[Last updated 30th May, 2018]
Hemorrhoids are a common problem that cause pain, itching and bleeding in the rectum and/or anus.
While they often resolve on their own, many people try home remedies or seek medical treatments to speed up relief from their hemorrhoids.
This article looks at various hemorrhoid treatment options so you can decide the best option for you.
What Are Hemorrhoids (Piles)?
Hemorrhoids are pillow-like clusters of veins in the smooth muscle walls of the anus and/or lower rectum.
They are also commonly known as piles.
While everyone has hemorrhoids, about 1 in 4 experience swelling and distension of these veins, causing symptoms that require management.
Hemorrhoids are classified as either internal or external depending on their location and the type of cells surrounding them. Typically, external hemorrhoids are the most bothersome.
Signs & Symptoms
There are a variety of symptoms indicating you may have hemorrhoids.
Common symptoms include:
- Extreme itching around the anus
- Irritation and pain around the anus
- Pain during bowel movements
- Blood on tissue after bowel movements
- Blood on stool
- Mucus and/or fecal leakage
- Hard, painful lumps felt at the anus
It’s important to find out if symptoms are related to hemorrhoids or other, more serious gut disorders like tumors or IBD.
Doctors diagnose hemorrhoids by using your medical history, symptoms and a physical exam.
During the physical exam, your doctor will check for abnormalities in the anus with a digital rectal exam. If abnormalities such as lumps or masses are found, they may suggest an additional test called a sigmoidoscopy. More serious issues should be ruled out.
Once hemorrhoids are identified, they’re graded from I to IV (1):
- Grade I: hemorrhoids bleed, but do not prolapse
- Grade II: hemorrhoids prolapse, but spontaneously reduce
- Grade III: hemorrhoids prolapse, but must be manually reduced
- Grade IV: hemorrhoids prolapse, but cannot be reduced
Summary: While everyone has hemorrhoids, or pillow-like clusters of veins, in the anus or rectum, they only cause problems once inflamed. Symptoms like anal itching, pain and irritation often result.
What Causes Hemorrhoids?
Symptomatic hemorrhoids develop with increases in pressure to the blood vessels in the anus or rectum.
Numerous factors can potentially cause more pressure including:
- Low fiber diets: A lack of high-fiber foods can cause denser, drier stool that involves more straining during bowel movements.
- Pregnancy: An enlarged uterus puts pressure on the rectum and anus, weakening the surrounding muscles due to hormonal changes.
- Obesity: Excessive weight produces more pressure.
- Prolonged sitting or standing: Blood may pool in the anal canal while in these stationary positions.
Other risk factors for hemorrhoids:
- History of rectal surgery
- Spinal cord injury
- Lifting heavy weight
- Anal intercourse
- Aging (most common in adults aged 45-65)
- Family history of hemorrhoids
- Colon cancer
Summary: Hemorrhoids are caused when more pressure is placed on the anus or rectum. Family history and aging are two uncontrollable risk factors, while low fiber diets and obesity are two controllable.
How to Get Rid of Hemorrhoids
While hemorrhoids often resolve on their own after a few days, many turn to treatment options for faster symptom relief.
Apply wrapped ice packs to the painful area, use alcohol-free baby wipes instead of dry toilet paper and sit on cushions rather than hard surfaces to reduce pain, inflammation and irritation.
More frequent hemorrhoid pain or more serious symptoms may require extra treatment.
Low grade hemorrhoids may improve with the help of various at-home remedies.
- Epsom salts and glycerin: Two tablespoons of Epsom salts mixed with 2 tablespoons of glycerin can be topically applied to the painful area with a gauze. Apply for 15-20-minutes and repeat every 4 to 6 hours.
- Myrtus communis essential oil: Also called Myrtle essential oil, it has been clinically studied to improve bleeding, pain, irritation and itching for minor (grade I) hemorrhoids. It can be applied with lotion or ointment formulations (2).
- Sitz bath: This is a type of bath for treating hemorrhoids. Alternatively you can sit in a regular warm bath for 15-20-minutes, 2 to 3 times per day. This technique helps calm spasms in sphincter muscles and relieves itching and irritation.
- Witch hazel: This is an astringent herbal compound often used for skin conditions. Though it hasn’t been clinically studied for hemorrhoid treatment, some find it can help reduce pain and swelling of hemorrhoids when applied topically. This may be due to its antioxidant and anti-inflammatory properties (3).
- HemorrHeal External Hemorrhoid Kit: This is home remedy kit that uses DMSO (dimethyl sulfoxide), potassium iodide and aloe vera juice. It includes detailed instructions, illustrations and ingredient information for making and using HemorrHeal at home. To learn more and see if it’s right for you click here.
Other remedies such as coconut oil, goldenrod and yarrow have also been touted to help with hemorrhoids. It’s not clear whether these treatments are effective and safe for all populations due to lack of research.
