Natural Remedies for Hemorrhoids: Sitz Baths, Fiber, Posture
I had inflammatory bowel disease for years, and the cycles of constipation and diarrhea that came with it left me with hemorrhoids that kept returning. Mine resolved with the habits and herbs in this article, and I never needed a procedure. The tissue stays more vulnerable after repeated injury, so a few days of constipation can still bring on a mild flare. This is how I prevent them and what I reach for when one comes back.
Natural remedies for hemorrhoids with a long history of traditional use include warm sitz baths, astringent herbs such as witch hazel and raspberry leaf, more fiber and water to soften stool, and a squatting posture on the toilet to reduce straining. Mild flares usually settle in about a week with these measures. Bleeding, severe pain, or a lump that will not go back in call for a healthcare provider.
Key takeaways
- Straining and long toilet sits are the main causes, so those habits are the first thing to change.
- Fiber and water soften stool. A meta-analysis found fiber cut persistent symptoms by 47% and bleeding by 50%.
- A footstool that raises the knees reduces straining.
- Sitz baths and witch hazel are traditional first-line herbal care.
- Senna is for occasional use only and is contraindicated in pregnancy.
- Rectal bleeding needs a provider's evaluation, even when hemorrhoids seem like the obvious cause.
Why hemorrhoids happen
Evidence: strong. Straining and prolonged sitting on the toilet are the best-documented contributors.
Everyone has hemorrhoids, because they are cushions of blood vessels inside the anal canal that help with continence. They become a problem when pressure makes them swell or slip downward, and sometimes bleed. Pushing during a bowel movement and sitting on the toilet for a long stretch both raise pressure in those veins and let blood pool. Constipation, pregnancy, heavy lifting, and a job that keeps you seated all add to the load.
The single most useful change is to spend less time on the toilet and stop pushing. I leave my phone outside the bathroom, and I get up as soon as I am done rather than waiting to see if more comes.
Prevention: softer stool and better posture
Evidence: strong. A 2006 meta-analysis of seven randomized trials covering 378 patients found fiber supplementation cut persistent symptoms by 47% and bleeding by 50%.
Hard stool means pushing, and for most people two changes fix it. Drink enough water to urinate at least five times a day, and eat enough fiber to pass a soft stool every day. Psyllium husk and ground flaxseed are the fiber sources I use when meals fall short. Raise fiber over a week rather than all at once, or you trade constipation for bloating.
Posture is the other half of prevention, because humans squatted to defecate for most of our history and the anorectal angle straightens in that position, so stool passes with less effort. A footstool that lifts the knees above the hips recreates that angle on a standard toilet. A 2003 study of 28 volunteers found squatting reduced both time on the toilet and straining in every participant, and a 2019 crossover trial in 52 healthy adults found a footstool device cut the odds of straining to under a quarter of baseline. That trial was in people without hemorrhoids, so it shows the mechanism rather than a treatment effect. I use a Squatty Potty, though any sturdy stool of the right height does the same job, and I miss it every time I travel.
Sitz baths
Evidence: traditional use, widely recommended in clinical practice. A 2005 review of 36 papers found a single randomized placebo comparison and concluded the practice rests on experience rather than data.
A sitz bath is a shallow bath for the pelvic area. Fill the tub just deep enough to cover the anus in warm water, add a cup of Epsom salt, and sit for 15 minutes. Keeping the water shallow concentrates whatever you add. I brew a strong pot of raspberry leaf tea and pour it in. Raspberry leaf is astringent, which means its tannins tighten swollen tissue, and it is well tolerated by almost everyone. Do this after bowel movements during a flare and again before bed.
If a hemorrhoid has slipped outside the anus, the end of a warm bath is a good time to guide it gently back in with a clean, lubricated finger, and you should stop if this hurts. A lump that will not go back, or that turns dark and hard, needs a provider that day.
Astringent herbs: witch hazel and raspberry leaf
Evidence: traditional use. Germany's Commission E approved witch hazel leaf and bark for hemorrhoids and varicose veins, and the European HMPC lists it as a traditional remedy for the itching and burning of grade I and II hemorrhoids.
