How Hemorrhoids Are Treated

Some hemorrhoids go away on their own without treatment. Others require medical treatments available over the counter or from a healthcare provider.

Hemorrhoid treatment helps relieve symptoms and resolve the underlying cause. Treatment may include a high-fiber diet, stool softeners, topical medications, and, in severe cases, specialist procedures to reduce or remove the hemorrhoid.

The treatment may vary for external hemorrhoids (occurring outside of the rectum) and internal hemorrhoids (occurring inside the rectum). External hemorrhoids tend to cause pain and itching, while internal hemorrhoids are typically painless but can cause rectal bleeding.

This article describes home remedies, lifestyle changes, and over-the-counter products that can help ease the symptoms of hemorrhoids. It also explains how specialist procedures and surgery may be needed if conservative measures fail to provide relief.

Home Remedies and Lifestyle

Home remedies have been used for centuries to manage symptoms of hemorrhoids. This can include changes in diet to promote healing and prevent complications by easing the passing of stools.

Best At-Home Treatments

A combination of home remedies may be used to alleviate discomfort and prevent infection. Some of the more popular include:

• Sitz bath: This involves sitting in a tub of warm water for 10 to 20 minutes to reduce itching and irritation. Epsom salts or baking soda can be added to reduce inflammation.
• Aloe vera gel, vitamin E oil, and coconut oil: These natural remedies are applied to the skin and can help soothe and shrink minor hemorrhoids.
• Ice application: Ice packs can relieve inflammation and pain but should never be used for longer than 15 to 20 minutes. Anything longer can lead to frostbite.
  
• Witch hazel: This astringent can help relieve minor bleeding and prevent infection. You can dab it on gently with a cotton ball or even add a couple of tablespoons to a sitz bath.
  

Diet and Hemorrhoids

A diet rich in soluble fiber can help relieve constipation and prevent hemorrhoids from returning. Soluble fiber dissolves in water and forms a gel-like goo that helps ease the passing of stools. By making stools soft, there is less chance of rectal pain or bleeding.

Try to consume between 25 and 35 grams of fiber daily to keep your bowel movements regular.

Excellent sources of insoluble fiber include:

• Beans and legumes
• Dried fruit
• Fresh fruits (but avoid bananas which can be binding)
• Fresh vegetables, including greens, peas, and green beans
  
• Whole grains, including barley, bran, brown rice, and whole-grain bread
• Prune juice

Fiber supplements containing psyllium, methylcellulose, or calcium polycarbophil can also help. 

OTC and Prescription Medications

Over-the-counter (OTC) and prescription medications can help relieve symptoms of hemorrhoids. Some can also promote healing by easing bowel movements. These include oral medications taken by mouth and topical medication applied to the skin.

OTC Pain Relievers

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil (ibuprofen) are highly effective in reducing the pain, swelling, and redness of mild to moderate hemorrhoids.

Topical anesthetics containing lidocaine can also help. Lidocaine works by numbing nerves at the site of the pain. Topical lidocaine is available as a gel, ointment, or cream.

Topical Hemorrhoid Creams

NSAIDs are a good, first-line defense against hemorrhoid pain and inflammation. But if these fail to provide relief, hemorrhoid creams can be used to actively shrink inflamed tissues.

OTC and prescription options include:

• Preparation-H: This is a popular OTC option previously made with shark oil but now formulated with 0.25% phenylephrine. Phenylephrine acts as a vasoconstrictor, actively shrinking blood vessels.
  
• Rectogesic ointment: Made with 0.2% glyceryl trinitrate (nitroglycerin), Rectogesic is available by prescription only and works by relaxing blood vessels beneath the surface of the skin.
• Hydrocortisone rectal cream: Available over the counter in 1.0% strength, hydrocortisone is a type of steroid drug that reduces inflammation by tempering the body's immune response.
  

Stool Softeners

As their name suggests, stool softeners are OTC products that soften stools and help relieve constipation. They are also commonly known as emollient laxatives.

Stool softeners contain the active ingredient docusate sodium and are sold under various brand names, including Colace, Correctol, Diocto, Doxinate, Dulcoease, Ex-Lax Stool Softener, Fleet Sof-Lax, Modane Soft, Phillips' Stool Softener, and Surfak.

Stool softeners take at least a couple of days to take effect.

Specialist Procedures

A conservative approach should provide relief of mild to moderate hemorrhoids. If not, more aggressive interventions may be needed to actively shrink or remove the hemorrhoid.

Non-Surgical Procedures

Several minimally invasive in-office procedures can be used to treat larger or severe hemorrhoids. These include:

• Rubber band ligation: For this procedure, a rubber band is placed around the hemorrhoid, cutting off the blood flow and causing it to shrink, usually within days.
• Sclerotherapy: A sclerosing (hardening) agent is injected into the hemorrhoid, causing the vein to collapse and shrivel up.
• Infrared coagulation: An intense beam of infrared light is used to destroy tissues inside the anal canal to cut off the blood flow to an internal hemorrhoid.
  

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Surgery

Surgery is reserved for only the most severe cases, including hemorrhoids that have thrombosed (filled with blood) or prolapsed (slipped outside of the anal canal).

Aggressive intervention may be needed since both conditions can cut off the blood supply and, in rare cases, lead to tissue death and gangrene.

Surgical options include:

• Excisional hemorrhoidectomy: This involves the removal of a hemorrhoid with a scalpel. Afterward, the wound is stitched shut or left open to heal on its own. A hemorrhoidectomy is performed under general anesthesia.
• Stapled hemorrhoidopexy: This is an alternative procedure in which a circular device staples the prolapsed hemorrhoid back into its original position while cutting off the blood supply. Although recovery time is shorter, hemorrhoid recurrence is possible. General or ​regional anesthesia may be used.
• Doppler-guided hemorrhoid artery ligation: This is a minimally invasive procedure in which an ultrasound is used to locate the arterial blood flow. The blood vessel is then tied off and the prolapsed tissue is sutured back into place. General, regional, or local anesthesia may be used.

Summary

Hemorrhoids can be treated with home remedies, diet, OTC painkillers, and topical medications that actively shrink inflamed tissues. If these don't work, specialist procedures and surgery may be explored, particularly if the hemorrhoid is severely thrombosed or prolapsed.

A Word From Verywell

Hemorrhoids tend to be more aggravating than anything else, but can sometimes be serious enough to require aggressive medical care. Do not hesitate to contact your healthcare provider if a hemorrhoid causes rectal bleeding, changes in stool color, and continuous or worsening pain.

While complications are rare, they can and do occur sometimes. At the same time, other conditions can mimic hemorrhoids and be potentially serious, including an anal or rectal abscess or even colorectal cancer.