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Hemorrhoids: Which Treatment Should I Use?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Hemorrhoids: Which Treatment Should I Use?

Get the facts

Your options

  • Use home treatments to control hemorrhoid symptoms.
  • Have a non-surgical procedure that cuts off the blood flow to hemorrhoids. This works only for internal hemorrhoids.
  • Have surgery to remove the hemorrhoid. This works for both internal and external hemorrhoids.

Key points to remember

  • Home treatments for hemorrhoids work for most people: Eat more fibre, drink more fluids, use a stool softener, and use ointments to help your symptoms.
  • When home treatments don't work on internal hemorrhoids, fixative procedures may help. These are treatments that involve cutting off the blood flow to the hemorrhoids using rubber bands, lasers, heat, or electrical currents. These procedures are usually less painful than surgery.
  • You might consider surgery to remove hemorrhoids (hemorrhoidectomy) for internal hemorrhoids that bulge from the anus or external hemorrhoids that are causing symptoms and have not improved with home treatment.
FAQs

What types of hemorrhoids are there?

  • External hemorrhoids are near the opening of the anus. They may be painful, but home treatments usually work to control them.
  • Internal hemorrhoids are inside the anal canal. They usually don't cause pain. But they can itch, cause a feeling of pressure, and make it hard to clean around the anus. They may also bleed or leak mucus. Sometimes they stick out of the anus.

What are home treatments for hemorrhoids?

You can try the following home treatments:

  • Blot the anus gently after bowel movements with white toilet paper moistened with water or a cleansing agent. You can also use moistened baby wipes or medicated pads, such as Tucks.
  • Avoid rubbing the anal area. And avoid soaps with perfumes or dyes.
  • Use hemorrhoid ointments, such as Preparation H.
  • Don't strain while you are having a bowel movement.
  • Apply ice several times a day. Also try applying moist heat (such as warm, damp towels) several times a day, or sit in warm water (sitz bath).
  • Eat more fibre, and drink more water.
  • Take stool softeners.

You can also take non-prescription pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) and naproxen (Aleve), can help with pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

What are non-surgical treatments for hemorrhoids?

These treatments cure most small and some large internal hemorrhoids. They aren't used for external hemorrhoids. They work by cutting off the blood supply to the hemorrhoid, which makes the hemorrhoid shrink or go away.

There are different ways to do this:

  • Rubber band ligation. This is the most successful non-surgical procedure. It is the one most often used for small and medium hemorrhoids. It involves tying off hemorrhoids with rubber bands.
  • Coagulation. This procedure involves using heat, a laser, or an electrical current to create scar tissue around the hemorrhoids. Infrared photocoagulation uses infrared light to do this.

When is surgery used?

Surgery for hemorrhoids is called hemorrhoidectomy. It is the most successful way to treat large internal hemorrhoids.

Surgery is used for small internal hemorrhoids when:

  • Several hemorrhoids are present.
  • Bleeding cannot be controlled with other treatments.
  • Both internal and external hemorrhoids are present.

Surgery may be a good choice for internal hemorrhoids that bulge from the anus. It is the only choice for external hemorrhoids that are causing symptoms and haven't improved with home treatment.

How well do treatments for hemorrhoids work?

  • Home treatment works for most people.
  • Non-surgical procedures are less risky and less painful than surgery. They require less time off from work and other activities.
  • Of the non-surgical procedures, rubber band ligation seems to work best. But it also appears to have a higher risk of complications, especially pain.
    • Rubber band ligation helps about 8 out of 10 people who have it done. That means it doesn't help about 2 out of 10.footnote 1
    • Infrared photocoagulation has about the same success rate as rubber band ligation. But improvements may not last as long.footnote 2
  • Surgery usually cures a hemorrhoid. But the long-term success of hemorrhoid surgery depends a lot on how well you are able to change your daily bowel habits to avoid constipation and straining.
  • Compared with non-surgical procedures, surgery is more risky and has a longer recovery period.

What are the risks of treatments for hemorrhoids?

Most non-surgical treatments have few risks. Possible problems may include:

  • Pain or discomfort. For some people, the pain may be so bad that they will not be able to do their normal activities for a day or so.
  • Bleeding, which may require another doctor visit to treat.
  • Temporary trouble urinating because of pain. If you are completely unable to urinate, you'll need treatment.
  • Infection or abscess.

