Both infrared coagulation and rubber band ligation are office procedures that can be done without anesthesia. They both cause the hemorrhoid to gradually disintegrate after it has clotted off.

Two studies compared all of the office treatments available for hemorrhoids. One study favored infrared coagulation while the other favored rubber band ligation. The study that favored infrared coagulation found that it caused less pain than rubber band ligation; the other study found no difference in pain level between the two procedures but found a slight advantage in effectiveness for rubber band ligation. Both procedures can cause pain during the procedure and for a few to several days afterwards. The one year results for hemorrhoid relief were similar for both groups.

Both infrared coagulation and rubber band ligation are office procedures that can be done without anesthesia. They both cause the hemorrhoid to gradually disintegrate after it has clotted off.

Two studies compared all of the office treatments available for hemorrhoids. One study favored infrared coagulation while the other favored rubber band ligation. The study that favored infrared coagulation found that it caused less pain than rubber band ligation; the other study found no difference in pain level between the two procedures but found a slight advantage in effectiveness for rubber band ligation. Both procedures can cause pain during the procedure and for a few to several days afterwards. The one year results for hemorrhoid relief were similar for both groups.

Lifestyle changes have not been studied in great detail but are the first recommendations in several recent sets of guidelines. Measures that are often helpful include:

Hemorrhoidectomy is the one treatment for hemorrhoids that usually does not require repeated treatments because the recurrence rate is quite low.

However, because it is surgery, pain and other complications can occur, and almost all experts recommend trying simpler office procedures first. Only about 5 to 10 percent of people (usually those with the largest or most congested hemorrhoids) will need this type of surgery.

Similar to "traditional" hemorrhoidectomy in that it is done only in an operating room under anesthesia, except that this procedure uses staples instead of stitches to close the wounds.

It takes less time than a traditional surgical hemorrhoidectomy and recovery is easier because there is less post-operative pain. However, it is expensive and it seems to be only slightly more effective than traditional surgical hemorrhoidectomy.

Like a traditional hemorrhoidectomy, this procedure can cause complications like pain and infection, especially if the staple goes deeper into the skin than intended. This only occurs rarely.

Topical anesthetics ("numbing" creams applied to the anus) have not been well studied for effectiveness, but hemorrhoid-sufferers commonly report relief of symptoms.

These creams should not be used for more than one week because allergic rashes can occur in the area where the cream is applied.

Topical steroids (steroid creams applied to the anus) have not been well studied for effectiveness, but hemorrhoid-sufferers commonly report relief of symptoms (itching, burning, pain).

These medications should not be used for more than one week because allergic rashes can occur.

Creams generally are believed to be more effective than suppositories. Suppositories are medicines that are designed to be inserted into the rectum.

None of these preparations has been properly tested to know if they work. They are included in some recommendations. Some hemorrhoid-sufferers say that the witch hazel in Tucks pads is temporarily soothing.

Neither sitz baths nor ice have been well tested for effectiveness in treating hemorrhoids. They are generally not a "first choice" recommendation because of lack of evidence of benefit. However, neither is harmful and if they make an individual more comfortable, they can be used.

Several studies have shown that sclerotherapy does not work as well as either rubber band ligation or infrared coagulation (see above), and can have several complications. In one study, hemorrhoid symptoms came back in 30 percent of patients within 4 years.

Even though it is an office procedure, pain is fairly common as a side effect and some patients can have more severe problems such as being unable to urinate, developing temporary (or rarely permanent) impotence, or getting an infection in the area.

Some experts were enthusiastic about cryotherapy for certain type of large (internal) hemorrhoids at first but the procedure is time-consuming and does not seem to work that well. Many hemorrhoid-sufferers need more treatments and pain, as well as a bad-smelling discharge, can last for some time after the procedure.

Phlebotonics are types of drugs that are sometimes used for problems with blood circulation in the veins. There is some evidence that they may decrease bleeding from hemorrhoids but do not necessarily help with pain or with hemorrhoids "falling out" (protruding). More study is needed to evaluate whether or not they are effective.

Diosmin is used in Europe and has recently been allowed for sale in the United States as a dietary supplement. Troxerutin and calcium dobesilate are botanical products that are available at some health food stores.