Haemorrhoids: home treatment and medication that help

Haemorrhoids, known to most patients as piles, are one of those conditions that people put up with for far longer than they need to.

Embarrassment keeps them out of the consulting room, and a quiet hope that things will settle on their own usually delays treatment by weeks.

In reality, most haemorrhoids respond beautifully to a simple combination of dietary changes, a short course of the right cream or suppository, and a few practical habits in the bathroom.

This guide sets out what I recommend to patients on a daily basis, what actually works, and the red flag symptoms that change the plan entirely.

What are haemorrhoids, exactly?

Haemorrhoids are swollen, engorged vascular cushions in the anal canal.

We all have these cushions from birth, as part of normal continence anatomy, and it is only when they become enlarged or prolapse outside the anus that they cause symptoms.

Internal haemorrhoids sit above the dentate line and are usually painless.

They tend to bleed bright red blood onto the paper or into the pan, or prolapse through the opening and then retract.

External haemorrhoids sit below the dentate line and are covered by pain-sensitive skin.

These are the ones that hurt, particularly when a small clot forms inside one, a condition known as a thrombosed external haemorrhoid.

The NHS piles page is a clear, reassuring resource and Patient.info offers a deeper dive. Both are worth a read if you are weighing up whether to book an appointment.

Who gets them, and why?

Anything that raises pressure in the rectal veins can tip the vascular cushions into symptomatic territory. The usual suspects are:

• Constipation and straining on the toilet.
• A low-fibre Western diet and insufficient fluid intake.
• Pregnancy, due to pelvic venous pressure and progesterone-related constipation.
• A sedentary job, long periods on the toilet reading a phone, and heavy lifting.
• Chronic cough, chronic diarrhoea and certain medications.

Piles are very common: roughly half of adults will have symptoms at some point, and rates climb after the age of 45.

Home treatment: the first two weeks

For most patients with mild to moderate symptoms, the following plan is all that is needed. I aim for visible improvement within a week and full settlement in two to three weeks. Our gastrointestinal health hub has related guidance on constipation and bowel habit, which often sit alongside haemorrhoid symptoms.

1. Soften the stool. The single most effective intervention. Aim for 25 to 30 g of dietary fibre a day from wholegrains, beans, fruit and vegetables. Drink 1.5 to 2 litres of water. A fibre supplement such as ispaghula husk, one to two sachets daily, is often the quickest way to achieve this while you adjust your diet. Lactulose 15 ml twice daily or a single nightly dose of macrogol helps short-term in pregnancy or when fibre alone is not enough.
2. Respect the urge. Do not postpone a bowel motion. The longer stool sits in the rectum, the drier and harder it becomes.
3. Five minutes on the loo, not twenty. Prolonged sitting with gravity working against you is a silent cause of recurrences. Keep the phone out of the bathroom.
4. Sit properly. A small footstool that raises the knees above the hips, bringing the bowel into a more natural anorectal angle, makes passing stool noticeably easier.
5. Clean gently. Use moist, unperfumed wipes or rinse with lukewarm water rather than scrubbing with dry paper. Pat dry.
6. Warm sitz baths. Ten to fifteen minutes in a shallow bath of warm water, two or three times a day, particularly after a bowel motion, soothes spasm and oedema beautifully. No additives needed.
7. Cold packs. For an acutely painful thrombosed pile, a cold pack wrapped in a cloth for ten minutes reduces swelling in the first 48 hours.

Medication: creams, ointments and suppositories

Over-the-counter and prescription products for haemorrhoids fall into a few groups. The British National Formulary section on anorectal preparations is the reference I use. Our anal health page gives more context on the broader category.

Anusol HC

Anusol HC combines hydrocortisone with soothing astringents such as zinc oxide and bismuth. The steroid calms inflammation quickly, the astringents shrink engorged vessels and protect the skin. Apply twice a day for up to seven days. I do not recommend longer courses of steroid-containing preparations because of the risk of skin thinning and rebound. It is the first prescription I reach for in a painful, inflamed flare.

Rectogesic

Rectogesic is a glyceryl trinitrate 0.4 percent ointment. It works by relaxing the internal anal sphincter, reducing the spasm and high resting pressure that perpetuate the problem, and improving blood flow to healing tissue. Its chief licensed use is for chronic anal fissure, but it has a role in symptomatic relief where sphincter hypertonia is a feature, often alongside haemorrhoids. Apply a small ribbon inside the anal canal twice daily. Headaches are the commonest side effect and usually ease within a few days. Our page on anal fissures explores this treatment in more depth.

Xyloproct

Xyloproct combines hydrocortisone with lidocaine, an astringent and an antiseptic. The local anaesthetic component is particularly welcome in acute painful piles because it offers near-immediate symptomatic relief. Like Anusol HC, it is a short-course product, not for long-term use.

Simple products and adjuncts

Plain zinc and castor oil ointment, witch hazel pads and petroleum jelly all have their place in mild symptoms or as a soothing addition between active treatments.

Flavonoid tablets such as diosmin and hesperidin are used in some European countries but are not a routine UK prescription.

A short course of laxatives, particularly in the first week, keeps stools soft while the tissue heals.

Pain relief

For general discomfort, paracetamol 1 g four times a day is my first choice. If additional anti-inflammatory cover is needed, naproxen 250 to 500 mg twice daily for a few days can help, with the usual food and stomach-protection considerations. I avoid codeine because constipation is exactly the problem we are trying to prevent.

