Hemorrhoid Treatment

Hemorrhoid treatment depends on the type and severity of your hemorrhoids, your symptoms, and how well they respond to conservative care. While mild cases may improve with at-home measures, persistent bleeding, pain, or prolapse may require medical treatment. Surgery is not the only option, and many hemorrhoids can be treated with office-based or minimally invasive procedures.

USA Hemorrhoid Centers provides evaluation and non-surgical treatment options for eligible patients, including hemorrhoid artery embolization (HAE). Learn about the available treatments, when to seek care, and which approach may be appropriate for your symptoms.

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Do Hemorrhoids Ever Go Away?

Whether a hemorrhoid resolves on its own depends on its type, grade, and severity.

Small, mild hemorrhoids often improve within a few days to a week with conservative care — a high-fiber diet, adequate hydration, and warm sitz baths. But that is not true for every case. Hemorrhoids are graded on a scale of 1 to 4 based on how far they extend outside the anal canal, and that grade significantly affects the likelihood of self-resolution.

Grade 1 and Grade 2 internal hemorrhoids, which remain inside the anal canal or prolapse briefly before retracting on their own, are more likely to improve with lifestyle adjustments. Grade 3 and Grade 4 hemorrhoids, which require manual reduction or remain permanently prolapsed, rarely resolve without medical treatment. External hemorrhoids without a blood clot can shrink on their own, though they may take several weeks. A thrombosed external hemorrhoid — one that has developed a blood clot — is most painful in the first 48 to 72 hours and often benefits from prompt medical evaluation.

One pattern that matters for long-term management: even when symptoms improve, the underlying vein tissue often remains weakened. Without addressing contributing factors like straining, constipation, or prolonged time on the toilet, symptoms tend to return. If hemorrhoids persist beyond one week, cause bleeding, or keep recurring, a medical evaluation will identify why and determine the appropriate treatment.

When Is Hemorrhoid Treatment Needed?

Several factors determine whether medical treatment is warranted:

1. Severity of symptoms: Mild symptoms are often manageable with lifestyle changes. More significant pain, bleeding, or prolapse typically warrants professional evaluation.
2. Duration: Hemorrhoids that have not improved after a week of at-home care, or that worsen over time, generally require treatment beyond conservative measures.
3. Impact on daily life: If hemorrhoids interfere with routine activities, work, sleep, or bowel habits, that is reason enough to seek care.
4. Complicated or severe cases: Thrombosed external hemorrhoids and prolapsed internal hemorrhoids that cannot be manually reduced may require timely intervention. Surgery is typically considered only when less invasive options have not provided adequate relief.

Treatment for External vs. Internal Hemorrhoids

There are two types of hemorrhoids, and they behave and are treated differently.

External hemorrhoids form under the skin around the anus. They are typically the more painful type, causing itching, swelling, and discomfort with bowel movements or prolonged sitting. Many mild external hemorrhoids improve with sitz baths, over-the-counter creams, increased fiber, and hydration. When a blood clot develops, pain can be severe, and prompt evaluation is recommended, particularly within the first 72 hours. 

Internal hemorrhoids are located inside the rectum and are not typically painful unless they prolapse. Their most common symptom is bright red blood and bleeding during and/or after bowel movements. The grade of an internal hemorrhoid, determined during examination, directly guides which treatment options are most appropriate.

Hemorrhoid Diagnosis

Because symptoms like rectal bleeding can have causes beyond hemorrhoids, including anal fissures, inflammatory bowel disease, and colorectal cancer, an accurate diagnosis matters before any treatment is pursued. 

A hemorrhoid diagnosis typically begins with a review of your symptoms and medical history. Your provider may perform a physical exam to check for external hemorrhoids, swelling, irritation, or other visible concerns around the anus.

To evaluate internal hemorrhoids, your provider will use an anoscope, a thin, lighted tube that allows them to examine the anal canal and lower rectum. This is also how hemorrhoid grade is determined, which is the key factor in matching you to the right treatment. Additional testing may be recommended to rule out other conditions.

How to Treat Hemorrhoids

Treatment follows a progression based on hemorrhoid type, grade, and how symptoms have responded to prior care. 

Lifestyle Changes and At-Home Remedies For Hemorrhoids

Home treatments for mild hemorrhoids can help reduce inflammation and discomfort. 