Rubber band ligation appears to cause more pain than other types of non-surgical procedures. Infrared photocoagulation usually causes fewer side effects.footnote 2

Risks of surgery

Surgery is more likely to cause side effects than non-surgical treatments. These side effects may include:

  • Pain, which may last for weeks. Passing bowel movements, even if they are soft, can be quite painful.
  • Bleeding, which may last for a few days. If the bleeding is severe, you may need treatment.
  • Being unable to urinate or pass stools. This may cause stools to become stuck in the anal canal (fecal impaction).
  • Infection.

In rare cases, a more serious problem may develop.

Who should not have procedures or surgery?

People who have certain health conditions may not be able to have surgery or procedures for hemorrhoids. These conditions include:

  • Bleeding disorders or taking blood thinners.
  • HIV infection or AIDS.
  • Rectal prolapse.
  • Anal tumours or narrowing at the opening of the anal canal.
  • Anal fissure or infection around the anus.
  • Crohn's disease or ulcerative colitis.
  • Cirrhosis of the liver.
  • Irritable bowel syndrome or other conditions that cause a person to have frequent diarrhea, severe constipation, or both.
  • Heart failure.
  • Portal hypertension.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?
Use home treatments Use home treatments
  • Blot the anus gently with white toilet paper moistened with water or a cleanser, or use moistened baby wipes or medicated pads.
  • Apply ice several times a day.
  • Apply moist heat (such as warm, damp towels) several times a day, or sit in a warm bath.
  • Eat more fibre. Drink more water.
  • Take stool softeners.
  • Use a hemorrhoid ointment.
  • Take pain medicine.
  • Most people get better using home treatment.
  • You avoid the risks that come with non-surgical procedures or surgery.
  • If home treatment doesn't work, you may have a lot of pain and discomfort.
  • If a hemorrhoid keeps bleeding a lot, you could become anemic.
  • If a hemorrhoid sticks out from the anus, you may have trouble keeping the area clean.
Have a non-surgical procedure Have a non-surgical procedure
  • This is done in the doctor's office. You go home the same day.
  • You will probably be awake during the procedure.
  • If you have many hemorrhoids, you may have treatment in a hospital and be asleep during the procedure.
  • Symptoms get better in about 8 out of 10 people who have this treatment.
  • All procedures may cause pain, bleeding, temporary trouble urinating, and infection.
  • Rubber band ligation appears to cause more pain than the other non-surgical procedures.
  • Infrared photocoagulation usually causes fewer side effects. But improvements may not last as long as with ligation.
  • You may need more than one treatment.
Have surgery Have surgery
  • You are asleep or you are numb from the waist down during the operation.
  • You will probably go home the same day.
  • Most people can return to work or their normal activities after 2 to 3 weeks.
  • Surgery almost always works to remove hemorrhoids and end symptoms.
  • Recovery from this surgery can be very painful.
  • Narrowing of the anus or rectum (anal or rectal stricture).
  • Other risks of surgery include infection, bleeding, and being unable to urinate or pass stools.
  • Hemorrhoids sometimes come back after surgery.

Personal stories about treating hemorrhoids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had hemorrhoids for many years, but they have never bothered me much. Once in a while they hurt or bleed, and I know that it's time to pay more attention to my diet and drink some extra water. My new doctor and I talked about them during my last visit. She asked if I had ever considered having them treated, and we talked about the pros and cons of my options. I decided that since they don't bother me very much, and because I know what to do if they flare up, I will just keep managing them as I have been. I can always have treatment later if they get worse.

John, age 40

Because I sit all day at work, my hemorrhoids can be a big inconvenience. I get plenty of fibre and water in my diet, but they are still bothering me. My doctor and I agreed that it would be reasonable for me to try the rubber band treatment. I will still have to watch what I eat and drink to keep my stools soft, but I hope that the treatment will take care of most of the pain so I can be more comfortable at work.

Genevieve, age 50

I had a rubber band hemorrhoid treatment several years ago. I recall that the treatment was quite painful, but it worked very well for a long time. Unfortunately, now the problem has come back. My doctor and I are talking about what to do next. He says I can do the rubber band treatment again or have surgery. Since the rubber band treatment worked well for me before, I plan to have it done again.

