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Hemorrhoids are common in both men and women, and nearly half of all people will experience hemorrhoids by the age of 50. For those experiencing hemorrhoids, there are plenty of at-home treatments and medications available to help reduce the pain and get rid of the irritation they can cause.
Also referred to as piles, hemorrhoids are swollen veins that occur inside and around the anus and rectum. Many people are not aware of hemorrhoids until they bleed, become uncomfortable, or start causing pain.
While hemorrhoids are one of the most common ailments, seeking professional medical help for the problem is nowhere near as common, which is why we’re here to help. For those unsure about how to treat hemorrhoids, let’s take a look at the causes and what can be done to treat the problem.
What are hemorrhoids?
Hemorrhoids are a gastrointestinal disease that is generally suffered by adults between the ages of 45 to 65. However, younger people can still get them, especially if they experience bouts of diarrhea or constipation.
Hemorrhoids can be caused by increased pressure on the abdomen resulting from prolonged straining, sitting, coughing, constipation, or pregnancy.
There are two kinds of hemorrhoids—internal hemorrhoids and external hemorrhoids.
- Internal hemorrhoids: These are typically less painful, even when they produce bleeding. However, internal hemorrhoids may also start to extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and tiny stool particles that may cause an irritation called pruritus ani. Wiping constantly to try to relieve the itching can worsen the problem.
- External hemorrhoids: Considered the most uncomfortable because the overlying skin around the anus, which contains many pain-sensing nerves, becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin that can itch and become irritated.
When hemorrhoids cause pain it can be quite debilitating. So when it reaches that point where they become troublesome, medical intervention is recommended.
How are hemorrhoids diagnosed?
Hemorrhoids can develop for no apparent reason, but often they are associated with chronic constipation or diarrhea, straining during bowel movements, and prolonged sitting.
As uncomfortable as it may be to speak about, it’s important to talk to a healthcare provider and be open about your symptoms. If you suspect you have hemorrhoids, a good place to start is with your primary care provider. Your physician will be able to conduct an examination and refer you to a specialist if necessary. Generally, a specialist such as a gastroenterologist or a proctologist will only be recommended if there is concern about complications.
A physical examination of the anus usually confirms a diagnosis of external hemorrhoids as they are easily visualized. This physical will likely include a digital examination of the lower rectum, which can confirm the structure of muscles and often locate any polyps and/or tumors.
An anoscopy is another type of physical examination. It employs an endoscopic device with a light to examine the interior wall of the anal canal and the very lowest part of the rectum. In other words, a small, rigid instrument called an anoscope, or anal speculum is inserted a few inches into the anus. Intimidating as it may sound, an anoscopy is considered painless, although you may feel some pressure.
In some cases, a more complete examination of the large intestine may be suggested, in which case a colonoscopy and/or flexible sigmoidoscopy can be utilized.
Barium enemas, which employ a contrast solution that is instilled into the rectum for x-ray imaging, may also be an option after the initial consultation.
Some questions your healthcare provider may ask during your appointment include:
- When did your symptoms start?
- Have you experienced this before?
- Does anything seem to trigger your discomfort?
- Are you taking any medication?
- Do I have hemorrhoids?
- What are my treatment options?
- Do you need to run any tests?
- Will there be a physical examination?
- How long will it take to heal?
- What caused the hemorrhoids?
We understand that this is a topic many people feel uncomfortable discussing, but we encourage you to find healthcare providers you trust and can speak openly with. They’re professionals, and the more information you give, the better they’ll be able to help and evaluate the right treatment option for you.
Hemorrhoid treatment options
If you’ve been diagnosed with hemorrhoids, the good news is that there are plenty of treatment options available. These include home remedies, like over-the-counter (OTC) medicines, sitz baths, and dietary changes, but can also extend to prescription medication or even surgery in some circumstances.
Remember, hemorrhoids are treatable, and there are ways to prevent the uncomfortable condition from flaring up again. Some ways to avoid piles in the future are to avoid straining during bowel movements, eat a high fiber diet—plenty of fruit, vegetables, and whole grains—and staying well hydrated. Regular exercise, going to the bathroom as soon as you feel the urge, and not sitting for extended periods can also help prevent another flare-up.
