External Hemorrhoids: Treatment and How Long They Last

What is an external hemorrhoid?

Hemorrhoids are cushions of blood vessels, connective tissue, and muscle that normally sit in the lower rectum and around the anal opening. When they swell, stretch, or become inflamed, they cause symptoms. External hemorrhoids develop outside the anal sphincter, beneath the skin. They can feel like a tender lump or swelling around the anus and may cause itching, pain, or discomfort — especially with sitting or during bowel movements 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2023).Treatment of Hemorrhoids.At-home treatment options for external hemorrhoids including warm soaks, over-the-counter topical preparations, fiber supplementation, and hydrocortisone duration limits; office and surgical procedures.

A thrombosed external hemorrhoid occurs when a blood clot forms inside the swollen vessel, causing sudden, often severe pain. The clot is typically most painful in the first 24 to 72 hours and then gradually resolves as the body reabsorbs it.

Why do external hemorrhoids form?

The most common contributing factors include straining during bowel movements, chronic constipation, prolonged sitting on the toilet, low-fiber diet, dehydration, and pregnancy 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2023).Treatment of Hemorrhoids.At-home treatment options for external hemorrhoids including warm soaks, over-the-counter topical preparations, fiber supplementation, and hydrocortisone duration limits; office and surgical procedures. Straining raises pressure in the anal blood vessels, which can cause them to enlarge and push outward. External hemorrhoids tend to develop from repeated or sustained straining episodes, making lifestyle modification a central part of prevention and treatment.

What at-home treatments actually help?

Consistent at-home care relieves most external hemorrhoids 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate:

Sitz baths Soaking the affected area in warm (not hot) water for 10–15 minutes, two to three times daily, is one of the most effective ways to reduce swelling, ease spasm, and relieve pain. A sitz bath basin that fits over a toilet seat works well. Plain warm water is sufficient — no salts or soaps needed.

High-fiber diet and adequate fluids Increasing dietary fiber softens stool and reduces straining — the primary mechanical driver of hemorrhoids. The target for most adults is 25 to 38 grams of fiber per day, though many Americans fall well short. Fiber supplements (psyllium husk, methylcellulose) are helpful if dietary changes alone are insufficient. Drink at least 6 to 8 glasses of water daily to help fiber work effectively 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate.

Over-the-counter topical preparations Creams and ointments containing witch hazel, hydrocortisone, or pramoxine can temporarily relieve itching and discomfort. These do not reduce the hemorrhoid itself but help manage symptoms while it resolves. Low-strength hydrocortisone products should not be used for more than 7 to 10 days without medical guidance 3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2023).Treatment of Hemorrhoids.At-home treatment options for external hemorrhoids including warm soaks, over-the-counter topical preparations, fiber supplementation, and hydrocortisone duration limits; office and surgical procedures.

Bowel habit modifications - Do not strain during bowel movements - Do not sit on the toilet longer than needed - Respond promptly to the urge to defecate; delaying can lead to harder stool and more straining

How long does an external hemorrhoid last?

With consistent at-home care, most uncomplicated external hemorrhoids improve noticeably within one to two weeks 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate. A thrombosed hemorrhoid is more painful and takes longer. The clot is often most painful in the first 24 to 72 hours; the body gradually reabsorbs it over two to four weeks. If a thrombosed hemorrhoid is extremely painful and is seen within the first 72 hours, a clinician can perform a simple incision and evacuation of the clot in an office setting, which typically provides rapid pain relief 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate.

When should you see a clinician?

Visit a primary care clinician or gastroenterologist if 2Ref 2Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK (2021).ACG Clinical Guidelines: Colorectal Cancer Screening 2021.Context for recommending colorectal cancer screening evaluation in adults with rectal bleeding, especially starting at age 45:

• Bleeding is more than spotting on toilet paper — especially bright red blood in the bowl
• Pain is severe and does not improve with at-home measures after a few days
• The hemorrhoid is large, hard, or you are concerned about a thrombosed clot
• Symptoms persist beyond two to three weeks despite appropriate self-care
• You are 45 or older and have not had a colorectal cancer screening (rectal bleeding always warrants evaluation to rule out other causes)

For large hemorrhoids that do not respond to conservative care, office-based procedures are available — including rubber band ligation (most common for internal hemorrhoids) — and surgical hemorrhoidectomy for severe or refractory cases 1Ref 1Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021).ACG Clinical Guidelines: Management of Benign Anorectal Disorders.Evidence-based guidance on conservative management of hemorrhoids including sitz baths, dietary fiber, timing of thrombosed hemorrhoid excision, and when office procedures or surgery are appropriate3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2023).Treatment of Hemorrhoids.At-home treatment options for external hemorrhoids including warm soaks, over-the-counter topical preparations, fiber supplementation, and hydrocortisone duration limits; office and surgical procedures.