Haemorrhoids, or haemorrhoidal disease, do not always require a procedure. In many patients, the first stage of treatment is conservative management: stool regulation, diet, hydration, reducing straining, changing toilet habits, topical treatment and, in selected patients, pelvic floor physiotherapy. Banding, laser treatment or surgery is considered when symptoms are significant, recurrent or do not improve despite properly conducted non-procedural treatment.
This article explains when haemorrhoids can be treated conservatively, when pelvic floor physiotherapy may be worth considering, and when procedural treatment may be needed. If you have rectal bleeding, itching, pain, a lump, prolapsing haemorrhoids or symptoms that keep returning despite treatment, book a proctology consultation in Gdańsk.
Author: Dr Kamil Smok, surgeon and proctologist | Medical review: Justyna Szul, MD, proctologist | Status: Draft — medical review required | Publication date: 29.06.2026 | Last updated: 29.06.2026
What exactly are haemorrhoids?
Haemorrhoids, more precisely haemorrhoidal cushions, are physiological vascular structures in the anal canal. They help maintain anal continence and are present in every person. A problem begins when they become enlarged, irritated, inflamed, bleed or prolapse.
The most common symptoms of haemorrhoidal disease include:
- bright red rectal bleeding, usually during bowel movements,
- itching and burning around the anus,
- discomfort or a feeling of moisture,
- a feeling of a lump or prolapsing tissue,
- soiling of underwear or discharge,
- a feeling of incomplete evacuation,
- pain, especially when thrombosis, fissure or inflammation is also present.
If the main symptom is blood on toilet paper or in the toilet, read also: rectal bleeding — when does it require diagnostics?
Key point: not every patient with haemorrhoids needs a procedure
A diagnosis of haemorrhoids does not automatically mean banding, laser treatment or surgery. In many patients, symptoms can be reduced or calmed down with well-conducted conservative treatment. This applies especially to early stages of the disease, mild symptoms and situations where the main problem is constipation, straining, diarrhoea or incorrect toilet habits.
Conservative treatment is not “inferior treatment”. It is often the foundation of therapy. Even when a procedure is needed, conservative management remains important because it may reduce recurrence risk. If after a procedure the patient still spends a long time on the toilet, strains strongly, has hard stools and does not manage constipation, symptoms may return.
“Not every patient with haemorrhoids needs banding, laser or surgery. Sometimes the most important step is to find out why the patient strains, has constipation or constantly irritates the anal area. Without working on the cause, procedures alone may not provide a durable effect.”
— Dr Kamil Smok, surgeon and proctologist
Grades of haemorrhoids
Internal haemorrhoids are often described in four grades. This classification helps guide treatment, but it is not the only factor in decision-making. Symptoms, bleeding, pain, recurrence, lifestyle, constipation, diarrhoea, comorbidities and examination findings also matter.
- Grade I — haemorrhoids do not prolapse outside; they may cause bleeding, itching or discomfort.
- Grade II — haemorrhoids prolapse during bowel movements but reduce spontaneously.
- Grade III — haemorrhoids prolapse and require manual reduction.
- Grade IV — haemorrhoids remain permanently outside and cannot be effectively reduced.
In simple terms: the earlier the grade and the milder the symptoms, the greater the chance that conservative treatment will be sufficient. The more significant the prolapse, recurrence and persistent symptoms, the more often procedural treatment is considered.
When is conservative treatment enough?
Conservative treatment is particularly important in grade I and II disease, with mild or moderate symptoms and when symptoms worsen mainly with constipation, long toilet sitting, diarrhoea or strong straining. It may also be used before a procedure or as maintenance treatment after a procedure.
Non-procedural treatment may be considered when:
- bleeding is mild and occurs mainly during bowel movements,
- there is no fixed prolapse of haemorrhoids,
- symptoms are periodic rather than constant,
- the main problem is constipation, hard stool or straining,
- symptoms appeared recently,
- there has not yet been a consistent attempt at diet, hydration and habit change,
- proctological examination does not show lesions requiring urgent intervention.
Important: conservative treatment should be selected after examination. Not every rectal bleeding is caused by haemorrhoids, so before treating the problem “on your own”, proctological diagnostics are worth considering.
