Hemorrhoid Treatment · Online Treatment
Hemorrhoid Treatment & Prescription Cream
Adult care by secure video visit, self pay option starting at $79, MD-only, insurance is not required.
Yes — adults (18+) can get prescription-strength hemorrhoid cream online. A board-certified MD reviews external hemorrhoid symptoms by secure video and, per ASCRS guidelines, can prescribe hydrocortisone 2.5% plus lidocaine 5% ointment alongside conservative care (fiber, fluids, sitz baths, avoiding straining). Visit price: $79 flat, no insurance required. A firm, extremely painful bluish lump (thrombosed hemorrhoid), heavy bleeding, fever, or new rectal bleeding in an adult 45 or older needs in-person or ER care.
Hemorrhoids are swollen veins around the anus that cause itching, discomfort, a lump near the anus, and sometimes a small amount of bright red blood on toilet paper. Most external hemorrhoids are uncomplicated and respond to conservative care: warm sitz baths, 25 to 30 grams of fiber daily, plenty of fluids, and avoiding straining on the toilet. When over-the-counter creams are not enough, prescription-strength hydrocortisone 2.5% and lidocaine 5% can reduce inflammation and pain. TeleDirectMD provides a safety-first telehealth evaluation for adults with external uncomplicated hemorrhoids: we screen for red flags including a firm, extremely painful bluish lump (thrombosed hemorrhoid), significant rectal bleeding, fever, and bleeding in someone 45 or older without a recent colonoscopy, then prescribe topical treatment and conservative-care guidance when appropriate. Internal or thrombosed hemorrhoids, heavy bleeding, and symptoms lasting more than 4 weeks require in-person evaluation. This page is for adults located in one of our covered states, including communities nationwide.
Board-certified MD · 44 states + DC · evenings & weekends · HSA/FSA accepted · 4.97★ (173 reviews)
Online MD-Only Hemorrhoid Care
flat self-pay · insurance not required
- Prescription hydrocortisone 2.5% cream or ointment when appropriate
- Lidocaine 5% ointment for pain relief
- Fiber, sitz-bath, and straining-avoidance guidance per ASCRS
- Red-flag screening for thrombosed, bleeding, or abscess concerns
Same-day appointments · HSA/FSA accepted
What it costs
$79 flat. HSA/FSA accepted.
One fee covers the visit — no facility fees, no surprise billing. Here is how it compares to other care settings.
- MD evaluation and red-flag screening for thrombosed hemorrhoids, abscess, and other causes of bleeding
- Prescription-strength hydrocortisone 2.5% and lidocaine 5% when clinically appropriate
- Fiber, fluid, sitz-bath, and straining-avoidance guidance per ASCRS
- Clear follow-up and referral instructions
How it works
How Online Hemorrhoid Treatment Works
Book your video visit
Insurance is not required. No referral needed. Before your visit, note when symptoms started, whether there is a lump, pain, itching, or bleeding, whether blood is on toilet paper or mixed into stool, and any history of colon cancer, IBD, or blood-thinner use.
See a licensed MD by video
We review your symptoms, bleeding pattern, bowel habits, medications, and red flags including a firm bluish lump, significant bleeding, fever, and age-related bleeding risk. We explain what can be managed by telehealth and what needs an in-person exam.
Get a treatment plan
If topical treatment is clinically appropriate, we send an e-prescription for hydrocortisone 2.5% and lidocaine 5% to common pharmacies such as CVS, Walgreens, Walmart Pharmacy, along with fiber, sitz-bath, and straining-avoidance guidance and a clear follow-up plan.
