toilet increases pressure on the veins around your anus, which worsens existing hemorrhoids and can trigger new ones. Health professionals generally recommend limiting toilet time to 10 minutes or less. If you haven’t had a bowel movement in that window, get up and try again later.
The simplest way to cut your time: leave your phone outside the bathroom. Scrolling is the number one reason people sit far longer than they need to. You can also set a timer. Avoid straining or bearing down. If you feel the urge to push hard, that’s a sign your stool is too firm, and you should revisit your fiber and water intake rather than forcing it.
Sitz Baths for Quick Relief
A sitz bath is a shallow warm soak that targets just your anal area. Fill a basin or bathtub with water at about 104°F (40°C) and sit in it for 15 to 20 minutes. The warmth increases blood flow, relaxes the surrounding muscles, and provides noticeable relief from pain, itching, and swelling. You can do this two to three times a day during a flare-up, and it costs nothing.
Over-the-Counter Products
Pharmacy shelves are packed with hemorrhoid creams, ointments, suppositories, and medicated wipes. The active ingredients that actually do something fall into a few categories:
- Phenylephrine temporarily narrows blood vessels in the area, which reduces swelling and discomfort. It’s the active ingredient in many brand-name hemorrhoid creams.
- Witch hazel works as an astringent, helping to soothe irritated tissue and reduce minor itching. Medicated pads soaked in witch hazel are a popular option for gentle cleanup after bowel movements.
- Hydrocortisone is a mild steroid that reduces inflammation and itching. It works well for short-term flare-ups, but you should not use it for more than 7 days. Longer use can thin the skin in the area, making the problem worse over time.
- Lidocaine or pramoxine are local numbing agents found in some products. They temporarily block pain signals and can help if sitting or walking is uncomfortable.
These products manage symptoms but don’t fix the underlying cause. They’re most useful as a bridge while dietary changes take effect, which usually takes a few days to a couple of weeks.
When Home Treatment Isn’t Enough
If you’ve been consistent with fiber, fluids, and good bathroom habits for several weeks and still have bleeding or tissue bulging out during bowel movements, an office-based procedure is the next step. Most people with mild to moderate internal hemorrhoids (grades I through III) can be treated this way, without general anesthesia or a hospital visit.
Rubber band ligation is considered the most effective office-based treatment. A small elastic band is placed around the base of the internal hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. The success rate is between 60% and 80%, though recurrence is possible. In one large trial, about half of patients had symptoms return within a year after a single banding session, but when multiple sessions were performed, the recurrence rate dropped to around 38%. The procedure causes mild discomfort for a day or two but is well tolerated overall.
Other office options include sclerotherapy (injecting a solution that shrinks the hemorrhoid) and infrared coagulation, though neither has the track record of banding for long-term results.
Surgical Options for Severe Cases
Surgery is typically reserved for large external hemorrhoids or advanced internal hemorrhoids (grades III and IV) that haven’t responded to less invasive treatment. The two main approaches have different trade-offs.
Excisional hemorrhoidectomy is the traditional surgery where the hemorrhoid tissue is cut away. It has the lowest recurrence rate of any treatment and is the gold standard for severe or combined internal and external hemorrhoids. Recovery involves meaningful pain for one to two weeks, and most people need about two to four weeks before returning to normal activity. Despite the tougher recovery, it provides the most durable results.
Stapled hemorrhoidopexy is a newer technique that repositions the tissue rather than removing it. It was initially popular because of the expectation of less postoperative pain, but the data has been disappointing. Meta-analyses show it carries a significantly higher rate of recurrent prolapse compared to traditional excision, and major surgical guidelines no longer recommend it as a first-line option due to its marginal effectiveness and higher risk profile.
A third option, Doppler-guided hemorrhoid artery ligation, uses ultrasound to locate and tie off the arteries feeding the hemorrhoid. It generally causes less pain than excisional surgery, but recurrence rates are higher. It may be a reasonable middle ground for patients who want to avoid the more painful recovery of a full hemorrhoidectomy.
Symptoms That Need Attention
Hemorrhoids cause bright red blood on toilet paper or in the bowl, itching, and sometimes a lump you can feel near the anus. These symptoms overlap with more serious conditions, so certain warning signs should prompt a medical evaluation. Persistent changes in bowel habits (new diarrhea or constipation lasting weeks), unexplained weight loss, overwhelming fatigue, abdominal cramping, or a feeling that your bowel won’t empty fully are not typical hemorrhoid symptoms. These can be associated with colorectal conditions that require imaging or a colonoscopy to rule out, particularly for adults over 50.
Rectal bleeding that doesn’t improve with a few weeks of conservative treatment also warrants a closer look, even if you’re fairly certain hemorrhoids are the cause. A proper examination can confirm the diagnosis and rule out anything else.