To relieve mild to moderate symptoms, we recommend instituting a high fiber diet, using a fiber supplement, and drinking more fluids.  We recommend between 25 and 30 grams of fiber per day between your diet and a fiber supplement.  Over-the-counter products have not showed any immediate or long-term benefit to hemorrhoids despite their regular use and availability. 

Most hemorrhoid flare-ups are mild and typically resolve within 2-3 days.  Issues lasting for days or weeks at a time require further evaluation.  Other potential etiologies of your symptoms may include anal fissures, thrombosed hemorrhoids, perianal or perirectal abscesses, pilonidal disease, colorectal cancer and inflammatory bowel disease.  Sometimes an office examination is all that is needed.  Occasionally a colonoscopy or an exam under anesthesia is better suited to confirm the diagnosis.

Mild internal hemorrhoids can be treated with internal hemorrhoid banding.  This is when tight rubber bands are placed around the base of the internal hemorrhoid cutting off its blood supply causing it to fall off. Most times this is done while undergoing a diagnostic procedure with sedation such as a colonoscopy.  Tissue residing on the outside consistent with external hemorrhoids would require excision.  Occasionally these present with a firm lump more on the outside.  These are caused from clotting of the underlying blood vessels.  These will eventually subside, but you may have quicker return to normal if the diseased tissue is resected and the incision is closed. 

More severe hemorrhoid disease of both internal and external requires a hemorrhoidectomy involving excision of the pathologic tissue in columns extending inside and outside the anus.  A hemorrhoidectomy is typically a painful procedure and is done only for significantly diseased hemorrhoids.