Over-the-counter medicines
Most mild cases of hemorrhoids can be treated with topical creams, gels, ointments, and wipes available OTC at your local pharmacy. The most popular OTC medications tend to contain a vasoconstrictor, used to tighten blood vessels and shrink skin tissue, which helps reduce the size of the hemorrhoid, thus alleviating pressure and pain.
These medications also tend to include skin protectants and sometimes even topical pain relievers, such as lidocaine. There are also some OTC hemorrhoid medications that contain hydrocortisone, a steroid, which helps reduce inflammation, thus reducing pressure and pain.
Prescription medications
If the condition is more severe, your healthcare provider may prescribe a stronger medication, often a combination topical preparation of hydrocortisone and pramoxine. These medicines work by reducing the size of the pile, as well as numbing the area to reduce discomfort.
Surgery
For large internal hemorrhoids or extremely uncomfortable external hemorrhoids, your healthcare provider may refer you to a surgical specialist who may want to do a traditional hemorrhoidectomy to remove them, or newer techniques using staples or a Doppler sensor to identify and cut off the blood supply. Medical treatments are effective, but unless you change your diet and lifestyle, hemorrhoids may come back.
Other nonsurgical options
When internal hemorrhoids continue to cause symptoms despite home treatment, your healthcare provider may recommend an office-based nonsurgical procedure. Here are the most common options:
- Rubber band ligation: This is the most widely used procedure for treating internal hemorrhoids. A small elastic band is inserted into the anal canal and then placed around the base of a hemorrhoid. The band cuts off the hemorrhoid's circulation, which causes the hemorrhoid to wither and fall off within a couple of weeks. The rubber band eventually falls off unnoticed. The procedure requires no anesthesia, although a numbing agent is sometimes used if you feel discomfort.
- Sclerotherapy: Sclerotherapy is a treatment that involves the injection of a chemical solution into blood vessels. This solution causes a local reaction that interferes with blood flow inside the hemorrhoid, causing it to shrink.
- Coagulation therapy: This treatment uses heat, laser, or electric current to cut off the hemorrhoid's blood supply. Once the hemorrhoid shrinks and dies, scar tissue forms on the anal canal wall to hold nearby veins in place so they don't bulge into the anal canal. One hemorrhoid is treated at a time, with a 10- to 14-day period between treatments.
Hemorrhoid medications
After visiting your healthcare provider, they may suggest you try either an OTC medicine or prescribe you something to help. The majority of medicines available to treat hemorrhoids are creams, ointments, or suppositories. These medicines are largely designed to reduce the itch that comes with hemorrhoids and shrink the enlarged tissue.
Over-the-counter
These topical creams, ointments, pads, and suppositories are used for mild cases, temporarily relieving pain and itching. They usually contain ingredients such as witch hazel, phenylephrine, lidocaine, or hydrocortisone. Brand names include Anusol, T.N. Dickinson's Witch Hazel Cleansing Pads, Tucks Pads, and Preparation H.
Do not use OTC hydrocortisone creams for more than a week, as it can cause thinning of the tissue.
You may also try pain relievers such as acetaminophen and ibuprofen to ease the discomfort while the hemorrhoid heals.
Prescription medications
Although smaller hemorrhoids often go away on their own, sometimes your doctor will need to prescribe something stronger. They may treat you with prescription-strength hydrocortisone and pramoxine topical preparations.
Hydrocortisone is a steroid that helps to reduce the size and swelling of a hemorrhoid, while pramoxine is a numbing agent. Brand names include Analpram, Pramasone, and Mezparox, with generic options also available.
What is the best hemorrhoid medication?
With so many medications available to treat hemorrhoids, you may be wondering which option is the best. Like most prescriptions, that can only be determined by your healthcare provider on a case by case basis. The best option will depend on your medical history, the severity of your hemorrhoids, and if you’re taking any other medications that may negatively interact with hemorrhoid medication.
