Most hemorrhoids improve within a week or two with simple at-home care: warm soaks, more fiber, softer stools, and over-the-counter products to ease discomfort. The key is reducing pressure on the swollen veins and keeping bowel movements soft so you’re not straining. If home treatment doesn’t work, there are effective in-office and surgical options that can resolve the problem more permanently.
Start With Fiber and Fluids
Increasing your fiber intake is the single most recommended first step, backed by every major gastroenterology guideline. Fiber softens and bulks up your stool so it passes more easily, which reduces the straining that makes hemorrhoids worse. The target is about 25 to 35 grams per day, or roughly 14 grams per 1,000 calories you eat. Most people fall well short of this.
You can get there through food (fruits, vegetables, whole grains, beans, lentils) or through a fiber supplement. If you go the supplement route, bulk-forming options like psyllium are significantly more effective than traditional stool softeners. A randomized trial of 170 people found that psyllium increased stool water content and bowel movement frequency over two weeks, while a common stool softener (docusate) had essentially no effect on either measure. Pair the fiber with plenty of water, since fiber without adequate fluid can actually make constipation worse.
Sitz Baths for Pain and Swelling
A sitz bath is just sitting in a few inches of warm water, and it’s one of the most reliable ways to calm hemorrhoid symptoms. You can use a small plastic basin that fits over your toilet seat or simply fill your bathtub partway. Aim for water around 104°F (40°C), warm enough to be soothing but not hot enough to burn. Soak for 15 to 20 minutes at a time, up to three or four times a day when symptoms are active. Many people find the most relief after bowel movements, when irritation tends to peak.
Over-the-Counter Products
Hemorrhoid creams, ointments, and suppositories can temporarily shrink swollen tissue and relieve burning and itching. Many contain phenylephrine, which constricts blood vessels to reduce swelling. Others contain hydrocortisone, a mild steroid that targets inflammation and itch. These products treat symptoms, not the underlying problem, so they work best as a bridge while dietary and lifestyle changes take effect. Witch hazel pads can also soothe irritation and are gentle enough for frequent use.
Avoid using hydrocortisone products for more than about a week at a stretch, since prolonged use can thin the skin in the area and create new problems.
Change Your Bathroom Habits
The shape of a toilet seat puts extra pressure on the rectum and anus, and sitting there for extended periods can cause veins to swell. This is one of the most overlooked contributors to hemorrhoids. Try to limit your time on the toilet to under 10 minutes per bowel movement. If nothing is happening, get up and try again later rather than sitting and waiting. Leave your phone in another room if that’s what keeps you there longer.
When you do go, avoid straining or bearing down forcefully. If your stool is soft enough (which is where the fiber comes in), you shouldn’t need to push hard. A small footstool under your feet can raise your knees above hip level, which straightens the angle of the rectum and lets gravity do more of the work.
When Home Treatment Isn’t Enough
If your symptoms haven’t improved after about a week of consistent home care, or if you’re seeing blood, it’s worth getting evaluated. Rectal bleeding is common with hemorrhoids, typically showing up as bright red blood on toilet paper or in the bowl, but it can also signal other conditions like inflammatory bowel disease or colorectal cancer. A doctor can confirm the diagnosis and rule out anything more serious, sometimes with a physical exam alone and sometimes with a scope.
Internal hemorrhoids are graded on a four-point scale that guides treatment decisions. Grade I hemorrhoids don’t prolapse (bulge out) at all. Grade II prolapse during a bowel movement but slide back in on their own. Grade III prolapse and need to be pushed back in manually. Grade IV are permanently prolapsed and can’t be reduced. Grades I and II almost always respond to conservative care. Grades III and IV are more likely to need a procedure.
In-Office Procedures
Rubber band ligation is the most commonly recommended office procedure for internal hemorrhoids that don’t respond to home care. A doctor places a tiny rubber band around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a few days. It’s 70% to 80% effective, and recovery is quick. Most people return to normal activities the same day, though you should avoid heavy lifting for about two weeks. You may feel pressure or mild discomfort for a day or two afterward.
Other office-based options include sclerotherapy (injecting a solution that shrinks the hemorrhoid) and infrared coagulation (using heat to cut off blood flow). These are generally less effective than banding but can be appropriate depending on the size and location of the hemorrhoid.
Surgical Options for Severe Cases
Surgery is reserved for people who don’t respond to office procedures, who have large grade III or grade IV hemorrhoids, or who have significant external hemorrhoids alongside internal ones. A traditional hemorrhoidectomy surgically removes the tissue entirely. It’s the most thorough option but also involves the longest recovery.
A newer alternative, hemorrhoidopexy, staples the hemorrhoid tissue back into its normal position rather than removing it. It’s only used for internal hemorrhoids, particularly large or prolapsed ones. Recovery tends to be faster and less painful than a traditional removal, which is why some surgeons prefer it for appropriate candidates.
One specific scenario calls for urgent treatment: a thrombosed external hemorrhoid, which is an external hemorrhoid that develops a blood clot. It causes sudden, severe pain and a hard, tender lump near the anus. If you get to a doctor within about three days of onset, excision of the clot provides the fastest relief. After that window, the clot typically begins to resolve on its own, though it can take several weeks.
Preventing Recurrence
Hemorrhoids have a tendency to come back, especially if the habits that caused them don’t change. The long-term strategy is straightforward: keep your fiber intake up, stay hydrated, don’t sit on the toilet longer than necessary, and avoid straining. Regular physical activity also helps by promoting healthy bowel function and reducing the time stool sits in the colon. If you have a job that involves sitting for long stretches, getting up to move periodically can reduce pelvic pressure. These aren’t dramatic changes, but they’re the difference between a one-time problem and a recurring one.