Most internal hemorrhoids improve with simple changes to your diet, bathroom habits, and daily routine. About 11% of adults have symptomatic hemorrhoids, with the majority being mild cases that respond well to home care. What you need to do depends on the severity of your symptoms, which range from occasional painless bleeding to tissue that bulges out and won’t go back in on its own.
Understanding the Four Grades
Internal hemorrhoids are classified on a scale from Grade I to Grade IV based on how far the tissue has shifted from its normal position. This grading system directly determines which treatments make sense for you.
Grade I hemorrhoids are the mildest. The tissue is swollen but stays inside the anal canal. You might notice small amounts of bright red blood on toilet paper or in the bowl, but nothing protrudes. Grade II hemorrhoids push out during a bowel movement but slide back in on their own afterward. Grade III hemorrhoids push out and stay out until you manually push them back in. These often come with itching and minor leakage. Grade IV hemorrhoids protrude and cannot be pushed back in at all, and they tend to develop chronic irritation and inflammation.
Painless bleeding can happen at any grade. The blood is typically bright red and shows up on the tissue, in the toilet water, or on the stool surface.
Dietary Changes That Make the Biggest Difference
Fiber is the single most important dietary factor. Current guidelines recommend 14 grams of fiber per 1,000 calories you eat, which works out to about 28 grams per day on a standard 2,000-calorie diet. Most people fall well short of that number. Increasing your fiber intake softens stool and reduces the straining that worsens hemorrhoids.
Some of the most fiber-dense foods per serving include half a cup of navy beans (9.6 grams), a cup of green peas (8.8 grams), a cup of raspberries (8 grams), half a cup of pinto beans (7.7 grams), and a cup of sweet potato (6.3 grams). A medium pear with the skin gives you 5.5 grams, and a medium apple with the skin provides 4.8 grams. Half a cup of high-fiber bran cereal alone delivers 14 grams, which is half the daily target in one sitting.
If you add fiber through supplements like psyllium husk, you need to increase your water intake at the same time. Fiber without enough fluid can actually make constipation worse. Aim for at least 48 to 64 ounces of water per day, and start increasing fiber gradually over a week or two to minimize bloating and gas.
Bathroom Habits That Reduce Pressure
Hemorrhoids are fundamentally a problem of pressure. Toilet seats have an open center, so when you sit, your pelvis is unsupported. Gravity pushes blood into the hemorrhoidal tissue, and the longer you sit, the more those vessels swell. This is why scrolling your phone on the toilet is a surprisingly significant risk factor. One study found you’re 46% more likely to develop hemorrhoids if you use your phone while sitting on the toilet, simply because it extends your time there.
Limit toilet time to five minutes or less. If a bowel movement doesn’t happen within that window, get up and try again later. Avoid straining or bearing down forcefully. If your stool is soft enough from adequate fiber and water, it should pass without significant effort. When you do feel the urge to go, respond promptly rather than holding it, since delaying can lead to harder stool and more straining later.
Over-the-Counter Treatments for Symptom Relief
OTC products won’t cure internal hemorrhoids, but they can ease discomfort while your dietary and habit changes take effect. Suppositories designed for internal hemorrhoids typically contain two key ingredients: a protectant like cocoa butter that coats and shields irritated tissue, and a vasoconstrictor like phenylephrine that temporarily shrinks swollen blood vessels. The result is short-term relief from itching, burning, and the feeling of fullness.
Hydrocortisone creams and suppositories reduce inflammation and itching but shouldn’t be used for more than about a week at a time, as prolonged use can thin the tissue. Warm sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes, increase blood flow to the area and relax the surrounding muscles. Many people find these especially soothing after a bowel movement.
Office Procedures for Persistent Hemorrhoids
When home care isn’t enough, particularly for Grade II and III hemorrhoids, your doctor can perform minimally invasive procedures right in the office without general anesthesia.
Rubber band ligation is the most common and well-studied option. A small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The banded tissue withers and falls off within a few days. Studies find the procedure is 70% to 80% effective, and most people return to normal activities immediately or within a day or two. Complications like significant bleeding, infection, or severe pain are rare.
Two other office-based options work for Grade I through III hemorrhoids. Infrared coagulation uses a burst of focused heat to seal off blood vessels feeding the hemorrhoid, causing it to shrink over time. Sclerotherapy involves injecting a chemical solution into the hemorrhoid that creates scar tissue and cuts off blood flow. Both have similar recurrence rates. Sclerotherapy is particularly useful for people on blood-thinning medications, since it carries a lower risk of post-procedure bleeding.
These procedures may need to be repeated if hemorrhoids recur, but they offer a significant step up from home care alone without the recovery time of surgery.
When Surgery Becomes Necessary
Surgery is generally reserved for Grade III hemorrhoids that haven’t responded to office procedures and for Grade IV hemorrhoids. The two main surgical approaches are traditional excisional surgery (hemorrhoidectomy) and stapled hemorrhoidopexy.
Stapled hemorrhoidopexy is less painful in the first three weeks and requires less pain medication during that window. However, by six weeks, return to normal activity is similar between the two approaches. The more important distinction is long-term effectiveness. A large randomized trial published in The Lancet found that traditional excisional surgery produced significantly fewer recurrences: about 25% of patients in the excisional group reported recurrence at two years compared to 42% in the stapled group. So the trade-off is somewhat more short-term pain in exchange for a substantially more durable result.
Recovery from either surgery typically involves several days of meaningful discomfort, restricted activity for a week or two, and a gradual return to full function over about six weeks. Stool softeners and a high-fiber diet are critical during recovery to prevent straining at the surgical site.
Signs That Need Prompt Attention
Most rectal bleeding from internal hemorrhoids is minor, showing up as a few drops of bright red blood. If you’re experiencing heavy bleeding, bleeding that doesn’t stop, or blood that appears dark or mixed into the stool rather than on its surface, those patterns warrant evaluation because they can signal conditions other than hemorrhoids. Persistent bleeding over weeks, even in small amounts, can lead to anemia, causing fatigue and lightheadedness. A hemorrhoid that protrudes and can’t be pushed back in, especially if it becomes increasingly painful, may need urgent treatment to prevent tissue damage from loss of blood supply.