Ricardo, age 38

I have given all the hemorrhoid home treatments a try, and they have helped. But I still feel like I need something more. It concerns me to have rectal bleeding, although my doctor has tested me and we are confident that I don't have anything more serious than hemorrhoids. I'm going to try one of the non-surgical treatments and see if that will help stop or reduce the bleeding so I can worry a little less. I have heard good things about the infrared photocoagulation treatment.

Barbara, age 47

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I've tried home treatments for a while, and I'm not happy with the results.

Not important
Somewhat important
Very important

I'd rather live with my symptoms than go through the temporary pain that non-surgical procedures or surgery might cause.

Not important
Somewhat important
Very important

My hemorrhoids bother me so much that I am willing to try anything, even surgery, to make them go away.

Not important
Somewhat important
Very important

I want to avoid surgery at all costs, but I'm willing to try a non-surgical procedure.

Not important
Somewhat important
Very important

I'm worried about the possible side effects of non-surgical procedures and surgery.

Not important
Somewhat important
Very important

My other important reasons:


Not important
Somewhat important
Very important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using only home treatments to treat hemorrhoids

Trying something besides home treatments

Leaning toward
Undecided
Leaning toward

Having a non-surgical procedure for hemorrhoids

NOT having a non-surgical procedure

Leaning toward
Undecided
Leaning toward

Having surgery for hemorrhoids

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, If I have hemorrhoids, I should try home treatment first.
2, Surgery may be a good choice if my hemorrhoids are causing symptoms that aren't helped by home treatment.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

3.
Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

What matters to you 

Print Summary

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer Kenneth Bark MD - General Surgery, Colon and Rectal Surgery
References
Citations
  1. American Gastroenterological Association (2004). American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology, 126(5): 1463–1473.
  2. Reese GE, et al. (2009). Haemorrhoids, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Hemorrhoids: Which Treatment Should I Use?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use home treatments to control hemorrhoid symptoms.
  • Have a non-surgical procedure that cuts off the blood flow to hemorrhoids. This works only for internal hemorrhoids.
  • Have surgery to remove the hemorrhoid. This works for both internal and external hemorrhoids.

Key points to remember

  • Home treatments for hemorrhoids work for most people: Eat more fibre, drink more fluids, use a stool softener, and use ointments to help your symptoms.
  • When home treatments don't work on internal hemorrhoids, fixative procedures may help. These are treatments that involve cutting off the blood flow to the hemorrhoids using rubber bands, lasers, heat, or electrical currents. These procedures are usually less painful than surgery.
  • You might consider surgery to remove hemorrhoids (hemorrhoidectomy) for internal hemorrhoids that bulge from the anus or external hemorrhoids that are causing symptoms and have not improved with home treatment.
FAQs

What types of hemorrhoids are there?

  • External hemorrhoids are near the opening of the anus. They may be painful, but home treatments usually work to control them.
  • Internal hemorrhoids are inside the anal canal. They usually don't cause pain. But they can itch, cause a feeling of pressure, and make it hard to clean around the anus. They may also bleed or leak mucus. Sometimes they stick out of the anus.

What are home treatments for hemorrhoids?

You can try the following home treatments:

  • Blot the anus gently after bowel movements with white toilet paper moistened with water or a cleansing agent. You can also use moistened baby wipes or medicated pads, such as Tucks.
  • Avoid rubbing the anal area. And avoid soaps with perfumes or dyes.
  • Use hemorrhoid ointments, such as Preparation H.
  • Don't strain while you are having a bowel movement.
  • Apply ice several times a day. Also try applying moist heat (such as warm, damp towels) several times a day, or sit in warm water (sitz bath).
  • Eat more fibre, and drink more water.
  • Take stool softeners.

You can also take non-prescription pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) and naproxen (Aleve), can help with pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

What are non-surgical treatments for hemorrhoids?

These treatments cure most small and some large internal hemorrhoids. They aren't used for external hemorrhoids. They work by cutting off the blood supply to the hemorrhoid, which makes the hemorrhoid shrink or go away.

