Sitz bath is a bath of plain warm water, either in the bathtub or in a special basin that can be placed on top of the toilet. Soaking in warm water for 10 minutes or so can relieve the swelling and pain of hemorrhoids, especially for prolapsed hemorrhoids.

Using soft or moist wipes

Instead of wiping with dry toilet paper, which can irritate external hemorrhoids, try using moistened wipes or rinsing with water after bowel movement. Some commercially available medicated pads also contain witch hazel, a natural astringent that can help reduce swelling and alleviate the pain.

Using over the counter analgesic creams or suppositories

Topical hemorrhoids creams (or suppositories) are basically lubricants to ease friction and irritation. Some have added ingredients of analgesics that deaden pain nerves, to give a more potent temporary relief. These analgesics include benzocaine, lidocaine, or other "-caine" derivatives. Some topical creams also contain astringents to reduce swelling.

A word of caution, some people are allergic to these analgesics and astringents, which may make their hemorrhoids condition worse.

Medicated creams, available only with prescriptions through your doctor, usually contain steroids to control inflammation.

Clot Removal

This minor surgery is usually done in an out-patient setting in your doctor's office. It is usually performed with local anasthesia on painful thrombosed hemorrhoids, where a blood clot develops in an external hemorrhoids.

In this procedure, your doctor would apply local anasthetics, cut the skin, lift out the clot, and then apply dressing to the wound. Although there may be lingering tenderness while the wound heals, the main source of pain (the clot) is gone.

Blood clots usually resolve themselves, so the choice of having them removed is largely a matter of whether or not you want to suffer the pain. Your doctor may even suggest that you leave the blood clot alone without surgery.

Rubber Band Ligation

Ligation or binding with rubber band is the medical treatment of choice for bleeding or prolapsed internal hemorrhoids. It can usually be done quickly in the doctor's office with no special preparation.

Here, the hemorrhoid is held with a forcep and rubber bands are slipped onto it, thus cutting off its blood supply. The hemorrhoids will shrivel and die in a couple of days to a week. Afterwards, the dead tissue and the rubber band will fall off with bowel movement.

For multiple hemorrhoids, the practice is to tie off only one at a time, with separate hemorrhoids treated about one month apart.

Although not usually painful (not many pain nerve endings in the anal canal), it is recommended that the patient drinks plenty of water, eat a high-fiber diet, and/or take stool softeners to ease bowel movement. Nevertheless, some people experience discomfort after the procedure.

In some rare instances, a small group of people experience clotting of an external hemorrhoids as the result of rubber banding an internal one, or have bleeding complications.

Cryosurgery

A popular method twenty years ago, cryosurgery has fallen out of favor because of the pain and possible complication involved.

Here, internal and external hemorrhoids are frozen and destroyed by a cryoprobe, which uses nitrous oxide or liquid nitrogen as freezing agents. The liquid nitrogen circulates through a system of tubes and cools the tip of the cryoprobe to freezing temperature.

The hemorrhoids can either be directly frozen or be ligated first. In either case, local anasthesia is usually used to deaden the pain.

Cryosurgery can be more painful than other medical surgeries. Furthermore, the open wound can become infected and for as long as a couple of weeks after surgery, patients can have abnormal rectal discharge or foul odor which may require the use of absorbent pads.

Sclerotherapy or Injection Therapy

In sclerotherapy, a sclerosing or hardening agent is injected into the base of a smaller bleeding internal hemorrhoids to cut blood circulation to the rest of the veins. It is often the preferred method of treatment for older patients, whose veins are more fragile.

The sclerosing agent is basically a scar-producing chemical solution that causes hemorrhoids to shrivel up.

In contrast to rubber banding, sclerotherapy can be applied to multiple areas at once. However, it is not as effective as rubber band ligation on larger hemorrhoids. Also, in very rare situation, sclerosed hemorrhoids can develop abscesses or other complications.

Infrared and BICAP Coagulations

In these procedures, infrared light and electric current are used to cauterize or burn off smaller hemorrhoids. However, because they are new and some patients feel pain due to the heat involved, these coagulation procedures are not yet popular.

Hemorrhoidectomy

A true surgical procedure, hemorrhoidectomy is usually reserved for severe cases of hemorrhoids. It is recommended for an internal hemorrhoid that is unusually large and troublesome, or for an external one that is large, very painful, or causes severe itching.

Surgical hemorrhoidectomy can be done by using scalpels or lasers. It requires anasthetic and hospitalization. Here, surgeons cut off the hemorrhoids and close the cut with stitches. Usually, a small anal pad is placed on the anus to absorb drainage. Post-surgery recovery period usually last three to ten days in the hospital and one to four weeks at home.

Although rare, complications from hemorrhoidectomy can include severe pain, inability to defecate, heavy bleeding, narrowing of the anal canal (called stricture), cleaving of the anal canal (called fissure formation), and scarring. If improperly done, surgeries can destroy essential nerve endings, which leave patients with the inability to tell flatulence apart from the urge to eliminate.

Because of these considerations and the availability of other forms of treatments, including the use of traditional herbs outlined below, only a very small percentage of hemorrhoids ( less than 1%) are actually treated by surgery.

Japanese Pagoda Tree (Sophora japonica)

Natural extracts of the Japanese pagoda tree has been shown to be effective in the strengthening of vein walls, normalization of the permeability of veins and capillaries, and maintenance of good vein health.

Clinical studies on purified Japanese pagoda tree extracts have shown that a significant majority of people taking it experience relief from the pain, itching, and discomfort of hemorrhoids.

In these studies, 96% of men and women with mild to severe cases of hemorrhoids had relief from bleeding, 88% had a significant reduction of remitted discharge, 95% had relief from inflammation, and 90% had relief from itching. Overall, 94% of subjects taking Japanese pagoda tree extracts were symptom-free or had significantly better hemorrhoids condition compared to ony 23% of those taking placebo.

Horse Chestnut (Aesculus hippocastanum)

Butcher's broom (Ruscus aculeatus)

Butcher's broom is an evergreen bush with stiff spine, which makes it a popular choice for making brooms (hence it's name). Closely related to asparagus, this herb has also been used as a vegetable.

Ruscogenins from the extract of the root of butcher's broom were shown to have natural vasoconstrictor properties or the ability to narrow blood vessels. Moreoever, butcher's broom also strengthens and tones veins, as well as lessens inflammation and swelling.