An Overview of the Four Stages of Hemorrhoid Treatment

January 22nd, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Sometimes hemorrhoid symptoms are very mild. For example, you might just see a few drops of blood when wiping and not feel any discomfort at all. On the other hand, some hemorrhoid cases can be very painful and severe, even to the point of requiring surgery.

Hemorrhoid treatment can be classified into four levels, depending of the severity of the symptoms. These levels are as follows:

  • Level One: Diet and Lifestyle Modification
  • Level Two: Topical Medications
  • Level Three: Relatively Painless In-office Procedures
  • Level Four: Surgery

Treatment Level One

This first treatment level consists of simple diet and lifestyle changes. This level of treatment is for mild hemorrhoid symptoms such as bleeding or hemorrhoids that bulge out of the anus upon straining. There might also be itching, burning or soiling of undergarments.

For immediate relief, you can try a sitz bath. Sitz baths help with hygiene and symptom relief. You simply soak your buttocks and anus in about 2-3 inches of warm water for about 10-15 minutes. You can do this after bowel movements or up to 2-3 times a day. There is no need to add soap to the water, and do not scrub, just soak.

Diarrhea and constipation can lead to hemorrhoid symptoms. For this reason, we recommend plenty of fiber and fluids in the diet as well. Regular exercise also is great for preventing constipation.

Finally, sitting on the commode for long periods can increase the pressure on hemorrhoids causing them to become symptomatic. So reading on the toilet is not a good idea. If you have not moved your bowels after about 5 minutes, it is best to get off the commode and try again later.

Treatment Level Two

If hemorrhoid symptoms persist despite diet and lifestyle changes, we recommend moving up to Treatment Level Two which consists of topical medications. These remedies can bring relief to the itching and pain associated with hemorrhoids. The ingredients vary, but typically there is an anti-pain component (anesthetic) and an anti-inflammatory agent. Many alternative medications, such as Witch hazel, have been found to be effective topical treatments as well.

Treatment Level Three

This treatment level is for hemorrhoids that continue to bleed, cause discomfort or bulge out of the anus. In these cases we recommend simple in office procedures for symptoms that have not responded to Treatment Levels One and Two.

Rubber band ligation is the most common of these procedures. Here the hemorrhoids are tied off with rubber bands, and this causes their blood supply to be cut off. The hemorrhoid tissue eventually dies and falls off on its own. The procedure is curative in up to 85% of cases, and it is nearly pain free.

Some other in office procedures are injection therapy, infrared light and electrotherapy.

Treatment Level Four

In the most severe hemorrhoid cases that have not responded to any other treatment, we recommend Treatment Level Four, that is, surgery. In these cases the hemorrhoids are persistently bulging or hanging out of the anus. These surgeries require anesthesia, and they are performed in an operating room.


For every hemorrhoid problem there is a specific level of treatment. Diet and lifestyle modifications are the basic recommendations that all persons with hemorrhoids should follow. If symptoms persist, then medications, procedures or surgery can be used.

Check out The H Doctor website. There are many articles and videos that give more information about hemorrhoid treatment levels.

Take charge of your health today.


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