There are different ways to do this:

  • Rubber band ligation. This is the most successful non-surgical procedure. It is the one most often used for small and medium hemorrhoids. It involves tying off hemorrhoids with rubber bands.
  • Coagulation. This procedure involves using heat, a laser, or an electrical current to create scar tissue around the hemorrhoids. Infrared photocoagulation uses infrared light to do this.

When is surgery used?

Surgery for hemorrhoids is called hemorrhoidectomy. It is the most successful way to treat large internal hemorrhoids.

Surgery is used for small internal hemorrhoids when:

  • Several hemorrhoids are present.
  • Bleeding cannot be controlled with other treatments.
  • Both internal and external hemorrhoids are present.

Surgery may be a good choice for internal hemorrhoids that bulge from the anus. It is the only choice for external hemorrhoids that are causing symptoms and haven't improved with home treatment.

How well do treatments for hemorrhoids work?

  • Home treatment works for most people.
  • Non-surgical procedures are less risky and less painful than surgery. They require less time off from work and other activities.
  • Of the non-surgical procedures, rubber band ligation seems to work best. But it also appears to have a higher risk of complications, especially pain.
    • Rubber band ligation helps about 8 out of 10 people who have it done. That means it doesn't help about 2 out of 10.1
    • Infrared photocoagulation has about the same success rate as rubber band ligation. But improvements may not last as long.2
  • Surgery usually cures a hemorrhoid. But the long-term success of hemorrhoid surgery depends a lot on how well you are able to change your daily bowel habits to avoid constipation and straining.
  • Compared with non-surgical procedures, surgery is more risky and has a longer recovery period.

What are the risks of treatments for hemorrhoids?

Most non-surgical treatments have few risks. Possible problems may include:

  • Pain or discomfort. For some people, the pain may be so bad that they will not be able to do their normal activities for a day or so.
  • Bleeding, which may require another doctor visit to treat.
  • Temporary trouble urinating because of pain. If you are completely unable to urinate, you'll need treatment.
  • Infection or abscess.

Rubber band ligation appears to cause more pain than other types of non-surgical procedures. Infrared photocoagulation usually causes fewer side effects.2

Risks of surgery

Surgery is more likely to cause side effects than non-surgical treatments. These side effects may include:

  • Pain, which may last for weeks. Passing bowel movements, even if they are soft, can be quite painful.
  • Bleeding, which may last for a few days. If the bleeding is severe, you may need treatment.
  • Being unable to urinate or pass stools. This may cause stools to become stuck in the anal canal (fecal impaction).
  • Infection.

In rare cases, a more serious problem may develop.

Who should not have procedures or surgery?

People who have certain health conditions may not be able to have surgery or procedures for hemorrhoids. These conditions include:

  • Bleeding disorders or taking blood thinners.
  • HIV infection or AIDS.
  • Rectal prolapse.
  • Anal tumours or narrowing at the opening of the anal canal.
  • Anal fissure or infection around the anus.
  • Crohn's disease or ulcerative colitis.
  • Cirrhosis of the liver.
  • Irritable bowel syndrome or other conditions that cause a person to have frequent diarrhea, severe constipation, or both.
  • Heart failure.
  • Portal hypertension.

2. Compare your options

  Use home treatments Have a non-surgical procedure
What is usually involved?
  • Blot the anus gently with white toilet paper moistened with water or a cleanser, or use moistened baby wipes or medicated pads.
  • Apply ice several times a day.
  • Apply moist heat (such as warm, damp towels) several times a day, or sit in a warm bath.
  • Eat more fibre. Drink more water.
  • Take stool softeners.
  • Use a hemorrhoid ointment.
  • Take pain medicine.
  • This is done in the doctor's office. You go home the same day.
  • You will probably be awake during the procedure.
  • If you have many hemorrhoids, you may have treatment in a hospital and be asleep during the procedure.
What are the benefits?
  • Most people get better using home treatment.
  • You avoid the risks that come with non-surgical procedures or surgery.
  • Symptoms get better in about 8 out of 10 people who have this treatment.
What are the risks and side effects?
  • If home treatment doesn't work, you may have a lot of pain and discomfort.
  • If a hemorrhoid keeps bleeding a lot, you could become anemic.
  • If a hemorrhoid sticks out from the anus, you may have trouble keeping the area clean.
  • All procedures may cause pain, bleeding, temporary trouble urinating, and infection.
  • Rubber band ligation appears to cause more pain than the other non-surgical procedures.
  • Infrared photocoagulation usually causes fewer side effects. But improvements may not last as long as with ligation.
  • You may need more than one treatment.
  Have surgery
What is usually involved?
  • You are asleep or you are numb from the waist down during the operation.
  • You will probably go home the same day.
  • Most people can return to work or their normal activities after 2 to 3 weeks.
What are the benefits?
  • Surgery almost always works to remove hemorrhoids and end symptoms.
What are the risks and side effects?
  • Recovery from this surgery can be very painful.
  • Narrowing of the anus or rectum (anal or rectal stricture).
  • Other risks of surgery include infection, bleeding, and being unable to urinate or pass stools.
  • Hemorrhoids sometimes come back after surgery.

