Acute haemorrhoids: treatment and what to do in the first 48 hours

2026-10-17

• Sudden pain, swelling and a lump at the anus call for calm but prompt action.
• In the first days, rest without long sitting, brief cold through a cloth and warm sitz baths can help.
• The main goal is soft stools without straining: water, fibre and short visits to the toilet.
• Use ointments, suppositories and painkillers on a doctor's or pharmacist's advice; never pierce or burn a lump.
• Heavy bleeding, fever or a dark lump that won't go back in means calling 103.

Yesterday it was bearable, but today every movement hurts: you can't sit down, there is a firm, painful lump at the edge of your back passage, and there is blood on the paper after the toilet. A flare-up like this often follows a long drive, heavy physical work, a festive feast or several days of constipation. It often happens in summer too, when the body loses a lot of fluid in the heat and stools become harder.

Acute haemorrhoids are frightening, but in most cases you can cope with them if you act sensibly and see a doctor in good time. Below is a clear plan for the first 48 hours: what to do at home, what to avoid and when you need help immediately.

What are acute haemorrhoids and how do you recognise them?

Haemorrhoids are normal cushions of blood vessels in the anal canal. During a flare-up they suddenly become engorged with blood, swollen and inflamed. This can show itself in different ways:

• a thrombosed external haemorrhoid, a firm, painful, bluish-purple lump that appears suddenly at the edge of the anus;
• prolapsed, swollen internal haemorrhoids that come out, hurt and are difficult to push back;
• bleeding, with bright red blood on the paper, in drops or a thin stream at the end of a bowel movement;
• itching, burning, or a feeling of fullness or of something being there.

Similar symptoms can be caused by an anal fissure, an abscess (a collection of pus) and other conditions, so the diagnosis must be made by a proctologist. You can read about the different types in our article on internal and external haemorrhoids.

When can't you wait, and when do you need urgent help?

If none of these apply, you can start with home measures, but book an appointment with a proctologist within the next few days. With a thrombosed external haemorrhoid, a doctor may offer a minor procedure in the first few days that quickly eases the pain, which is another reason not to delay.

What should you do in the first 48 hours?

While you wait for your appointment, these steps can help reduce pain and swelling:

1. Cold. Many people find that a cold compress wrapped in cloth, applied for 5–10 minutes several times a day, helps in the first hours. Never put ice directly on the skin.
2. Warm sitz baths. Sit in clean, warm but not hot water for 10–15 minutes several times a day and after each bowel movement. Evidence for their benefit is limited, but many people find they ease pain and spasm.
3. Soft stools. Drink enough water and eat vegetables, pumpkin, porridge and prunes; if your doctor has recommended a stool softener, take it as directed.
4. Short toilet visits. Don't strain, don't sit for long and don't take your phone in. If nothing happens within a couple of minutes, get up and try later.
5. Gentle hygiene. After every bowel movement, wash with cool or warm water and pat the skin dry with a soft towel, without rubbing or scented wipes.
6. Less sitting. Don't sit for hours: lying on your side is better, and at work stand up every 30–40 minutes. A soft cushion on your chair reduces pressure.
7. No heavy lifting. For these few days, avoid lifting heavy things, intense workouts and cycling.

What should you eat and drink during a flare-up?

The aim is soft stools that pass without effort. Drink water steadily throughout the day, especially in hot weather. Vegetable soups, mashkhurda, porridge, baked pumpkin, yoghurt and kefir, fruit and prunes are all good choices. Many people notice that spicy seasonings and alcohol make burning and discomfort worse; firm evidence is scarce, but it makes sense to cut back on them during a flare-up. You will find more about diet and bowel habits in our article on constipation and haemorrhoids.

Ointments, suppositories and tablets: what can you take?

Topical products such as ointments, creams and suppositories, as well as painkillers, can bring relief, but it is best to choose them with a doctor or pharmacist: some have contraindications, and steroid ointments should not be used for long. We have described ways to ease the pain in our article on pain relief for haemorrhoids.

The indications of the over-the-counter medicine Phlebodia 600 (diosmin 600 mg) include symptomatic treatment of acute haemorrhoids: according to the instruction, the dose in this case is 2–3 tablets a day with meals. If symptoms persist after several days of treatment, you should see a doctor. The medicine is not used under the age of 18 or while breastfeeding, it is contraindicated in the first trimester of pregnancy, and later in pregnancy it should be used only on a doctor's recommendation. You will find the details in the official instruction. Before use, read the instruction leaflet and consult a specialist.

What should you avoid?

• Piercing, squeezing or cauterising a lump yourself.
• Applying irritants such as garlic, onion, pepper, alcohol or vinegar, or using strong heat.
• Steaming in a bathhouse or sitting in a hot bath, as strong heat increases blood flow to the haemorrhoids.
• Giving yourself enemas or taking strong laxatives without a prescription.
• Putting up with it for weeks in the hope that it will go away on its own if the pain and bleeding are not easing.

What happens next, and how can you prevent another flare-up?

With the right care, acute symptoms often settle within a few days, while the swelling and firmness fade gradually. In most cases, treatment of acute haemorrhoids is conservative: regulating the bowels, topical products and medicines chosen by your doctor, while procedures and operations are needed by only some people. If haemorrhoids prolapse regularly, bleeding keeps recurring or flare-ups happen again and again, a proctologist will discuss modern minimally invasive treatments with you.

Prevention is simple: soft, regular stools, fibre and water, movement throughout the day, short toilet visits and breaks from long sitting, whether at the office, behind the wheel or behind a shop counter. If you have a long drive between regions ahead, make stops and get out to stretch.

The main points

Acute haemorrhoids are unpleasant but usually manageable. Rule out the warning signs, rest without sitting for long, keep your stools soft, be gentle with hygiene and don't put off seeing a proctologist. That way the first 48 hours become the start of your recovery rather than a long battle with pain.

Sources: 1. van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22(6):650–662. 2. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2018;61(3):284–292. 3. Instructions for medical use of Phlebodia 600 (Republic of Uzbekistan).

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