Witch hazel (Hamamelis virginiana) is the classic Western herb for this condition. Dab distilled witch hazel onto a cotton pad and hold it against the area after each bowel movement and after your bath. The tannins tighten the tissue and take the itch down within a few minutes. Choose an alcohol-free version if the alcohol stings. Raspberry leaf (Rubus idaeus) does similar work in the bath, and a cooled, strong infusion can be applied on a pad the same way.
Herbal salves and oil suppositories
Evidence: traditional use for the herbs involved, chiefly calendula, plantain, yarrow, and comfrey. No trials exist on finished products.
Oil-based suppositories infused with soothing herbs helped me most with itching. The oil lubricates while the herbs support the damaged tissue, and since they melt you will want to wear a pad. I make my own with this suppository kit (affiliate link, I earn a small commission at no cost to you).
For an external salve I like the hemorrhoid salve from Wild Carrot Herbals. It carries the same category of herbs and it works about as well for me as the standard drugstore ointment. That ointment is built on petrolatum and mineral oil, and I prefer a plant-oil base on inflamed skin.
Laxative herbs for occasional constipation
Evidence: strong for senna as a short-term laxative. Prolonged use depletes potassium and leads to dependence, and the AHPA Botanical Safety Handbook classifies senna as not for use in pregnancy.
Senna (Senna alexandrina) is an anthraquinone stimulant laxative and the active herb in Smooth Move tea. I keep a box for emergencies and travel, and I follow the package directions. Stimulant laxatives belong to occasional use, because with regular use the bowel comes to rely on them and constipation worsens once you stop. The Commission E monograph also notes that prolonged use causes electrolyte loss, particularly potassium, which matters more for anyone on diuretics or heart medication. Senna is too stimulating for pregnancy and is contraindicated during it. For daily support, psyllium or magnesium along with the water and fiber changes above do the work without those risks.
Bidets
Evidence: practical. No hemorrhoid trials exist; the benefit is less friction and cleaner skin.
Repeated wiping abrades inflamed tissue. A bidet rinses instead, which is gentler during a flare and cleaner after every bowel movement. Pat dry with a soft cloth rather than rubbing. A 2023 University of Florida study detected PFAS compounds in toilet paper sold in the Americas, Africa, and Western Europe, so using less of it removes one more daily exposure.
Red light therapy
Evidence: limited. Photobiomodulation has small trials for wound healing and post-surgical pain. Direct research on hemorrhoids is sparse.
We use a red light panel at home for other reasons, and I include the area during a flare. The mechanism is plausible, since red and near-infrared light have been studied for tissue repair and pain relief, but I would not buy a device for hemorrhoids alone. It is low risk and costs nothing once you own one.
When to see a healthcare provider
Evidence: strong. These are standard escalation criteria in colorectal care.
Most hemorrhoids settle with the measures above, but some do not, and some symptoms are not hemorrhoids at all. See a provider promptly for any of the following.
- Rectal bleeding, especially if it is dark, mixed into the stool, or new and you are over 45. Bleeding has other causes that need to be ruled out.
- A painful lump that will not go back in, or that turns dark and hard. That can be a thrombosed or strangulated hemorrhoid.
- Severe pain, fever, or symptoms that have not improved after a week of home care.
- Any change in bowel habit that lasts.
When conservative care fails, office procedures such as rubber band ligation and, for large or prolapsed hemorrhoids, surgery are established options. A colorectal specialist can explain which fits your case. Whatever route you take, keep the habits above afterward, because hemorrhoids return when straining and long toilet sits continue.
Frequently asked questions
Can hemorrhoids go away on their own?
Mild ones often do once stool softens and straining stops, and an external flare usually settles in about a week.
How long should a sitz bath be?
Sit for 15 minutes in warm, shallow water after bowel movements during a flare.
Is witch hazel safe to use on hemorrhoids?
Yes for external use, and an alcohol-free version is the better choice if the standard one stings. It is not for internal use.
Does a squatting footstool help with hemorrhoids?
It reduces straining, which is the main cause. Studies of squatting and footstool devices report less effort and shorter time on the toilet.
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