Hemorrhoid treatment: from home care to procedures

Hemorrhoid treatment usually starts at home. Softer stools, less time on the toilet, and a warm soak are the steps clinicians still put first. Creams, flavonoid pills, office procedures, and surgery are the next rungs if bleeding, itching, or a lump that slips out keeps coming back.

If you want a plan for tonight and the next two weeks, use how to get rid of hemorrhoids fast. This page is the map of hemorrhoid treatment: what each step is, what the studies found, and when to move up.

Hemorrhoids are the third most common outpatient gut diagnosis in the United States, with nearly 4 million office and emergency visits a year ². A 2019 review pointed out that, aside from fiber, everyday medical treatments have not been studied in a formal way, and even the fiber results looked uneven to those authors ². A 2006 meta-analysis of seven fiber trials still found a consistent drop in bleeding and in symptoms that would not settle ³.

Which hemorrhoid treatment fits your symptoms

Match the treatment to the problem you actually have. A painless streak of bright red blood is a different job from a sudden hard lump that makes sitting miserable.

Internal hemorrhoids form inside the anal canal. They often bleed and, unless they prolapse (slip out), they usually do not hurt much. The four grades of internal hemorrhoids run from a cushion that only bleeds to one that stays outside. External hemorrhoids are under the skin at the opening. They are the ones that itch, swell, and sometimes clot. The American Gastroenterological Association expert review on hemorrhoids says hemorrhoids cause significant pain when they are acutely thrombosed, and that sharp pain during a bowel movement is more often an anal fissure ⁷. If the pain feels like a split, read hemorrhoid or anal fissure before you assume a cream is the whole answer. If one has slipped out, see how to push a prolapsed hemorrhoid back in.

Home care for hemorrhoids: fiber, fluid, and the toilet

The NIDDK page on hemorrhoid treatment tells most people to start with high-fiber foods, a fiber supplement such as psyllium, water or other nonalcoholic drinks, no straining, and no long sits on the toilet ¹. The NHS piles page gives the same core: plenty of fluid and fiber so stools stay soft, a warm bath, and no extra pushing ⁶.

The Dietary Guidelines figure cited by NIDDK is 14 grams of fiber for every 1,000 calories, which is 28 grams a day on a 2,000-calorie diet ⁴. A medium pear with the skin has about 5.5 grams, a cup of raspberries about 8 grams, and a half cup of cooked navy beans about 9.6 grams ⁴. Only about 5 percent of Americans meet the fiber recommendation, so a supplement is a practical way to close the gap ⁵. Which foods to add, and how to raise the dose without a week of bloating, is covered in hemorrhoid home remedies.

Psyllium is the fiber used in several of those hemorrhoid trials ³. In a constipation trial, psyllium (5.1 grams twice a day) raised stool water content more than docusate sodium (100 mg twice a day) over two weeks ¹⁰. That trial was not in people with hemorrhoids. When a softener still has a short-term role is covered in stool softener, fiber, or laxative. Capsule options are on our best fiber supplements for hemorrhoids page.

For pain, NIDDK lists acetaminophen, ibuprofen, naproxen, and aspirin ¹. The NHS names paracetamol, the same drug as acetaminophen, and says not to take ibuprofen if the hemorrhoids are bleeding ⁶. Skip painkillers that contain codeine. Codeine can cause constipation ⁶. Follow the label.

The NHS says piles often get better on their own after a few days ⁶. MedlinePlus says symptoms of external hemorrhoids go away within a few days for many people ⁸. Fiber trials that checked more than once usually looked again at about 6 weeks and at 3 months, and the benefit held at both points ³. NIDDK and MedlinePlus both say to contact a clinician if you are no better after 1 week at home ^1,8.

Sitz baths and store-bought hemorrhoid treatments

A sitz bath is a soak of the anal area in a few inches of warm water, either in a basin that sits on the toilet or in a bathtub. NIDDK suggests a warm sitz bath several times a day for pain ¹. The NHS suggests a warm bath for itching and pain, and an ice pack wrapped in a towel for discomfort ⁶. The AGA review says sitz baths are often advised and that the scientific data behind them are limited ⁷. Step-by-step water temperature, soak length, and what not to add are in how to take a sitz bath.

Creams, ointments, and suppositories can take the edge off itch and soreness while the stool-softening steps do the longer job. NIDDK says they may relieve mild pain, swelling, and itching of external hemorrhoids, and that doctors most often recommend over-the-counter products for 1 week ¹. Stop and call a doctor if they do nothing after that week, or if you get a rash or dry skin around the anus ¹.

Hydrocortisone is the steroid in many of these products. The NHS instructions for hydrocortisone for piles say not to use it for more than 7 days ⁹. The AGA review says topical steroids should not be used for more than 2 weeks at a time, and that topical anesthetics, astringents such as witch hazel, corticosteroids, and vasoactive agents can be considered even though there is little data that they work ⁷. Follow the label. If the label says 7 days, stop there unless a doctor has told you otherwise.

