Ice or heat for hemorrhoids: which helps more?

Ice and heat help different parts of a hemorrhoid flare. A wrapped cold pack is for swelling and throbbing on the outside. Warm water is for the tight muscle that makes a bowel movement hurt. Cold water, in the one pressure study that tested it, did not relax that muscle. You can use both on the same day, at different times.

The NHS piles page lists both: an ice pack wrapped in a towel to ease discomfort, and a warm bath to ease itching and pain ¹. This page covers when each one helps, what the studies measured, and how to do them without a burn or a numb patch of skin. Step-by-step soak instructions live in how to take a sitz bath.

When cold helps

Cold is a surface treatment. It is the better first move when an external hemorrhoid is puffy, hot, and throbbing, or when a firm lump has appeared under the skin. That lump is often a thrombosed hemorrhoid, a small clot. Cold will not remove the clot. It can take the edge off while you decide, with a clinician, whether the lump needs to be opened. The painful window is usually the first few days.

The NHS instruction is simple: wrap the ice pack in a towel ¹. Do not sit on bare ice or a bare gel pack. Buyers of contoured packs say the pack is too cold straight from the freezer, that hard seams can scratch, and that the cold lasts about 15 to 20 minutes. A cloth fixes the first problem. A pack that has split should be thrown out.

A Cochrane review of local cooling after perineal trauma in childbirth included 10 trials and 1,233 women. Ice packs or cold gel pads, used for 10 to 20 minutes, may reduce perineal pain in the first two days. The certainty of that evidence is very low, wound-healing results were uncertain, and side effects were poorly reported ¹². Those trials are about tears and grazes from birth, which often overlap with postpartum hemorrhoids and are not the same as a hemorrhoid study. They are still the best timed protocol we have for how long a cold pack stays on this part of the body. Care after birth is covered in postpartum hemorrhoids.

Cold water is a different question from an ice pack. In a 1986 study, resting anal pressure was measured in volunteers and in people with hemorrhoids, anal fissure, or proctalgia fugax (a brief spasm pain). Pressure fell after the anus was immersed at 40 degrees C. It did not change at 5 degrees C or at 23 degrees C (Dodi’s 1986 pressure study ²). If the pain is a spasm, use the warm soak. A wrapped pack is for swelling and surface pain, which that pressure study was not designed to measure.

When warm water helps

Warm water relaxes the internal anal sphincter, the inner muscle that keeps the anus closed at rest. In the 1986 study, a 5-minute immersion at 40 degrees C (104 degrees F) lowered resting pressure in every group, with p less than 0.01. In volunteers the drop lasted 15 minutes. In patients it lasted 30 minutes ².

A 1993 study asked why a warm bath eases anorectal pain. Eighteen healthy volunteers and 28 patients (18 with fissures and 10 with hemorrhoids) sat in water at 40, 45, and 50 degrees C for 10 minutes at each temperature. Pain relief was clearer and lasted longer at the higher temperatures. Pressure in the anal canal, and the electrical activity of the internal sphincter, fell in the bath and drifted back to baseline over 25 to 70 minutes. Rectal temperature did not rise, so the author argued the muscle was not being warmed through directly. He called the response a thermosphincteric reflex, a nerve signal from warm skin to a relaxing sphincter ³.

Those hotter baths are a lab finding, not a home target. A 2005 review of sitz baths found case reports of skin burns, and also of infections spread when baths were shared, including herpes and a streptococcal outbreak in a maternity setting ⁴. Use water that feels warm on the inside of your wrist, around the 40 degrees C that worked in the pressure study. If it stings, it is too hot. Empty the basin when you are done, and do not share the water.

The NIDDK treatment page suggests a sitz bath, a tub of warm water, several times a day for pain ¹¹. A 2026 AGA expert review says sitz baths are often advised and that scientific data are limited ¹³. Both can be true: the pressure studies show a real muscle effect, and symptom trials are mixed, especially after surgery.