These measures can provide temporary pain relief for hemorrhoids: 

• A high-fiber diet to soften stool and reduce straining
• Adequate daily fluid intake
• Warm sitz baths to reduce inflammation and discomfort
• Limiting time on the toilet and avoiding straining
• Over-the-counter creams, ointments, or suppositories for temporary relief

These measures can ease symptoms, but do not correct the underlying problems. ,  If symptoms persist beyond a week or include significant pain or bleeding, the next step is an office-based procedure. 

Office-Based Procedures 

For Grade 1, Grade 2, and select Grade 3 internal hemorrhoids that have not responded to conservative care, office-based procedures are the standard recommended next step. They require no surgery and no general anesthesia.

Rubber band ligation is the most commonly used and most effective office-based treatment for internal hemorrhoids. A small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls away within about a week. The procedure is performed in a physician’s office without sedation.

Sclerotherapy involves injecting a chemical solution into the hemorrhoid to reduce blood supply and shrink the tissue. It is a preferred option for patients with bleeding disorders or other conditions where banding is not advisable.

Infrared coagulation uses focused infrared light to reduce blood flow to the hemorrhoid. Like banding and sclerotherapy, it is suitable for lower-grade internal hemorrhoids and is performed in an office setting.

For patients whose symptoms have not improved with conservative care, an evaluation can determine whether an office-based procedure or a non-surgical option like HAE is the more appropriate next step based on hemorrhoid grade and symptom profile. 

Surgical Treatment

Surgery is generally reserved for Grade 3 and Grade 4 hemorrhoids, external hemorrhoids that have not responded to other treatments, or cases involving combined internal and external hemorrhoids with significant prolapse.

Hemorrhoidectomy is the surgical removal of hemorrhoidal tissue and is the most effective option for high-grade or refractory hemorrhoids. Recovery involves more downtime than office-based procedures and typically requires a structured pain management plan.

Thrombectomy is used for thrombosed external hemorrhoids. It involves incision and full surgical removal of the clot and the affected tissue, not simple drainage, and is most effective within 72 hours of symptom onset.

Non-Surgical Hemorrhoid Treatment: Hemorrhoid Artery Embolization (HAE)

For patients seeking a minimally invasive alternative to surgery, hemorrhoid artery embolization (HAE) that addresses the problem at its vascular source. Rather than removing tissue, HAE reduces blood flow to the hemorrhoidal arteries using image-guided technology, allowing the hemorrhoids to shrink gradually. 

HAE is most effective for patients whose primary symptom is bleeding. It is performed on an outpatient basis by an interventional radiologist, with no rectal incisions or wounds. 

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About Hemorrhoid Artery Embolization (HAE)

During HAE, a small catheter is guided through the arterial system to the branches of the superior rectal artery that supply the hemorrhoidal tissue. Embolic material is delivered through the catheter to reduce that blood supply, causing the hemorrhoids to shrink over time.

Published data across nearly 400 patients show technical success rates of 93% to 100% and clinical success rates ranging from 63% to 94%. A 2023 randomized controlled trial comparing HAE to surgical hemorrhoidectomy found similar rates of symptom control at 12 months, with the HAE group reporting significantly less post-procedure pain and lower medication use. Some patients require a second procedure if symptoms recur.

Benefits of HAE Include

• No rectal wounds or stitches
• Same-day procedure
• Significantly less post-procedure pain than hemorrhoidectomy 
• Low rate of major
• Symptom improvement sustained at 6 to 12 months in clinical follow-up 

HAE is best suited for patients with bleeding internal hemorrhoids who have not responded to conservative management and who prefer to avoid surgery or are not surgical candidates. 

Insurance Coverage for Non-Surgical Hemorrhoid Treatment

Non-surgical hemorrhoid treatment can be covered by insurance when considered medically necessary. USA Hemorrhoid Centers works with most major insurance providers, including Medicare and select Medicaid plans, to help patients understand their coverage before treatment.

 Contact our team to verify your coverage before your visit.

Get Evaluated at USA Hemorrhoid Centers

If you have rectal bleeding, prolapse, or persistent discomfort that has not improved after a week of at-home care, you do not have to keep managing it on your own. The interventional radiologists at USA Hemorrhoid Centers will evaluate your symptoms, determine your hemorrhoid type and grade, and walk you through every treatment option — including non-surgical approaches — so you can make a confident decision about your care. 

We accept most insurance plans, including Medicare and some Medicaid plans.

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