Conservative treatment of haemorrhoids — what really matters?
| Treatment element | Goal | Why it matters |
|---|---|---|
| Fibre | softening and forming stool | reduces straining and irritation of haemorrhoidal cushions |
| Hydration | easier stool passage | fibre without enough fluids may worsen bloating or constipation |
| Shorter toilet time | reducing congestion and straining | long sitting may worsen symptoms |
| Constipation management | regular, soft stool | hard stool and straining are common recurrence factors |
| Topical treatment | reducing itching, burning and irritation | helps symptomatically, but does not always remove the cause |
| Pelvic floor physiotherapy | improving defecation mechanics and reducing abnormal straining | especially important when tension, dyssynergia or chronic constipation are present |
Diet, fibre and hydration — the foundation of non-procedural treatment
One of the main goals of conservative treatment is to achieve soft, regular stools without strong straining. In practice, this means increasing fibre intake, maintaining hydration and gradually changing eating habits.
Helpful measures may include:
- vegetables, fruit, legumes and wholegrain products,
- gradually increasing fibre to reduce bloating,
- drinking water regularly, especially when increasing fibre intake,
- limiting products that worsen constipation in a given patient,
- if needed, fibre supplements such as psyllium after discussing this with a doctor.
The goal is not an “ideal diet”, but stool that does not require long sitting or strong straining. This is often one of the most important parts of conservative treatment.
Toilet habits — small changes, significant impact
In many patients, haemorrhoid symptoms worsen not only because of stool consistency, but also because of how bowel movements happen. Long sitting on the toilet, using a phone, straining “just in case” and trying to pass stool without a natural urge may increase congestion around the anus.
In conservative treatment, it is worth focusing on:
- avoiding long sitting on the toilet,
- not using a phone during bowel movements,
- not forcing stool by straining,
- responding to the natural urge to pass stool rather than postponing it,
- using a position with the feet slightly raised, which may make defecation easier in some patients,
- calm breathing and relaxation of the abdomen and pelvic floor during bowel movements.
This is especially important in people who feel they “must push hard” or that something remains after bowel movement.
Pelvic floor physiotherapy — when can it help with haemorrhoids?
Pelvic floor physiotherapy is not a method of “removing haemorrhoids”. It may, however, be an important part of conservative treatment in patients whose haemorrhoid symptoms are driven by chronic constipation, abnormal straining, excessive pelvic floor tension or dyssynergic defecation.
Dyssynergic defecation means that during an attempt to pass stool, the muscles do not coordinate properly — instead of relaxing, they may tighten. The patient may feel blocked, incompletely emptied, forced to strain strongly or spend a very long time on the toilet.
Physiotherapy may include:
- learning the correct position and mechanics of defecation,
- working with breathing and intra-abdominal pressure,
- learning pelvic floor relaxation,
- biofeedback, if indicated and available,
- working with muscle tension within the pelvis,
- education about straining, constipation and bowel rhythm.
Physiotherapy is especially worth considering when the patient:
- has chronic constipation despite diet and hydration,
- strains strongly during bowel movements,
- spends a long time on the toilet,
- has a feeling of incomplete evacuation,
- has recurrent symptoms despite topical treatment,
- has coexisting pelvic floor pain, tension or difficulty relaxing,
- quickly returns to the same symptoms after proctological procedures.
In such situations, banding or laser alone may not solve the problem if the patient continues to overload the anal area every day through abnormal straining. That is why, in selected patients, physiotherapy may be an important part of recurrence prevention.
“Sometimes a patient asks about banding, but in the examination and medical history we see that the main problem is constipation, spending many minutes on the toilet and straining. In that case, treatment should address not only the haemorrhoids, but also the mechanics of defecation.”
— Justyna Szul, MD, proctologist
Medicines, ointments and suppositories — when do they make sense?
Topical preparations may be helpful for short-term relief of symptoms such as itching, burning, swelling or irritation. They may improve comfort, but usually do not solve the problem if the cause is chronic straining, constipation, diarrhoea or advanced prolapse of haemorrhoids.
In practice, topical medicines should be treated as symptomatic therapy, not the only treatment. If a patient uses one ointment or suppository after another for weeks, and bleeding or prolapse returns, diagnostics and a change in strategy are needed.
