Hemorrhoids: What Actually Treats Them, and What Does Not

Hemorrhoids are extremely common, mildly humiliating to discuss, and surrounded by products that mostly soothe rather than solve. The treatment with the best evidence is unglamorous and sits in the supermarket aisle rather than the pharmacy shelf. Here is what actually reduces symptoms, what the creams can and cannot do, and the one symptom that should never be assumed to be hemorrhoids.

What hemorrhoids are, and the short answer on treatment

Hemorrhoids are swollen blood vessels in and around the anus. Everyone has the underlying cushions of tissue; the problem arises when they become enlarged and inflamed. Internal hemorrhoids sit inside and typically cause painless bleeding, while external ones form under the skin at the opening and can be painful, especially if a clot forms.

Fibre and better toilet habits are first-line treatment in evidence-based guidance, and the effect is not trivial: fibre supplementation reduces hemorrhoid bleeding by around 50 percent and improves symptoms overall. Creams, wipes, witch hazel and sitz baths ease discomfort but do not address the cause, and the data supporting them is limited. If symptoms persist, office procedures such as rubber band ligation are effective, with success rates commonly reported between 70 and 80 percent.

Why they develop

Pressure is the common thread. Straining during bowel movements is the main driver, which is why constipation is so strongly linked with hemorrhoids. Sitting on the toilet for long periods, often with a phone, keeps the area under pressure and allows the tissue to swell. Chronic diarrhoea irritates in a different way but also contributes.

Other causes raise pressure in the abdomen or pelvis: pregnancy and childbirth, heavy lifting, prolonged sitting, obesity and chronic coughing. Age plays a role too, as the supporting tissue weakens over time. Family history matters for some people. The pattern is useful because it points directly at the fix: if you can make stools softer and reduce time and effort spent straining, you remove most of the mechanical cause.

What actually works at home

These steps have the best evidence and cost little.

• Increase fibre gradually toward around 25 to 30 grams a day from vegetables, fruit, legumes, oats and whole grains. Psyllium husk is a well-studied supplement option.
• Drink enough fluid, which is necessary for fibre to soften stool rather than harden it.
• Do not delay going when you feel the urge, since waiting makes stool drier and harder.
• Limit toilet time to a few minutes and leave the phone outside the bathroom.
• Use a footstool so the knees sit above the hips, which straightens the anorectal angle and reduces straining.
• Warm sitz baths for 10 to 15 minutes to ease discomfort, recognising this is symptom relief rather than treatment.
• Stay active, which supports regular bowel movements.

If constipation persists despite fibre, an osmotic laxative such as polyethylene glycol is reasonable and is often more useful than another cream. Keeping stools soft is the single most effective thing you can do.

Pregnancy deserves a separate mention, since hemorrhoids are very common in the third trimester and after birth, driven by pressure from the growing uterus, hormonal changes and straining during delivery. Most settle in the weeks after birth with fibre, fluid and sitz baths. Several over-the-counter products are not recommended in pregnancy, so it is worth asking a midwife or pharmacist which ones are suitable rather than choosing from the shelf.

Creams, ointments and what they really do

Over-the-counter products for hemorrhoids generally contain local anaesthetics, astringents such as witch hazel, mild corticosteroids or vasoconstrictors. They can reduce itching, burning and discomfort in the short term, which has value, but there is little data supporting lasting benefit, and none of them shrink the underlying problem.

Two practical cautions. Products containing steroids should not be used for more than about a week without medical advice, since prolonged use thins the skin in a sensitive area. And ongoing itching that does not settle may not be hemorrhoids at all: skin conditions, fungal infection, overcleaning and reactions to scented wipes are all common culprits. Gentle cleaning with water and patting dry, rather than vigorous wiping with perfumed products, often helps more than another tube.

Procedures that work when home treatment is not enough

For internal hemorrhoids that keep bleeding or prolapsing despite good habits, office-based treatment is the usual next step and does not require a hospital stay. Rubber band ligation places a small band at the base of the hemorrhoid, cutting off its blood supply so it shrinks and falls off within days. It is the preferred first procedure for most people, with a lower failure rate than alternatives such as infrared coagulation.

Sclerotherapy, where a solution is injected to shrink the tissue, is another option, often used for smaller hemorrhoids or in people on blood thinners. Surgical removal, a haemorrhoidectomy, is reserved for large, severe or recurrent cases and for most external hemorrhoids that need treatment, since it is more effective but involves significant recovery pain. A thrombosed external hemorrhoid, which produces sudden severe pain and a firm lump, can sometimes be drained in the first couple of days for rapid relief, after which it usually settles on its own.

When to see a doctor

Always see a doctor for rectal bleeding, particularly the first time, if you are over 40, if the pattern changes, or if bleeding continues despite treatment. Hemorrhoids are the most common cause, but bowel cancer, inflammatory bowel disease and other conditions can produce identical bleeding, and assuming it is hemorrhoids is how serious diagnoses get delayed.

Seek prompt care for severe pain, a hard painful lump that appears suddenly, heavy bleeding, dizziness or weakness suggesting blood loss, fever with pain, or symptoms alongside unexplained weight loss or a change in bowel habit lasting several weeks. If you are pregnant, ask which treatments are suitable rather than using products off the shelf. This is general information rather than medical advice. The useful summary is that fibre, fluid and shorter toilet visits treat the cause, while creams only treat the feeling.

Frequently asked questions

What is the fastest way to get rid of hemorrhoids?

Soften the stool and stop straining: increase fibre and fluid, limit toilet time to a few minutes and use a footstool. Warm sitz baths and creams ease symptoms while the cause is addressed.

Do hemorrhoid creams actually work?

They reduce itching and discomfort in the short term, but there is limited evidence they treat the underlying problem. Steroid-containing products should not be used for more than about a week without advice.

Do hemorrhoids go away on their own?

Mild ones often settle within days to weeks once straining and constipation are addressed. Larger or prolapsing hemorrhoids usually need a procedure such as rubber band ligation.

Is bleeding from hemorrhoids dangerous?

The bleeding itself is usually minor, but it should never be assumed to be hemorrhoids. Bowel cancer and other conditions cause identical bleeding, so a first episode or any change needs assessment.

Does a footstool help with hemorrhoids?

Yes. Raising the knees above the hips straightens the anorectal angle and reduces straining, which is one of the main mechanical causes.

Read next

• Constipation: What Actually Helps, According to the Latest Guidelines

  Treating the cause behind most hemorrhoids.

• Fibre: The Most Underrated Nutrient in Your Diet

  How to reach a fibre intake that actually helps.

• Bloating: Common Causes and What Actually Helps

  Other common digestive complaints, examined.

This article is for general informational purposes only and is not medical advice. Always consult a qualified healthcare professional about your individual situation, and never start or stop a medication without your doctor. See our Medical Disclaimer.