The single best thing you can do for hemorrhoids is increase your fiber intake to soften your stools and reduce straining. That one change resolves most mild to moderate cases on its own. But depending on how severe your symptoms are, the best approach usually combines a few strategies: fiber, topical relief, sitz baths, and sometimes a medical procedure. Here’s what actually works, ranked from first-line basics to more advanced options.
Fiber Is the Foundation
Dietary and behavioral changes are the primary first-line treatment for hemorrhoids, according to guidelines from the American Society of Colon and Rectal Surgeons. The logic is simple: soft stools that pass easily mean less pressure on swollen veins, less straining, and faster healing. Most people don’t eat enough fiber. The recommended intake is about 14 grams per 1,000 calories you eat, which works out to roughly 25 to 35 grams a day for most adults. The average American gets about half that.
If you can’t close that gap through food alone (beans, whole grains, vegetables, berries), a psyllium husk supplement is one of the most effective options. It absorbs water in your gut and turns hard stools into softer, bulkier ones that are easier to pass. Drink plenty of water when you take it, and increase your dose gradually over a week or two. Jumping to a full dose too quickly can cause gas and cramping.
Sitz Baths for Immediate Relief
A sitz bath is just a shallow soak in warm water, and it’s one of the simplest ways to calm pain, itching, and swelling. Fill your bathtub or a plastic sitz basin (they sit on top of your toilet) with 3 to 4 inches of warm water, around 104°F (40°C). Soak for 15 to 20 minutes. You can do this three to four times a day during a flare-up. The warm water increases blood flow to the area, which helps with healing, and it relaxes the muscles around the anus so there’s less spasm and discomfort. No soap, no additives needed.
Topical Treatments That Help
Over-the-counter creams, ointments, and pads can take the edge off while your hemorrhoids heal. The most useful ingredients fall into a few categories:
- Hydrocortisone creams reduce redness, itching, and swelling. These are mild corticosteroids, and they work well for short-term use (a week or two). Using them longer can thin the skin in the area, so they’re not meant for everyday maintenance.
- Lidocaine-based products numb the nerve endings in the skin, which helps with sharp or burning pain. Combination products with both lidocaine and hydrocortisone tackle pain and inflammation at the same time.
- Witch hazel pads act as an astringent, meaning they tighten and soothe inflamed tissue. They can relieve itching, burning, and irritation from hemorrhoids or after bowel movements. You can use them up to six times a day as needed, and many people find them gentler than creams.
These products manage symptoms while the underlying cause (usually straining or hard stools) gets addressed through fiber and hydration. They won’t shrink hemorrhoids permanently on their own.
Oral Flavonoid Supplements
Flavonoid supplements, particularly diosmin, are widely used in Europe and increasingly recommended elsewhere for hemorrhoid flare-ups. These plant-based compounds strengthen vein walls and reduce inflammation. In clinical trials, diosmin has shown strong results for hemorrhoid bleeding specifically. One multicenter study found that 99% of patients treated with diosmin experienced effective bleeding relief within about a week, compared to 82% in the control group. These supplements are available over the counter in most countries and carry minimal side effects. They’re worth considering if you’re dealing with bleeding or frequent flare-ups.
When Home Treatment Isn’t Enough
If you’ve been consistent with fiber, sitz baths, and topical treatments for a few weeks and your hemorrhoids aren’t improving, office-based procedures are the next step. The most common and effective one is rubber band ligation. A doctor places a tiny rubber band at the base of an internal hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. It has a success rate between 60% and 80%, and the procedure itself takes just a few minutes in a doctor’s office with no anesthesia required.
Recurrence is the main downside. About half of patients see symptoms return within a year after a single banding session, but that drops to closer to 38% when multiple sessions are performed. For people with more advanced internal hemorrhoids (grade III or IV) or significant external hemorrhoids, surgical removal (hemorrhoidectomy) offers better long-term symptom control. The tradeoff is more pain during recovery and a higher complication rate, though patient satisfaction ends up similar between banding and surgery.
Internal vs. External Hemorrhoids
The best treatment partly depends on which type you have. Internal hemorrhoids form inside the rectum and are the ones most likely to bleed painlessly or prolapse (bulge out). These respond well to the full range of options: fiber, topical treatments, banding, and surgery if needed. Most people with grade I or II internal hemorrhoids (small, not prolapsing or only prolapsing temporarily) get better with conservative treatment alone.
External hemorrhoids sit under the skin around the anus and tend to cause more pain, especially if a blood clot forms inside one. A thrombosed external hemorrhoid feels like a hard, painful lump. If you catch it within the first 72 hours, having a doctor surgically remove the clot provides fast relief. After 72 hours, the clot usually starts to resolve on its own, and sitz baths become the better option since the worst pain has typically peaked by then.
Habits That Prevent Recurrence
Hemorrhoids come back frequently, so prevention matters as much as treatment. Beyond keeping your fiber intake high and staying hydrated, a few habits make a real difference. Don’t sit on the toilet longer than necessary. Scrolling your phone for 15 minutes while bearing down creates exactly the kind of sustained pressure that causes hemorrhoids. Go when you feel the urge, and if nothing happens within a few minutes, get up and try later.
Regular physical activity helps keep your bowel movements consistent and reduces the pressure that sitting for long hours puts on your pelvic veins. Even a daily 20-minute walk makes a measurable difference. Avoid straining or holding your breath during bowel movements. If your stools are soft enough from adequate fiber and water, you shouldn’t need to push hard. That combination of soft stools, short bathroom visits, and regular movement is what keeps hemorrhoids from becoming a recurring problem.