To make things easier to understand, we’ve broken down some of the different prescription medications available to treat hemorrhoids:
| Best medications for hemorrhoids | ||||
|---|---|---|---|---|
| Drug name (generic) | Drug class | Administration route | Standard dosage | Side effects |
| Analpram (hydrocortisone ace-pramoxine) | Rectal corticosteroid | Topical cream | 30 gm of 2.5% | Thinning of skin, local skin irritation |
| Pramosone | Rectal corticosteroid | Topical cream | 28.4 gm of 2.5% | Allergic reactions including itching, hives, or swelling of the lips; thinning of the skin |
| Mezparox HC | Rectal corticosteroid | Topical cream | 28.4 gm of 2.5% | Blistering, burning, dryness, thinning of the skin |
| Proctosol HC | Rectal corticosteroid | Topical cream | 30 gm of 2.5% | Shortness of breath, stomach pain, rectal bleeding, headaches |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
Again, the best option available for you will be determined by having an open conversation with your healthcare providers. They’ll take all the variables into account, such as your symptoms, lifestyle, medical history, and if you’re taking any other medications that may interact with treatment.
What are common side effects of hemorrhoid medicine?
Hemorrhoid medications are generally considered safe drugs, however, as with all medications, there is the potential for side effects. If you decide to use a treatment that contains steroids, it is not advised to continue its use for more than one week as it can lead to skin damage.
Here are some side effects to look out for when using hemorrhoid medications, including creams and gels:
- Skin irritation at the site of application
- Rectal bleeding
- Severe irritation inside or around the rectum
- Allergic reaction, including rash, hives, or swelling of the lips
- Increased blood pressure
- Headache, dizziness, and nausea
Although side effects with these medications are rare, and this is not a comprehensive list, please speak to your healthcare provider immediately if you notice any signs of a negative reaction.
What are the best home remedies for hemorrhoids?
If you’d prefer to avoid medication, or you’d like to complement your treatment with at-home remedies, here are some ways you can alleviate your hemorrhoids at home:
- Sitz baths: A regular sitz bath can relieve itching and irritation. Fill a tub with three to four inches of warm (not hot) water and sit in it with your knees bent for about 10 to 15 minutes. Gently pat (don’t rub!) yourself dry with a towel afterwards. For an extra soothing effect, try adding Epsom salts to the bath.
- Fiber supplements: These reduce hemorrhoid bleeding, inflammation, and enlargement by drawing water into your stool to make it easier to pass. A psyllium husk fiber supplement, such as Metamucil or a generic equivalent, is a good choice, although psyllium may cause gas or bloating. In that case, try a supplement containing wheat dextrin (Benefiber) or methylcellulose (Citrucel).
- Cold compress: Applying ice packs to the anus for 10-15 minutes can help reduce swelling and reduce discomfort. To avoid ice burns always place ice in a cloth or paper towel, and never apply it directly to the skin.
- Aloe vera: Aloe vera has been used in many cultures for centuries to treat hemorrhoids due to its believed anti-inflammatory properties. Given the sensitivity of the area, only use pure aloe vera to treat hemorrhoids, and perform a patch test 24-48 hours on your inner wrist prior to application to check there is no allergic reaction.
Frequently asked questions about hemorrhoids
What can you put on hemorrhoids to shrink them?
Many people successfully treat hemorrhoids by applying either witch hazel or over-the-counter and prescription creams/ointments. These medicines are specifically targeted at hemorrhoids, and often contain hydrocortisone to reduce swelling.
Do hemorrhoids go away?
Small hemorrhoids often clear up within a few days. However larger hemorrhoids or smaller ones that persist for more than a week may require the attention of a doctor and treatment.
How can I treat piles at home?
There are a number of ways to treat piles at home, including OTC medications, warm baths, applying witch hazel to the affected area, taking stool softeners, and eating a high fiber diet.
What do hemorrhoids look like?
The appearance of hemorrhoids can vary, and sometimes they cannot be seen without an internal examination. Generally, thrombosed hemorrhoids protrude from the anus as a dark bluish lump. The color is due to a blood clot inside a blood vessel. Non-thrombosed piles, however, lack this color and look more like a rubbery lump at the anal verge.
Can I pop a hemorrhoid?
Although a hemorrhoid may feel like a firm pimple, it is not recommended that you pop it to release blood and reduce its size. It’s very easy to damage the delicate tissue of the anus. Given the area is exposed to high amounts of bacteria thanks to bowel movements, popping a hemorrhoid would cause an open wound extremely vulnerable to infection.