Long-term use of steroid-containing preparations should not be continued without medical supervision. Treatment should be matched to the diagnosis.
When is a procedure needed?
Procedural treatment is needed when conservative treatment is not enough, symptoms are significant or the disease is more advanced. This does not mean that every patient should immediately undergo a procedure. The decision should be based on examination, haemorrhoid grade, symptoms and the impact on everyday life.
A procedure may be considered when:
- bleeding recurs despite conservative treatment,
- haemorrhoids prolapse and cause discomfort,
- manual reduction of haemorrhoids is needed,
- itching, burning or discharge persist despite treatment,
- symptoms significantly reduce quality of life,
- flare-ups are frequent,
- examination shows haemorrhoids suitable for procedural treatment,
- the patient has undergone a consistent trial of conservative treatment but improvement is insufficient.
One of the acute problems that often worries patients is a painful lump near the anus. This may be perianal thrombosis, a condition that requires separate assessment.
What procedural treatment methods are available?
The method is chosen by the doctor after examination. Haemorrhoid grade, dominant symptoms, size of the cushions, prolapse, previous treatment and patient preferences all matter.
Minimally invasive methods
In many patients with grade II–III internal haemorrhoids, office-based or minimally invasive methods may be considered, such as:
- banding, or the Barron method,
- sclerotherapy,
- coagulation or other vessel-closing methods,
- laser treatment in properly qualified patients.
Not every method is suitable for every patient. Sometimes conservative treatment is the better choice, sometimes banding, sometimes laser, and sometimes surgery. Examination and qualification decide.
Surgical treatment
Surgery may be needed in more advanced disease, significant prolapse, persistent symptoms, external lesions or when minimally invasive methods are insufficient. Surgery is not the first choice for every patient with haemorrhoids.
Conservative treatment or procedure — how to think about the decision?
| Situation | Conservative treatment is more often enough | A procedure is more often considered |
|---|---|---|
| Haemorrhoid grade | grade I–II, mild symptoms | grade III–IV, prolapse, recurrence |
| Main problem | constipation, straining, itching, periodic bleeding | fixed prolapse, frequent bleeding, lack of improvement |
| Response to treatment | improvement after diet, fibre, habit change and topical treatment | no improvement despite consistent treatment |
| Defecation mechanics | constipation, tension and abnormal straining play a major role — consider physiotherapy | a procedure may be needed, but without correcting straining, recurrence is more likely |
| Alarm symptoms | no alarm symptoms after medical assessment | diagnostics first, not an automatic “haemorrhoid procedure” |
Does every haemorrhoid need surgery?
No. Many patients can be managed without surgery. In some people, conservative treatment is enough; others need office-based methods, and some need surgery. The key is to match treatment to the individual patient, not to the word “haemorrhoids” alone.
It is also worth avoiding the simplistic approach of “nothing or a procedure”. Between these extremes there is a large space for conservative treatment, education, physiotherapy, stool regulation and minimally invasive methods.
When should you not wait?
It is worth seeing a proctologist if symptoms are new, recurrent or worsening. In particular, consultation should not be postponed when bleeding or a painful lump appears.
Book a visit if:
- rectal bleeding recurs,
- you see blood on toilet paper, stool or in the toilet,
- severe pain appears,
- you feel a lump near the anus,
- haemorrhoids prolapse,
- symptoms persist despite treatment,
- you have a feeling of incomplete evacuation,
- the problem returns after ointments, suppositories or previous procedures.
More urgent assessment is needed in case of heavy bleeding, black stool, anaemia, weight loss, fever, purulent discharge, rapidly increasing pain, a rapidly growing lump or rapid deterioration of general condition.
For anal lumps, read also: a lump near the anus — what can it mean?
Diagnostics — the first step in choosing treatment
Before treatment is chosen, diagnostics are needed. Haemorrhoid symptoms may resemble other anal conditions, so patients should not be qualified for banding, laser or surgery based only on a symptom description.
During consultation, the doctor may perform:
- medical history,
- inspection of the anal area,
- digital rectal examination, if indicated and possible,
- anoscopy,
- assessment of haemorrhoid grade,
- discussion of conservative treatment, procedural treatment or further diagnostics.
Anoscopy allows the doctor to assess the anal canal and helps determine whether symptoms really come from haemorrhoids or whether another approach is needed.
