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Hemorrhoids

Hemorrhoids (piles) are swollen veins in and around the anus. They are common, often settle within days with fiber, fluids and not straining, and can be treated in the office if they don’t. But rectal bleeding always deserves a doctor’s check — never assume it’s “just hemorrhoids.”

Call 911 or go to the emergency room if you have:

  • A lot of blood, or bleeding that won’t stop — for example, the toilet water turns red or you pass large clots (NHS).
  • Bleeding with fainting, dizziness or lightheadedness. Confusion, a fast heart rate, pale skin, cold hands and feet or sweating can mean shock, which is life-threatening (NIDDK).
  • Black or tarry stools (NIDDK).

See a doctor — don’t assume it’s hemorrhoids — if you have:

Get care right away for severe anal pain with bleeding, especially with belly pain, diarrhea or fever (NIDDK). See a doctor soon for a sudden, very painful hard lump — it may be a clotted hemorrhoid that can be removed in the office (ASCRS).

What are hemorrhoids?

Hemorrhoids, or piles, are swollen and inflamed veins around the anus or in the lower rectum (NIDDK). Everyone has cushions of hemorrhoidal tissue as part of normal anatomy; only in a minority do they enlarge or cause symptoms (ASCRS).

Thrombosed hemorrhoids

A blood clot in an external hemorrhoid (NIDDK) appears as a bluish, painful lump, sometimes after heavy straining. The pain is usually constant, can be severe, often peaks 48 to 72 hours after it starts and is largely easing after four or five days. As the clot is absorbed it may leave a harmless skin tag (ASCRS).

Symptoms

  • External: itching, one or more hard, tender lumps, and aching or pain, especially when sitting. Straining, rubbing or over-cleaning makes it worse. Symptoms often go away within a few days (NIDDK).
  • Internal: usually painless, bright red blood on the stool, toilet paper or in the bowl, or a prolapsed hemorrhoid, which may hurt (NIDDK). A few drops of blood can turn the water a dramatic color (ACG). Prolapse can cause itching, mucus and trouble cleaning (ASCRS).

Complications include clots, skin tags, infection, a strangulated prolapsed hemorrhoid whose blood supply is cut off, and anemia (NIDDK).

Causes and how common they are

Causes include straining during bowel movements, sitting on the toilet for long periods, long-lasting constipation or diarrhea, a low-fiber diet, pregnancy, often lifting heavy objects, and the weakening of supporting tissues with age (NIDDK). Most raise pressure in the belly that is passed down to the anus (ASCRS). For constipation help, see our Bowel Problems guide; MBHA’s Irritable Bowel guide is being written.

Hemorrhoids affect about 1 in 20 Americans, and about half of adults older than 50 have them (NIDDK).

Why rectal bleeding should always be checked

Bleeding from the lower gut can come from hemorrhoids and fissures, but also from diverticular disease, polyps, colorectal cancer and colitis (NIDDK) — see our Diverticulitis guide. Blood thinners can cause it too. Don’t self-diagnose (NHS). Polyps and early cancer don’t always cause symptoms, so keep up with screening as well (CDC); see our screening section and Cancer guide.

Your doctor will ask about your symptoms and toilet habits, examine the area, do a rectal exam with a gloved finger, and may look inside with a short scope, usually in the office without anesthesia (NIDDK). A sigmoidoscopy or colonoscopy may follow (ASCRS).

Anal fissures

An anal fissure is a small tear in the lining of the anus, often after a hard stool (ACG). It causes sharp pain when you pass stool, burning pain that can last hours, and bright red blood (NHS). Fissures are often mistaken for hemorrhoids, and delay can let them become long-lasting (ASCRS). Most heal when stools are kept soft (ACG); see a GP if there is no improvement after 7 days of self-care (NHS). Stubborn fissures may need prescription ointment, Botox injections or minor surgery (ASCRS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Fiber, fluids and not straining first; sitz baths; over-the-counter creams, ointments and suppositories for a short time; office procedures (rubber band ligation, sclerotherapy, infrared coagulation) for internal hemorrhoids that keep bleeding or prolapsing; surgery (hemorrhoidectomy or stapled hemorrhoidopexy) for large or severe hemorrhoids; early removal of a very painful clot. Cost estimate being researched. Most hemorrhoids get better with simple measures. Fewer than 10% of people seen for symptomatic hemorrhoids need surgery. Hemorrhoids often come back, so daily habits matter long term.
Chiropractic No role in treating hemorrhoids. Not a treatment for hemorrhoids, so no cost is listed. We found no studies of chiropractic care for hemorrhoids. Don’t let it delay a medical check of rectal bleeding.
Acupuncture Studied mainly as an add-on for pain in the days after hemorrhoid surgery. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Some small trials found less pain after surgery, but a review called the evidence inconclusive. We found little research on acupuncture for hemorrhoid symptoms themselves.
Herbal medicine Psyllium fiber supplements; flavonoid products such as micronized purified flavonoid fraction (sold as dietary supplements in the U.S.); witch hazel as an astringent in some over-the-counter products, for external use. Cost estimate being researched. Fiber is a cornerstone of treatment. A Cochrane review found flavonoid-type products may ease bleeding and other symptoms, but the studies had limitations. Little data for witch hazel. Ask about interactions with your medicines.
Massage therapy No role in treating hemorrhoids. Not a treatment for hemorrhoids, so no cost is listed. We found no studies of massage for hemorrhoids. Don’t use it to put off seeing a health care provider.
MBHA Wellness Coach Build up fiber and fluids step by step, don’t strain, keep toilet time short (leave the phone outside), go when you feel the urge, move every day, tips for pregnancy, and reminders for colorectal cancer screening from 45. Cost estimate being researched. These habits are the cornerstone of treating and preventing hemorrhoids, whether or not you also need a procedure. They support — not replace — a check of any bleeding.

