What to do about symptomatic hemorrhoids

For LeBrett, prevention and lifestyle changes remain the first step. Adjusting diet and daily habits to prevent constipation and keep stools soft can go a long way toward avoiding hemorrhoids. “Common interventions to help achieve this include eating a fiber-rich diet (guidelines recommend 25-30 g of fiber per day, and most Americans do not meet this goal), staying well hydrated, taking a fiber supplement such as psyllium, and, if needed, using a stool softener or an over-the-counter laxative,” says LeBrett. She also suggests using a household stool like a Squatty Potty, which elevates the legs and helps straighten the rectum to make bowel movements easier.

Fong also stresses conservative care, including more fiber, more water, regular movement, and less straining or prolonged sitting. If symptoms are already present, a topical ointment that addresses itching, bleeding, and swelling may be worth trying. “If that doesn't help, colorectal surgeons know about eight different ways to treat hemorrhoids, ranging from less invasive banding (ligation), injection, or infrared coagulation (IRC), to more invasive options like laser, transanal hemorrhoidal dearterialization (THD), and finally, excision. Most people do not need excision,” says Fong.

LeBrett also advises cutting back on electronics use in the bathroom so you do not stay there longer than necessary.

How has hemorrhoid care changed over time?

Although packaging and branding may look newer, LeBrett says the underlying medicine has not changed much. “The ingredients that work, like protectants, lidocaine for pain and itch, phenylephrine to temporarily shrink swelling, and witch hazel, have decades of safety data behind them and are regulated by the FDA. Fiber, water, and better bathroom habits are still the foundation,” LeBrett explains.

What has changed is how these treatments are presented and discussed. “For decades, the hemorrhoid aisle was a wall of identical yellow boxes, so patients grabbed whatever was on the bottom shelf, used it awkwardly, and never asked questions,” LeBrett recalls. Today, packaging is designed to help people choose, with clearer names and plain-language guidance on what each product is for and when to use it.

For more advanced symptomatic hemorrhoids, Fong says the gold standard for most surgeons is full excision of all three hemorrhoidal columns. The drawback, she says, is that the procedure is painful and can leave significant cosmetic and functional scarring. “We have evolved from more radical surgery to less invasive procedures. We now also understand hemorrhoid anatomy and physiology better, and the pelvic floor, so we can use topical compounds that treat the root of the problem, rather than just putting a band-aid on it,” says Fong.

Formats have also become more tailored. As LeBrett points out, there are wipes and sprays for people who do not want to use creams, plus portable options for travel, work, or life with a new baby. “There’s also far more accessible education, so people understand what they’re treating and when to see a doctor. Where that last part matters: rectal bleeding or pain that doesn’t improve should always be evaluated, not self-treated indefinitely,” says LeBrett.

How have newer brands changed hemorrhoid treatment?

LeBrett says hemorrhoid creams used to ignore the sensory side of care. They were greasy, medicinal, and made only to provide relief for a few hours. Newer brands like Norms, she says, have improved on traditional products by keeping the same proven ingredients while thinking more carefully about how people actually find and use care. “That matters, because what I see with patients is that it’s really overwhelming. They need a roadmap for what to use, when, and how to use it. Traditional hemorrhoid products have never given them one, and the category has historically been built by men, for men, even though pregnant and postpartum women are some of the people who need care most,” says LeBrett. She adds that treatment labels are confusing, the options look alike, and the product formats have barely changed in decades.

For a brand like Bummed, co-founder and CEO Jennifer Dwork says the aim is to offer a more effective solution than what is available over the counter. Because OTC products mainly relieve symptoms and do not heal the underlying issue, Bummed created compounded prescription creams that were once available only through a specialist such as a gastroenterologist or colorectal surgeon. “We’ve made them accessible to everyone across the U.S., as long as a medical provider on our site deems them appropriate,” says Dwork. The Bummed medications include prescription ingredients such as diltiazem, which is clinically proven to heal up to 91% of fissures. They also contain multiple active ingredients, including lidocaine and bupivacaine for pain relief, hydrocortisone to reduce swelling and irritation, and metronidazole to treat infection. “We also have formulations with nitroglycerin and nifedipine, depending on what your symptoms and medical history are. These are well-researched prescriptions that are effective and generally very safe, and we’re so happy we can make them more accessible to folks who otherwise wouldn’t be able to go and see a specialist,” Dwork says.

LeBrett adds that access is another major difference among newer brands. Depending on where you shop, she says some newer models require extra steps before relief is available. “Part of the problem has always been too many barriers to treatment, and every extra step is one more reason to put it off. Norms meets people where they are. It uses the same proven, FDA-regulated ingredients patients have relied on for decades, at maximum strength, with clear packaging that tells you what each product is for,” says LeBrett. And although someone may want immediate relief, Norms is also sampled in doctors’ offices. As LeBrett notes, that means patients who are too embarrassed to ask questions can still leave with relief in hand.

Why is there more interest in butt care now?

Consumer awareness has grown. “Patients now ask me about ingredients the same way they ask their dermatologist. People have started giving the rest of their body the care they used to save for their face, and that’s finally reaching the parts nobody used to talk about,” LeBrett shares. She compares hemorrhoid treatment with skin care, noting that perianal skin is thin and sensitive, much like the skin under the eyes or on the lips.

And pain is hard to ignore. “I think that people are finally realizing that your face can be completely made up and you can dress really well, but if your butt hurts, you are completely miserable, so I am so excited that self-care is finally extending to butt care,” says Fong.

The mini-product trend in beauty has also reached hemorrhoid care. LeBrett says that along with full-size tubes, Norms recently introduced Squeezies, single-use sachets that can be carried anywhere. “That’s practical, because flare-ups don’t wait until you’re home. It’s also fun, and that matters more than it sounds. A product you’re happy to carry is a product you’ll actually use when you need it,” says LeBrett.