When to see your GP

Book an appointment if any of the following apply:

• Bleeding that does not settle within a week, heavier bleeding, or dark rather than bright red blood mixed with the stool.
• A change in bowel habit lasting more than three weeks.
• Unexplained weight loss, a family history of bowel cancer, age over 45 with new symptoms, or abdominal pain.
• Severe pain not controlled by the measures above.
• A hard, tender, purple lump at the anal margin within the first 72 hours, as this is often a thrombosed external haemorrhoid and can be incised under local anaesthetic for rapid relief.
• Recurrent piles despite a good lifestyle and medication plan.

A careful examination, usually including a digital rectal examination and sometimes proctoscopy, takes only a few minutes and rules in or out the more serious possibilities.

Procedural and surgical options

When conservative care is not enough, several office and surgical treatments exist for internal haemorrhoids:

• Rubber band ligation. Quick, effective, performed in clinic, with mild aching for a day or two afterwards. Suitable for grade 2 and some grade 3 internal piles.
• Sclerotherapy and infrared coagulation. Older office techniques still useful in selected cases.
• Haemorrhoidal artery ligation and stapled haemorrhoidopexy. Day-case surgical options for more advanced disease.
• Conventional haemorrhoidectomy. The gold standard for severe or recurrent disease. More painful recovery, but excellent long-term outcomes.

Pregnancy, postnatal and older adults

Haemorrhoids in pregnancy are common and usually settle after delivery.

NSAIDs are avoided in the third trimester, so the mainstay is stool softening, warm baths, topical zinc-based preparations and, where needed, a short course of Anusol HC after discussion with the midwife or GP.

In older adults, always be meticulous about excluding bowel cancer before settling on a diagnosis of piles: a new symptom in later life deserves a careful look.

Prevention: keeping them away for good

1. Fibre and fluid, every day.
2. Move daily. A 30 minute walk counts.
3. Do not ignore the urge, do not linger on the loo.
4. Lift smart, split heavy loads, and avoid holding the breath during effort.
5. Treat chronic cough, diarrhoea and constipation promptly.

The bottom line

Haemorrhoids are common, uncomfortable and very treatable.

Fix the stool first, make the bathroom friendlier, use a short course of a well-chosen cream or ointment, and only involve the surgeon when conservative care has had a fair run.

Know when to ask about bleeding or weight loss rather than assume it is just piles.

The vast majority of patients I see with this problem are back to normal in a fortnight and, with a few diet and toilet habits, stay that way.

Common questions patients ask me about haemorrhoids

Is bright red blood on the paper always piles?

It very often is, but never assume.

Bright red bleeding that is clearly separate from the stool, particularly in a younger adult with painful piles and a recent episode of constipation, is usually haemorrhoidal.

Bleeding mixed into the stool, dark altered blood, a change in bowel habit, unexplained weight loss, iron deficiency anaemia or any new symptoms over the age of 45 should always prompt a proper examination and often a referral for colonoscopy.

Can I exercise with piles?

Yes, and you should. Walking, swimming and cycling are all fine.

I ask patients to go easier on heavy weight training during a flare, because the Valsalva straining under a heavy barbell puts huge pressure on the pelvic veins.

Once symptoms settle, everything can resume. Keep the core engaged but avoid breath-holding during maximal effort.

Why does sitting make it worse?

Prolonged sitting compresses the pelvic veins and raises pressure in the haemorrhoidal plexus.

A doughnut cushion, a standing desk option or simply a reminder to stand every 30 minutes helps considerably.

Long-haul flights and long car journeys are classic triggers for a first flare.

Are haemorrhoid creams safe in pregnancy?

Simple soothing preparations such as zinc and castor oil ointment, witch hazel pads and plain petroleum jelly are fine.

Steroid-containing creams such as Anusol HC should be used only briefly and after a chat with the midwife or GP.

Stool softeners, warm baths and good perianal hygiene are the mainstay during pregnancy and the postnatal period.

Should I have my piles removed to stop them coming back?

Not usually. Surgery is reserved for severe, recurrent or prolapsing piles that have not responded to conservative care. Rubber band ligation in clinic handles most problematic internal piles.

Formal haemorrhoidectomy is highly effective but the recovery is genuinely uncomfortable and reserved for the right patient.

Do spicy food or coffee cause piles?

Neither causes haemorrhoids, but both can irritate the anal canal during a flare and produce a burning sensation after bowel motions. If you notice a clear pattern, ease off during the flare and reintroduce gradually once healed.

A week by week plan for a flare

Here is the plan I typically write down for a patient arriving with a painful haemorrhoidal flare.

1. Days 1 to 3. Warm sitz baths three times a day. Ispaghula husk or macrogol to keep the stool soft. Anusol HC or Xyloproct twice a day. Paracetamol 1 g four times daily, with naproxen 500 mg twice daily for added relief if appropriate. Cold pack for ten minutes if there is an acutely tender external lump.
2. Days 4 to 7. Continue baths and softeners. Stop steroid-containing cream at day seven. Aim for 25 to 30 g of fibre and two litres of fluid daily. Re-establish a short, unhurried toilet routine.
3. Week 2. Gradually step down medication. Most symptoms should be resolved or nearly so. Maintain diet and habit changes.
4. Follow up. If bleeding persists, pain is not controlled, or symptoms recur within weeks, book a review. A proctoscopy and a conversation about banding or other procedures may be the next sensible step.

Piles respond well to a tidy plan and a bit of dignity restored to the bathroom routine. Most patients, within a fortnight, wonder why they waited so long to come and see me.