Approach 1 of 6

Conventional medicine (AMA)

Most hemorrhoids get better with simple measures (ACG); fewer than 10% of people seen for symptomatic hemorrhoids need surgery (ASCRS). Treatment steps up only as far as needed:

  1. Daily habits — more fiber, a fiber supplement, plenty of fluids and exercise — are the cornerstone, whether or not you need surgery (ASCRS). Avoid straining and long toilet sessions (AGA, 2026). See the Wellness Coach section.
  2. Soothing a flare with sitz baths, short-term over-the-counter creams and suppositories, and simple pain relief — see Easing a flare at home.
  3. Office procedures for internal hemorrhoids that keep bleeding or prolapsing: rubber band ligation, sclerotherapy or infrared coagulation (NIDDK).
  4. Surgery — hemorrhoidectomy or stapled hemorrhoidopexy — for large external hemorrhoids, mixed internal and external hemorrhoids, or grade 3 to 4 prolapse (ASCRS). See Office procedures and surgery.

A clotted (thrombosed) external hemorrhoid

If the pain is already easing, warm baths, pain-relieving creams and pills and fiber are used. If you are in severe pain, a doctor may numb the area and remove the clot in the office (ASCRS). The American Gastroenterological Association (AGA) advises that acutely thrombosed hemorrhoids are best treated surgically with incision and drainage (AGA, 2026) — so a sudden, very painful lump is worth a prompt visit.

Special situations

  • Blood thinners may rule out banding; sclerotherapy may be an option to discuss (ASCRS).
  • Crohn’s disease or ulcerative colitis: hemorrhoid treatment should wait until the disease is in full remission (AGA, 2026).
  • Pregnancy: fiber, treating constipation and ointments; banding or infrared coagulation can be considered after the birth if symptoms persist (AGA, 2026).

What it costs

Visits, procedures, surgery and over-the-counter products: cost estimate being researched. For colonoscopy prices and coverage, see the screening section of our Bowel Problems guide.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating hemorrhoids. A PubMed search found no studies of chiropractic care or spinal manipulation as a hemorrhoid treatment. Rectal bleeding, a painful lump or a change in bowel habits needs a medical check — see the warning signs at the top of this page.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Most acupuncture research here asks one narrow question: does it ease pain after hemorrhoid surgery? We found little research on acupuncture for hemorrhoid symptoms themselves, such as bleeding, itching or prolapse.

  • A 2022 review of four trials (275 patients) found less pain with electroacupuncture at some time points, especially during the first bowel movement after surgery, but manual acupuncture gave inconsistent results, study quality varied, and the evidence was not conclusive (Chen et al., 2022).
  • A 2018 trial (72 patients) found lower pain scores at some time points after one electroacupuncture session than after sham acupuncture (Wu et al., 2018).
  • A 2012 trial (50 patients) after stapled surgery found acupuncture added to pain medicines did not significantly lower pain compared with medicines alone, though it beat sham acupuncture and reduced the need for extra pain medicine (Langenbach et al., 2012).

If you want to try it after surgery, ask your surgeon first and use it alongside your pain plan.

Safety and cost

Complications are relatively rare, but poorly delivered acupuncture can cause serious harm such as infections; needles must be sterile and single-use (NCCIH). Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We don’t list doses or brands — follow the label or your provider — and no product is a reason to skip a check of rectal bleeding.

Psyllium and other fiber supplements

NIDDK lists fiber supplements such as psyllium or methylcellulose among home treatments (NIDDK). Psyllium absorbs liquid in the intestines and forms a bulky stool that is easier to pass. Take it with plenty of liquid; don’t take digoxin, aspirin or nitrofurantoin within 3 hours of it; tell your doctor about rectal bleeding, a past bowel blockage or trouble swallowing; and don’t use it for more than a week unless your doctor says to (MedlinePlus).