What the studies found when cold and heat were compared

For an ordinary flare, there is no large trial that assigns people to an ice pack versus a warm sitz bath and follows pain for a week. The closest emergency-department trial is small. Twenty-four people with acute anal pain from hemorrhoids or fissures were randomized to sitz baths under 15 degrees C or over 30 degrees C, with the same pain medicine in both groups. Pain scores did not differ in a statistically significant way. Pain stayed flat in the cold group and drifted down in the warm group, and the day-1 versus day-7 change in the warm group was not significant (p = 0.244) ⁶. Twelve people per group cannot crown a winner.

A review of the older literature reported that cold sitz baths decreased perineal edema more than warm ones, and that patients tended to prefer warm water ⁴. That lines up with using cold for puffiness and warm water for comfort.

After hemorrhoidectomy, the trials split:

Chen’s ice result is the strongest recent head-to-head, and it is about the first day after an operation, in one hospital, with short follow-up. It does not mean an ice pack outperforms a sitz bath for a mild home flare. Gupta’s trial is a reminder that adding a warm bath after surgery does not always cut pain beyond ordinary pain medicine. If you are in the weeks after an operation, follow the written instructions you were given, and read hemorrhoidectomy recovery for the rest of the timeline.

How to ice a hemorrhoid safely

1. Put a gel pack or ice in a thin towel or cloth. The NHS specifies a towel ¹. A pack sold for this area still needs the cloth if it feels sharp or painfully cold.
2. Lie on your side or recline so the pack rests against the outside. You do not insert it.
3. Leave it for 10 to 20 minutes, the session length in the perineal cooling trials ¹². Then take it off so the skin can rewarm.
4. Repeat a few times during the day if the lump is throbbing, with a break between sessions. There is no trial that sets an exact daily maximum for hemorrhoids. Stopping at 20 minutes a session is the limit we can point to.
5. Skip ice on skin that is already numb, pale, or broken open beyond a normal flare. The Cochrane review did not find a clear harm signal, and it also said side effects were often unreported ¹².

Our notes on packs shaped for this area are in ice packs for hemorrhoids.

How to take a warm sitz bath safely

A sitz bath is a basin that sits on the toilet, or a few inches of warm water in a clean tub, so only the hips are soaked.

1. Fill it with warm water, about 40 degrees C (104 degrees F). Test it on your wrist. The 45 and 50 degree baths in the 1993 study are hotter than you want at home, because burns are a known sitz bath injury ^3,4.
2. Sit for about 10 minutes. That matches the bath time in the sphincter study. The pressure study used 5 minutes and still measured a drop ^2,3.
3. Repeat two or three times a day, including after a bowel movement. The NIDDK says several times a day ¹¹. A pregnancy protocol used three salty baths a day, and both that group and a cream group also took fiber. Healing was recorded in all 284 women on the sitz plan and in 84.8% of 211 women on the cream plan ¹⁰. The salt was part of that hospital’s recipe. Plain warm water is what the pressure studies used, and nothing in those studies shows you need to add salt.
4. Pat dry. Rubbing with a towel undoes the point of a gentle soak ¹.
5. Wash the basin and use fresh water every time. Shared bath water is how the infection outbreaks in the 2005 review were described ⁴.

If a basin is awkward, a warm handheld spray was similar to a sitz bath for pain after surgery and easier to use ⁹. Portable options are reviewed with sitz baths. A full first-two-days plan, including stools and soaks, is in how to get rid of hemorrhoids fast.

If ice and heat are not enough

Soften the stool at the same time. A soak will not fix a hard bowel movement that you have to strain through. Home steps that have more than temperature behind them are in hemorrhoid home remedies and the full treatment guide.

GuideThrombosed hemorrhoid: what the sudden painful lump is

A thrombosed hemorrhoid is a clot under the skin. Why the first 72 hours matter, how pain eases over 1 to 3 weeks, and when to get care.

Most small flares ease over several days once stools are soft. A lump that is getting larger, or pain that stops you walking, needs a same-day look.

Screening for colorectal cancer starts at age 45 in the USPSTF recommendation ¹⁴. If a wrapped ice pack and a 10-minute warm soak have not changed the pain after two or three days, call and describe the lump, the bleeding, and what you have already tried.