The NHS splits the products by place: creams, ointments, and sprays for hemorrhoids on the outside, and suppositories for hemorrhoids on the inside ⁹. A full comparison of creams, pads, and supplements is in over-the-counter hemorrhoid treatment. Our best hemorrhoid products page sorts the types, and hemorrhoid creams focuses on burning, itching, and soreness.

Flavonoid pills and what the trials found

Flavonoid pills, also called phlebotonics, are plant compounds sold for vein tone. Diosmin, often paired with hesperidin, is the one most trials used. People take them during a flare, along with a fiber supplement.

A Cochrane review of phlebotonics for hemorrhoids pooled 20 studies against a control, with 2,344 people ¹¹. Phlebotonics lowered the odds of itching (odds ratio 0.23), bleeding (odds ratio 0.12), and discharge, and they raised the odds of overall symptom improvement (odds ratio 15.99). Pain was not clearly better than control. The authors said the direction of benefit looked real and that safety concerns in the trials were few, and they also said the methods of many trials were weak ¹¹.

A later review looked only at micronized purified flavonoid fraction, the formula closest to several products on the shelf. It included 10 randomized trials and 1,164 people ¹². Three studies, pooled, favored the flavonoid group for bleeding (relative risk 1.46). The authors rated that bleeding evidence as low quality because the trials were few and did not all agree. They did not find a clear benefit for the other symptoms they checked ¹².

Single trials fill in the picture, and they do not all say the same thing:

• In a triple-blind trial of 134 people in an acute flare, a mix of diosmin, troxerutin, and hesperidin reduced pain, bleeding, swelling, and clots by 12 days compared with placebo. By day 6, that group also used fewer paracetamol tablets ¹³.
• In a double-blind trial of 100 people with grade 1 or grade 2 internal hemorrhoids, everyone got a bulk laxative. Adding diosmin beat placebo on exam findings at day 4. By day 14, the two groups were no longer different ¹⁴.

Flavonoid pills are a reasonable short trial during a flare when bleeding is the main symptom. A prolapsing hemorrhoid that keeps coming out still needs the office and surgery steps below. After hemorrhoid surgery, a 2024 review of 10 trials (775 people) found flavonoids reduced pain and bleeding in recovery ²². Products in this category are compared on the best hemorrhoid pills, and every review and trial is broken down in diosmin for hemorrhoids.

Office procedures: banding, infrared, and injection

Office treatments are for internal hemorrhoids that keep bleeding or slipping out after home care. You are awake. Numbing medicine may be used. The NHS says you should be able to go home the same day ⁶.

Rubber band ligation, also called banding, is the office treatment most often used first. A clinician places a small rubber band around the base of an internal hemorrhoid. NIDDK explains that the band cuts off the blood supply, the banded part shrivels and falls off, most often within a week, and scar tissue shrinks what remains ¹. Only a doctor should do this.

A 1995 meta-analysis of 18 randomized trials compared the main options ¹⁵. Rubber band ligation worked better than sclerotherapy (injection of a scarring solution) for all grades studied, and people treated with sclerotherapy or infrared coagulation were more likely to need another treatment than people who were banded. Banding caused more pain than those two. Hemorrhoidectomy, the operation that cuts the hemorrhoid out, worked better than banding and caused more complications and more pain. The authors recommended banding as the first treatment for grades 1 to 3, and hemorrhoidectomy for people who do not respond to banding ¹⁵.

A Cochrane review of banding versus excisional hemorrhoidectomy, three trials of poor quality, found a similar split by grade ¹⁶. For grade 2 hemorrhoids (they slip out and go back on their own), one small trial found no clear difference in remission. For grade 3 hemorrhoids (they have to be pushed back in), cutting them out worked better. Fewer people needed a repeat procedure after surgery. Pain was more common after surgery (relative risk 1.94). The authors suggested banding for grade 2, and surgery for grade 3 or for a recurrence after banding ¹⁶. The AGA review says banding and infrared coagulation have similar short-term benefits, banding holds up better for prolapse and repeat bleeding, and either office treatment should come before hemorrhoidectomy for grades 1 to 3 ⁷. Grade 4 internal hemorrhoids, which stay out, need surgery ⁷.

Infrared coagulation uses a short burst of heat so scar tissue shrinks the hemorrhoid. In a crossover trial of 94 people, banding hurt more than infrared in the first 24 hours. By 72 hours the scores were similar. Ninety-one of the 94 people were treated successfully, and for a third hemorrhoid half chose banding and half chose infrared ¹⁸. Sclerotherapy, an injection that scars the hemorrhoid, was less effective than banding in the 1995 meta-analysis, with a similar complication rate ¹⁵.