Keep in mind that many of these remedies haven’t been well-studied. In fact, some recommendations you may have found, including apple cider vinegar and tea tree oil, could potentially exacerbate symptoms.
Softer stool is easier to pass and less likely to irritate hemorrhoids.
Eating more fiber is certainly a helpful preventative treatment. If you’re constipated, fiber supplements like psyllium and methylcellulose can be effective.
Creams and suppositories also help treat hemorrhoid symptoms.
Creams like Preparation H include topical anesthetics that help numb hemorrhoids pain. Other products use astringents and low-dose steroids to decrease inflammation and shrink swollen tissues. Higher strength products are also available by prescription, including lidocaine or hydrocortisone.
Pain relievers like acetaminophen and ibuprofen can be used to manage pain, but avoid using aspirin if you have bleeding hemorrhoids.
Summary: Various home remedies and over-the-counter products are available for hemorrhoids based on their severity. Most treatments work to control symptoms.
How To Treat Severe Hemorrhoid Cases
When conservative management doesn’t work or if hemorrhoid symptoms are severe, you may want to ask your doctor about prescription medication or medical procedures to help ease your pain.
Medication is often used to address bleeding associated with hemorrhoids.
Micronised purified flavonoid fraction (MPFF), calcium dibisilate, nitrates and nifedipine can effectively ease acute symptoms with good tolerance (4).
If medications don’t provide relief, more intensive medical procedures are available.
Rubber band ligation uses a rubber band to cut off circulation to the hemorrhoid. Infrared coagulation and radiofrequency ablation therapy work similarly to cut off circulation. Without proper blood flow, the hemorrhoid shrinks and symptoms improve.
Sclerotherapy involves the injection of a vein-destroying chemical into the hemorrhoid. The chemical damages the blood vessels, which blocks circulation and shrinks the hemorrhoid.
This treatment is typically used for patients who experience bleeding even after trying standard therapy. Those using anticoagulants or with cirrhosis or immunosuppression may also be ideal candidates for this treatment (6).
In some cases, doctors combine therapies, but there is poor evidence supporting this approach. Keep in mind that during any medical procedure, complications can result including bleeding, fissures, urinary retention and pain.
When standard therapy and outpatient medical procedures fail, surgical removal of hemorrhoids is a last resort option.
A hemorrhoidectomy involves the removal of hemorrhoids with a laser or scalpel while under general anesthesia.
Alternatively, stapled hemorrhoidectomy uses a staple gun to control bleeding hemorrhoids. It’s typically reserved for prolapsed internal hemorrhoids.
After non-surgical treatment, hemorrhoids recur about 50% of the time, whereas surgery reduces that rate to just 5%. There is no consensus on which procedure is best (9).
Summary: When hemorrhoids are severe and fail to resolve on their own, more intensive treatments are available including prescription-strength medication, various medical procedures and surgery.
Prevention via diet and lifestyle is the most effective option to control hemorrhoids.
Consume a diet that supports normal bowel movements.
This typically means eating enough fiber and drinking enough fluids (10).
It’s important to slowly increase fiber intake by about 5-gram increments, otherwise you may experience gas, bloating or cramping. Try using a psyllium husk fiber supplement if you have difficulty getting enough from food alone. The goal is to consume 25 to 40 grams of total fiber per day (10).
Drink about half of your body weight (in pounds) in ounces each day. This means a 150-pound person would drink 75 ounces of fluid daily. You’ll need to drink more if you are losing extra fluid through sweat, diarrhea or vomiting.
It’s best to avoid eating spicy foods and drinking alcohol if you have a history of recurring hemorrhoids (11).
A few easy lifestyle changes can also prevent hemorrhoids.
Here are some general tips to consider:
- Avoid straining during a bowel movement. It’s okay to give up after 2 minutes.
- Use the restroom as soon as you feel the urge to have a bowel movement.
- Take a squatting position or use a squatty potty to assist in easier bowel movements.
- Include regular moderate exercise and avoid being too sedentary, which prevents constipation.
- Wear comfortable clothing and undergarments that do not place excess pressure on the body. This also avoids irritation and sweat from provoking hemorrhoids.
- Use good hygiene by cleaning your anus daily.
While hemorrhoids cannot be completely cured, they can be well managed if you follow these preventative tips.
Summary: Prevention is your best bet against hemorrhoids. Eat a high-fiber diet with adequate fluids to support regular bowel movements. Exercise regularly, avoid straining and practice good hygiene.
Be Patient When Treating Hemorrhoids
Most hemorrhoids will not interfere with normal daily living and resolve on their own after a few days.
There are conservative, at-home treatments to help with your symptoms like sitz baths, myrtus communis essential oil and stool softeners.
If hemorrhoids persist, more aggressive treatment options are available including prescription medications, rubber band ligation and surgical removal.
Remember that hemorrhoids are not life-threatening. Patience and following appropriate preventative tips are the best ways to manage them.