Occasionally, increased pressure on external hemorrhoids causes them to break and bleed. The bleeding causes a lump (clotted hemorrhoid) to form. A person may suffer from severe pain at the site of the clotted hemorrhoid during the first 24 to 48 hours.

A procedure to relieve the pain can be performed in a doctor's office or outpatient clinic. The doctor makes a small cut where the bleeding has occurred (excision for clotted hemorrhoid) to remove the clotting and decrease pressure and pain.

Many people who have internal hemorrhoids have bothersome symptoms and can get relief from home treatment. If medical treatment is necessary, the most widely used nonsurgical treatments are fixative procedures. These procedures are most successful if a person has small hemorrhoids.

Most experts believe rubber band ligation is the most effective nonsurgical treatment (fixative procedure) for internal hemorrhoids. It is the standard to which newer methods of treating hemorrhoids are compared.


Rubber band ligation is used more often than any other fixative procedures to treat small and medium-sized internal hemorrhoids. Rubber band ligation is more likely than other fixative procedures to make symptoms go away and to stop hemorrhoids from recurring in the long term.

Coagulation therapy causes less pain than rubber band ligation and causes fewer and less serious side effects. Coagulation therapy isn't as effective as rubber band ligation, so it may need to be repeated.

Not all doctors have the experience or the equipment to perform all types of fixative procedures. This may help you decide which procedure to choose. Ask your doctor which procedure he or she does the most and how happy people have been with the outcomes of that procedure.

See the Home Treatment section in this topic for tips on keeping hemorrhoids from getting worse or coming back after treatment.

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