Banding is often repeated. In the HubBLe trial, a multicentre comparison of hemorrhoidal artery ligation and rubber band ligation, 87 of 176 people (49 percent) had recurrence at 1 year after banding, compared with 48 of 161 (30 percent) after Doppler-guided artery ligation ¹⁷. The gap was mostly extra procedures: 32 percent of the banding group had another hemorrhoid procedure, versus 14 percent after artery ligation. Banding hurt less. Mean pain the next day was 3.4 after banding and 4.6 after artery ligation. Serious adverse events were more common after artery ligation (7 percent) than after banding (1 percent). The authors wrote that patients might prefer a course of repeat banding to the more invasive operation ¹⁷.

What banding feels like in the first week, including the urge to have a bowel movement and the small amount of bleeding when the band falls off, is in rubber band ligation: what to expect. The full comparison of banding, sclerotherapy, infrared coagulation, and surgery is in hemorrhoid procedures.

Mild pain is the most common problem after banding ²⁰. Serious infection is uncommon. The AGA review says anyone having a hemorrhoid procedure should know that pelvic sepsis is a small possibility, and should go to an emergency department for severe pain, fever, or trouble urinating ⁷.

Surgery for hemorrhoids

Surgery is the top of the ladder. NIDDK describes two operations you will hear named in clinic ¹. Hemorrhoidectomy removes large external hemorrhoids and prolapsing internal hemorrhoids that have not responded to other treatments. Hemorrhoid stapling, also called stapled hemorrhoidopexy, uses a stapling tool to remove a ring of internal tissue and pull a prolapsing hemorrhoid back inside. Both are done with anesthesia ¹.

The eTHoS trial compared those two operations in 777 adults with grade 2 to 4 hemorrhoids ¹⁹. Stapled hemorrhoidopexy hurt less in the short term, and serious complication rates were similar: 24 of 338 people (7 percent) after stapling and 33 of 352 (9 percent) after traditional excision. Over 24 months, quality of life was better after traditional excisional surgery. The authors said traditional removal should be considered the surgical treatment of choice as part of a tailored plan ¹⁹.

A PROSPECT review of pain after excisional hemorrhoidectomy recommends a pudendal nerve block, acetaminophen with an anti-inflammatory and an opioid, topical lidocaine, laxatives, and oral metronidazole ²¹. Most of that evidence comes from studies of one treatment at a time ²¹. Week-by-week recovery is in hemorrhoidectomy recovery.

A clot in an external hemorrhoid is its own branch of this ladder. In a retrospective series, symptoms settled in an average of 24 days with conservative care and in 3.9 days after excision. Recurrence was 25.4 percent after conservative care and 6.3 percent after surgery ²³. The AGA review says acute thrombosed hemorrhoids are often extremely painful and are best treated with a small incision and drainage ⁷. Whether to treat yours tonight or to wait is covered in a thrombosed hemorrhoid.

Pregnancy, and when to leave the ladder

The AGA review says hemorrhoids occur in up to two-thirds of women during pregnancy, and that treatment should stay conservative: fiber, care of constipation, and topical ointments ⁷. If symptoms remain after birth, banding or infrared coagulation can be considered then ⁷. A review for family doctors suggests the same home steps, notes that common topical agents have not been formally tested in pregnancy, and says the usual ingredients are unlikely to harm a third-trimester baby. Most symptoms ease after delivery ²⁵.

One prospective study followed 204 women who used hydrocortisone-pramoxine foam in the third trimester and a similar group who did not. Exposure was not tied to lower birth weight, earlier birth, or more complications ²⁶. A Cochrane review of conservative care in pregnancy found that oral rutoside pills looked helpful for symptoms in two small trials, and said they should not be recommended until safety is clearer. Diet changes and local treatments, the things most people actually use, had not been properly studied in pregnancy ²⁷. Check any medicine, including a store cream, with your obstetric provider. The pregnancy-specific plan is in hemorrhoids during pregnancy.

Home treatment has a time limit. See a clinician if symptoms are no better after 1 week, or sooner if bleeding is new ^1,8. MedlinePlus notes that hemorrhoids are a common cause of rectal bleeding and that Crohn’s disease, ulcerative colitis, colorectal cancer, and anal cancer can bleed too ⁸. The US Preventive Services Task Force recommendation on colorectal cancer screening says screening should start at age 45 for adults at average risk ²⁴. Bleeding at that age, without a recent screen, needs more than a cream.

NIDDK says to seek care right away for severe anal pain and rectal bleeding, particularly if you also have abdominal discomfort, diarrhea, or fever ¹. The NHS says nonstop bleeding, a lot of blood, large clots, or severe pain need emergency care ⁶. What the appointment usually includes is laid out in when to see a doctor for hemorrhoids.