Medical Compass: What’s the best way to treat hemorrhoids?

Medical Compass: What’s the best way to treat hemorrhoids?

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Increasing dietary fiber can make a big difference

By David Dunaief, M.D.

Dr. David Dunaief

We all have hemorrhoids. They’re vascular structures that help control our stool. When they become irritated and inflamed, we often say we “have hemorrhoids.” What we really mean is that our hemorrhoids are causing us pain.

Many of us have suffered at one time or another from hemorrhoid pain. They affect men and women equally, though women have a higher propensity during pregnancy and childbirth.

When our hemorrhoids are irritated, we may experience itchy and painful symptoms, making it hard to concentrate and uncomfortable to sit. This is because the veins in your rectum are swollen. They often bleed, especially during a bowel movement, which can be scary. Fortunately, hemorrhoids are not a harbinger of more serious disease.

There are two types of hemorrhoids: external, occurring outside the anus; and internal, occurring within the rectum.

Treating external hemorrhoids

Fortunately, external hemorrhoids tend to be mild. Most of the time, we can treat them with analgesic creams or suppositories that contain hydrocortisone, such as Preparation H. 

Another treatment option is a sitz bath.  All of these can help relieve the pain. Because we can treat them with over-the-counter solutions, external hemorrhoids generally do not require a doctor’s appointment.

For a more comprehensive solution, the most effective way to reduce this bleeding and pain is to increase your fiber intake with dietary changes and supplementation (1). 

Sometimes, however, there is thrombosis (clotting) of external hemorrhoids. In these cases, they may become more painful and require medical treatment.

If you have rectal bleeding and either have a high risk for colorectal cancer or are over the age of 50, you should consult your physician to confirm it is not due to a malignancy or other cause, such as inflammatory bowel disease.

Treating internal hemorrhoids

Internal hemorrhoids can be a bit more complicated. The primary symptom is bleeding with bowel movement, not pain, since the hemorrhoids are usually above the point of sensation in the colon, called the dentate line. If there is pain and discomfort, it’s generally because the internal hemorrhoids have prolapsed, or fallen out of place, due to weakening of the muscles and ligaments in the colon. This allows them to fall below the dentate line.

The first step for treating internal hemorrhoids is the same as for external hemorrhoids: add fiber through diet and supplementation. Study after study shows significant benefit. For instance, in a meta-analysis by the Cochrane Systems Data Review 2005, fiber reduced the occurrence of bleeding by 53 percent (2). In another study, after two weeks of fiber and another two-week follow-up, daily incidence of bleeding decreased dramatically (3).

What are the treatments for persistent hemorrhoid pain?

There are several minimally invasive options to address persistent and painful hemorrhoids, including banding, sclerotherapy and coagulation. The most effective of these is banding, with an approximate 80 percent success rate (4). This is usually an office-based procedure where rubber bands are placed at the neck of each hemorrhoid to cut off the blood flow. To avoid complications from constipation, patients should also take fiber supplementation. Side-effects of the procedure are usually mild, and there is very low risk of infection. However, severe pain may occur if misapplication occurs with the band below the dentate line. If this procedure fails, hemorrhoidectomy (surgery) would be the next option.

How do you prevent hemorrhoid problems?

First, sitting on the toilet for long periods of time puts significant pressure on the veins in the rectum, which can increase the risk of inflammation. Though you may want private time to read, the bathroom is not the library. As soon as you have finished moving your bowels, it is important to get off the toilet.

Get plenty of fluids. This helps soften the stool and prevent constipation. Exercise also helps prevent constipation. You should not hold in a bowel movement; go when the urge is there, or the stool can become hard, resulting in straining, constipation, and more time on the toilet.

How do I get more fiber?

Eating more fiber helps to create bulk for your bowel movements, avoiding constipation, diarrhea and undue straining.

Americans, on average, consume 16g per day of fiber (5). The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25 to 38 grams, depending on gender and age (6). I typically recommend at least 40 grams. My wife and I try to eat only foods that contain a significant amount of fiber, and we consume approximately 65 grams a day.

You may want to raise your fiber level gradually; if you do it too rapidly, be forewarned – side-effects are potentially gas and bloating for the first week or two.

I generally recommend adjusting your diet before reverting to supplementation. Fruits, vegetables, whole grains, nuts, beans and legumes all have significant amounts of fiber. Grains, beans and nuts have among the highest levels of fiber. For instance, one cup of black beans has 12g of fiber.


(1) Dis Colon Rectum. Jul-Aug 1982;25(5):454-6. (2) (3) Hepatogastroenterology 1996;43(12):1504-7. (4) Dis Colon Rectum 2004 Aug;47(8):1364-70. (5) (6) Am J Lifestyle Med. 2017 Jan-Feb; 11(1): 80–85.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit or consult your personal physician.