Personal stories

Personal stories about treating hemorrhoids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had hemorrhoids for many years, but they have never bothered me much. Once in a while they hurt or bleed, and I know that it's time to pay more attention to my diet and drink some extra water. My new doctor and I talked about them during my last visit. She asked if I had ever considered having them treated, and we talked about the pros and cons of my options. I decided that since they don't bother me very much, and because I know what to do if they flare up, I will just keep managing them as I have been. I can always have treatment later if they get worse."

— John, age 40

"Because I sit all day at work, my hemorrhoids can be a big inconvenience. I get plenty of fibre and water in my diet, but they are still bothering me. My doctor and I agreed that it would be reasonable for me to try the rubber band treatment. I will still have to watch what I eat and drink to keep my stools soft, but I hope that the treatment will take care of most of the pain so I can be more comfortable at work."

— Genevieve, age 50

"I had a rubber band hemorrhoid treatment several years ago. I recall that the treatment was quite painful, but it worked very well for a long time. Unfortunately, now the problem has come back. My doctor and I are talking about what to do next. He says I can do the rubber band treatment again or have surgery. Since the rubber band treatment worked well for me before, I plan to have it done again."

— Ricardo, age 38

"I have given all the hemorrhoid home treatments a try, and they have helped. But I still feel like I need something more. It concerns me to have rectal bleeding, although my doctor has tested me and we are confident that I don't have anything more serious than hemorrhoids. I'm going to try one of the non-surgical treatments and see if that will help stop or reduce the bleeding so I can worry a little less. I have heard good things about the infrared photocoagulation treatment."

— Barbara, age 47

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I've tried home treatments for a while, and I'm not happy with the results.

         
Not important
Somewhat important
Very important

I'd rather live with my symptoms than go through the temporary pain that non-surgical procedures or surgery might cause.

         
Not important
Somewhat important
Very important

My hemorrhoids bother me so much that I am willing to try anything, even surgery, to make them go away.

         
Not important
Somewhat important
Very important

I want to avoid surgery at all costs, but I'm willing to try a non-surgical procedure.

         
Not important
Somewhat important
Very important

I'm worried about the possible side effects of non-surgical procedures and surgery.

         
Not important
Somewhat important
Very important

My other important reasons:

 
         
Not important
Somewhat important
Very important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using only home treatments to treat hemorrhoids

Trying something besides home treatments

             
Leaning toward
Undecided
Leaning toward

Having a non-surgical procedure for hemorrhoids

NOT having a non-surgical procedure

             
Leaning toward
Undecided
Leaning toward

Having surgery for hemorrhoids

NOT having surgery

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
If I have hemorrhoids, I should try home treatment first.

  • True
  • False
  • I'm not sure
You're right! Try eating more fibre, drinking more fluids, using a stool softener, and using ointments to help your symptoms.

2.
Surgery may be a good choice if my hemorrhoids are causing symptoms that aren't helped by home treatment.

  • True
  • False
  • I'm not sure
That's right. Surgery may help hemorrhoids that bulge from the anus or cause symptoms that don't get better with home treatment.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer Kenneth Bark MD - General Surgery, Colon and Rectal Surgery
References
Citations
  1. American Gastroenterological Association (2004). American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology, 126(5): 1463–1473.
  2. Reese GE, et al. (2009). Haemorrhoids, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
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