Who can you see at Wyspa Medycyny Przyjaznej?
At Wyspa Medycyny Przyjaznej in Gdańsk, proctology consultations are provided by doctors dealing with diagnosis and treatment of anal and rectal diseases. A patient with haemorrhoid symptoms, bleeding, pain, a lump, itching, burning or prolapse can book a visit with:
- Sara Godyńska, MD, proctologist,
- Justyna Szul, MD, proctologist,
- Dr Kamil Smok, surgeon and proctologist.
The aim of the visit is not automatic qualification for a procedure, but identifying the cause of symptoms and choosing treatment: conservative, physiotherapeutic, procedural or combined.
Booking:
Book a proctology consultation
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Frequently asked questions
Can haemorrhoids be treated without surgery?
Yes, in many patients, especially in early stages, improvement may be achieved with conservative treatment: stool regulation, fibre, hydration, toilet habit changes, topical treatment and sometimes pelvic floor physiotherapy.
When is a haemorrhoid procedure needed?
A procedure is considered when symptoms persist despite conservative treatment, haemorrhoids prolapse, bleeding recurs or the disease significantly affects quality of life. The decision is made by the doctor after examination.
Can physiotherapy help with haemorrhoids?
Physiotherapy does not remove haemorrhoids, but in selected patients it may help reduce factors that worsen the condition, such as abnormal straining, chronic constipation, pelvic floor tension or dyssynergic defecation.
Is banding always needed?
No. Banding is one method for treating internal haemorrhoids, but not every patient needs it. In some people conservative treatment is enough, while others may benefit from another method.
Is laser treatment for haemorrhoids suitable for everyone?
No. Laser treatment requires qualification. The decision depends on disease grade, symptoms, anatomy, previous treatment and patient expectations.
Can haemorrhoids come back?
They may recur, especially if risk factors continue: constipation, straining, long toilet sitting, diarrhoea, obesity or abnormal defecation mechanics.
Where should haemorrhoid treatment begin?
It should begin with a proctology consultation and examination, often including anoscopy. Only after diagnosis can the doctor decide whether conservative treatment is enough or a procedure is needed.
Haemorrhoids do not always require a procedure
Start with diagnostics. A proctologist will assess whether conservative treatment, physiotherapy and habit changes are enough, or whether a procedural method is needed.
Book a proctology consultation →Summary
Haemorrhoids can be treated in different ways. In early stages, the foundation is often conservative treatment: diet, fibre, hydration, stool regulation, toilet habit changes, topical treatment and — in selected patients — pelvic floor physiotherapy. Not every situation needs to end with banding, laser or surgery.
A procedure is needed when symptoms are significant, recurrent, haemorrhoids prolapse or conservative treatment does not provide enough improvement. Even then, it is worth remembering that without correcting constipation, straining and lifestyle factors, the problem may return.
If you have haemorrhoid symptoms, book a proctology consultation in Gdańsk. The goal of the visit is to match treatment to your situation — not to automatically refer you for a procedure.
Read also
- Proctologist Gdańsk — proctology hub
- Haemorrhoid treatment in Gdańsk
- Can haemorrhoids go away on their own? Facts and myths
- Haemorrhoid banding — Barron method
- Laser or haemorrhoid banding?
- Rectal bleeding — diagnostics
- A lump near the anus — causes
- Perianal thrombosis — symptoms and treatment
- Anal pain when sitting — causes
Sources and medical context:
- American Society of Colon and Rectal Surgeons — Management of Hemorrhoids, 2024
- NIDDK — Treatment of Hemorrhoids
- NIDDK — Eating, Diet & Nutrition for Hemorrhoids
- Cleveland Clinic — Hemorrhoids: Symptoms, Diagnosis, Treatment
- Cleveland Clinic — Hemorrhoid Banding
- Rao SSC — Diagnosis and Treatment of Dyssynergic Defecation
- Wyspa Medycyny Przyjaznej — proctology consultation in Gdańsk
This article is for informational purposes only and does not replace medical consultation. Rectal bleeding, severe pain, a lump, black stool, anaemia, weight loss, fever, purulent discharge or rapid deterioration of general condition require individual medical assessment. Draft version — medical review required before publication.