Hemorrhoid Treatment Trends in the U.S. (2025): From At-Home Relief to Office Procedures

Hemorrhoids—swollen vascular cushions in the anal canal—are incredibly common in adults and often flare with constipation, pregnancy/postpartum changes, low fiber intake, prolonged sitting, and heavy straining. While many cases resolve with conservative care, 2025 is seeing clear shifts in how Americans prevent, diagnose, and treat hemorrhoids—especially toward evidence-based self-care, telehealth triage, and quick office procedures that minimize downtime.

Medical note: The information below is general education, not a substitute for personalized medical advice. Rectal bleeding requires evaluation to rule out other causes.

What’s Driving Today’s Trends

• Constipation and sedentary time: Hybrid work and screen time correlate with less movement and more delayed bathroom trips—both raise hemorrhoid risk.

• Fiber awareness boom: Consumers are embracing soluble fiber (psyllium) and hydration to normalize stool consistency (the single most effective lifestyle fix).

• Telehealth & home monitoring: Patients now start with virtual visits, photo-based triage (when appropriate), and home BP/glucose checks for safe procedure planning.

• Preference for minimally invasive care: Procedures done in minutes with local anesthesia—especially rubber band ligation (RBL)—continue to grow.

Tier 1: At-Home & Pharmacy Options (First-Line for Most)

1. Fiber therapy (Psyllium > Wheat bran):

   • Goals: 25–35 g/day total fiber, using psyllium or mixed-fiber supplements; increase slowly with water to reduce gas.

   • Why it helps: Softer, bulkier stools mean less straining, fewer flares, and better post-procedure comfort.

2. Sitz baths & hygiene:

   • Warm water soaks (10–15 min, 1–3x/day) relax the sphincter and reduce swelling.

   • Unscented wipes or water cleansing (pat dry) avoid irritation.

3. Topicals for symptom relief:

   • Witch hazel (astringent), lidocaine/pramoxine (numbing), phenylephrine (vasoconstrictor) can reduce itching/burning.

   • Low-dose hydrocortisone (≤1%) helps short term (≤7–10 days) but avoid prolonged use to prevent skin thinning.

4. Stool-softening strategy:

   • Polyethylene glycol (PEG) or docusate as needed; build routines: regular toilet time, feet on a stool to straighten the anorectal angle, and no “doom-scrolling” on the toilet (limit to ~5 minutes).

Who benefits: Internal Grade I–II hemorrhoids, postpartum patients, and external flare discomfort.
When to escalate: Ongoing bleeding, prolapse, or pain that persists beyond 1–2 weeks despite the above.

Tier 2: In-Office Procedures (Fast Relief with Minimal Downtime)

Rubber Band Ligation (RBL) — The U.S. Front-Runner

• What it treats: Symptomatic internal Grade II–III (and selected Grade I) hemorrhoids.

• How it works: A tight band strangulates the hemorrhoid; tissue sloughs off in a few days.

• Why it’s trending: High success, minutes to perform, no general anesthesia, and rapid return to activity. Newer single-use ligators and multi-band devices streamline care.

• What to expect: Pressure or cramping for 24–48 hours; fiber/fluids and short NSAID course are typical. Rare risks: delayed bleeding, infection.

Infrared Coagulation (IRC)

• Best for: Smaller internal hemorrhoids, patients desiring very quick sessions with minimal discomfort.

• Pros/cons: Easy and well-tolerated, but may require more sessions than RBL.

Sclerotherapy (Including Polidocanol Foam)

• What it is: Injection of a sclerosant to scar and shrink internal hemorrhoids.

• Why it’s rising: Useful when anticoagulation or anatomy makes RBL less ideal; foam formulations distribute more evenly.

• Considerations: Post-procedure pressure is mild; multiple sessions may be needed.

Tier 3: Surgical Pathways (For Advanced or Refractory Disease)

• Excisional Hemorrhoidectomy: Gold standard for large external or combined internal–external Grade III–IV disease; highest long-term cure rates but more postoperative pain and recovery.

• Doppler-Guided Hemorrhoidal Artery Ligation (HAL/THD) with Mucopexy: Targets arterial inflow and lifts prolapse; less pain than excision, with moderate recurrence risk.

• Stapled Hemorrhoidopexy: Once popular for prolapse but used more selectively now due to specific complication profiles.

Special Populations & 2025 Considerations

• Pregnancy & Postpartum: Emphasize fiber, fluids, PEG, sitz baths, cooling pads; short courses of low-dose topical steroids if needed; procedures usually deferred until after delivery/breastfeeding unless severe.

• Anticoagulation/Antiplatelets: Choice between IRC/sclerotherapy vs RBL depends on bleeding risk—coordinate with the prescribing clinician.

• Athletes & heavy lifters: Prevention plan centers on bowel regularity, progressive core training, and avoiding Valsalva straining.

• Telehealth follow-up: Photo-guided wound checks and symptom questionnaires shorten recovery visits.

Prevention & Recurrence Control (Save This Checklist)

• Fiber 25–35 g/day + 2–3 L/day fluids (adjust for medical conditions).

• Don’t delay the urge to defecate; establish a same-time daily routine.

• Toilet posture: Knees elevated on a small footstool; lean forward slightly.

• Limit time on the toilet to ~5 minutes; no phones.

• Move daily: Walking breaks reduce pelvic congestion.

• Manage cough/allergies and weight; review constipating meds with your clinician.

Red-Flag Symptoms (See a Clinician Promptly)

• Rectal bleeding with dark stools, dizziness, or anemia symptoms

• New or changing bleeding over age 40–45 without recent colon screening

• Severe pain (possible thrombosis, fissure, abscess)

• Fever, purulent drainage, or inability to reduce prolapse