Flavonoids (micronized purified flavonoid fraction)

  • Phlebotonics, a group that includes plant flavonoids, are thought to improve the tone of veins and are also used for vein problems such as chronic venous insufficiency (Perera et al., Cochrane, 2012); MBHA’s Veins guide is being written. MPFF is a flavonoid product made from diosmin and hesperidin (Hnátek, 2015).
  • A 2012 Cochrane review (20 trials, 2,344 participants) found benefits for itching, bleeding, bleeding after surgery, discharge and overall symptoms, but no clear effect on pain. Safety concerns were few, but the studies had methodological limitations (Perera et al., Cochrane, 2012).
  • If you see flavonoid products sold as supplements, remember that the FDA does not review supplements for safety and effectiveness before sale, and labels may not match contents (NCCIH).

Witch hazel

Witch hazel is an astringent allowed in over-the-counter hemorrhoid products for external use, labeled to help protect irritated skin and briefly relieve irritation or burning (FDA rules, 21 CFR 346). The AGA says there is little data to support topical treatments, witch hazel included (AGA, 2026).

Herb-drug interactions

Supplements may interact with medicines or pose risks before surgery, and “natural” doesn’t always mean safe (NCCIH). If you are pregnant, check with your doctor, midwife or pharmacist before using any cream or medicine (NHS). Tell your clinician and pharmacist about everything you take.

Approach 5 of 6

Massage therapy

Massage has no role in treating hemorrhoids, and a PubMed search found no studies of massage as a hemorrhoid treatment. Don’t use massage therapy to put off seeing a health care provider about a medical problem (NCCIH), including rectal bleeding or a painful lump.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

The habits that ease hemorrhoids also help prevent them (NIDDK). An MBHA Wellness Coach can help you build them one step at a time — alongside, never instead of, a medical check of any bleeding.

Fiber goals

Fluids

Water and other liquids help fiber work; ask your doctor how much is right for you (NIDDK). Cutting down on alcohol and caffeine helps avoid constipation (NHS).

Toilet habits

Move every day

Exercise is part of the core advice from colon and rectal surgeons (ASCRS), and regular activity may relieve constipation (NIDDK).

During pregnancy

Eat plenty of fiber and drink water, exercise regularly, avoid long periods of standing or sitting, don’t strain, clean with moist toilet paper and pat dry, and ease pain with a cloth wrung out in iced water. Check with your doctor, midwife or pharmacist before using any cream (NHS). MBHA’s Pregnancy guide is being written; see also our women’s health guide.

Screening reminders

Colorectal cancer screening is recommended for adults 45 to 75 without symptoms (USPSTF, 2021). A coach can help you track when your next test is due — but bleeding is a reason to see a doctor now, not to wait for screening (CDC).

Another approach

Easing a flare at home

Most hemorrhoids can be treated at home (NIDDK). Along with the habits in the Wellness Coach section:

Over-the-counter creams, ointments and suppositories

These may relieve mild pain, swelling and itching (NIDDK). FDA rules allow local anesthetics (such as lidocaine or pramoxine), vasoconstrictors that temporarily shrink swollen tissue (such as phenylephrine), protectants (such as petrolatum or zinc oxide) and astringents (such as witch hazel). Vasoconstrictor labels warn people with heart disease, high blood pressure, thyroid disease, diabetes or trouble urinating from an enlarged prostate not to use them without a doctor’s advice. Labels say to see a doctor if bleeding occurs or there is no improvement in 7 days, and children under 12 should see a doctor (FDA rules, 21 CFR 346). Doctors most often recommend using these products for 1 week (NIDDK).

Hydrocortisone: short-term only

If over-the-counter hydrocortisone doesn’t help within 7 days, stop and call your doctor (MedlinePlus). A doctor may prescribe a steroid cream or suppository for 1 to 2 weeks (ACG); the AGA advises no more than 2 weeks at a time (AGA, 2026).

See your doctor if symptoms last beyond a week or you have bleeding (NIDDK). Hemorrhoids often come back (ACG).

Another approach

Office procedures and surgery

Office procedures (internal hemorrhoids only)

The AGA says banding and infrared coagulation are safe and effective, banding lasts longer for prolapse and repeat bleeding, and both should come before surgery for grade 1 to 3 hemorrhoids. Rarely, a serious pelvic infection (pelvic sepsis) can follow, so your doctor should explain the risk and when to go straight to the emergency department (AGA, 2026).

Surgery

  • Hemorrhoidectomy removes the tissue in an operating room. It is highly effective and recurrence is uncommon, but it hurts more and has more complications than office procedures; full activity may take 2 to 4 weeks (ASCRS).
  • Stapled hemorrhoidopexy lifts the tissue back into place, aiming for less pain (ASCRS).
  • After surgery, sitz baths, fiber and liquids help; contact your surgeon or the emergency department if you can’t urinate (ASCRS). Treatment doesn’t always stop piles coming back (NHS).

What it costs

Cost estimate being researched.

Member stories

Living with Hemorrhoids? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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