Treatment
Common Medication Options
These are common options for external uncomplicated hemorrhoid symptoms. The actual medication is determined by the MD after reviewing your symptoms, bleeding pattern, allergies, and medical history. Per ASCRS guidelines, conservative care is first-line, with topical prescription medication added for symptom relief.
| Option | Examples | Used for | Key considerations |
|---|---|---|---|
| Hydrocortisone 2.5% cream/ointment (Rx) | Anusol-HC, Proctocort | Itching, inflammation, irritation | Apply twice daily for up to 7 days only; longer use thins skin |
| Lidocaine 5% ointment (Rx) | Generic lidocaine | Pain relief | Apply as needed to the affected area |
| Witch hazel pads (OTC) | Tucks | Itching, discomfort | Apply after bowel movements as needed |
| Pramoxine / phenylephrine (OTC) | Preparation H | Itching, discomfort, minor swelling | Use as directed; phenylephrine briefly narrows blood vessels |
| Docusate sodium (OTC) | Colace | Stool softening to prevent straining | 100 mg twice daily; not a stimulant laxative |
| Psyllium fiber (OTC) | Metamucil | Fiber supplementation | 25 to 30 g fiber daily with adequate fluids |
Example options only. The actual medication, dosing, and duration are determined by the MD after reviewing your symptoms, risk factors, allergies, and medical history. TeleDirectMD does not prescribe controlled substances, opioid pain medications, or specialist-only ointments such as nitroglycerin or nifedipine.
Understanding it
What Are Hemorrhoids?
Hemorrhoids are swollen, enlarged veins in the lower rectum and around the anus. They are classified by location: internal hemorrhoids form inside the rectum and are usually painless but can bleed or protrude, while external hemorrhoids form under the skin around the anus and tend to cause itching, discomfort, and sometimes a tender lump. Hemorrhoids are extremely common in adults.
Hemorrhoids develop when increased pressure in the anal area causes the veins to swell. Common triggers include straining during bowel movements, chronic constipation, sitting on the toilet for long periods, low-fiber diets, pregnancy, obesity, and heavy lifting. Most hemorrhoids are uncomplicated and improve with conservative measures such as fiber, fluids, sitz baths, and avoiding straining.
TeleDirectMD evaluates external uncomplicated hemorrhoids by video visit. Because rectal bleeding can come from causes other than hemorrhoids, we screen carefully and refer anyone with red flags such as significant bleeding, blood mixed with stool, bleeding at 45 or older without a recent colonoscopy, or a history of colorectal cancer or inflammatory bowel disease to in-person evaluation.
Causes & risk factors
Causes and Risk Factors
Hemorrhoids result from increased pressure on the veins around the anus. Understanding the likely trigger helps guide prevention and tells us how urgently care is needed.
- Straining and constipation: hard stools and straining during bowel movements are the most common triggers, which is why fiber and fluids are first-line prevention
- Prolonged sitting: sitting on the toilet for long periods, especially while reading or using a phone, increases pressure on the anal veins
- Low-fiber diet: a diet low in fiber leads to hard stools and straining
- Pregnancy and childbirth: increased abdominal pressure and hormonal changes make hemorrhoids common during and after pregnancy
- Obesity and heavy lifting: excess weight and repeated heavy lifting raise intra-abdominal pressure
- Aging: supporting tissue in the anal canal weakens with age, making hemorrhoids more common in middle and older adults
- Chronic diarrhea: frequent bowel movements can also irritate and worsen hemorrhoids
Not every case of itching or bleeding is hemorrhoids. Anal fissures, perianal abscess, fistulas, and, less commonly, colorectal conditions can cause similar symptoms. That is why significant bleeding, bleeding mixed with stool, or bleeding in someone 45 or older without a recent colonoscopy warrants in-person evaluation rather than telehealth alone.
Symptoms & red flags
Symptoms and Red Flags for Hemorrhoids
Use this table to understand which hemorrhoid symptoms are appropriate for telehealth and which require urgent in-person evaluation.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Perianal itching, mild discomfort, or a soft lump | External uncomplicated hemorrhoid | Yes | No |
| Small amount of bright red blood on toilet paper | External hemorrhoid or fissure | Often yes | If bleeding is heavy or recurrent |
| Pain with a firm, bluish lump near the anus | Thrombosed external hemorrhoid | No | Urgent in-person evaluation; may need drainage within 72 hours |
| Blood mixed with stool, clots, or soaking a pad | Possible source higher in the colon | No | Urgent in-person or ER evaluation |
| Bleeding with dizziness, lightheadedness, or fainting | Significant blood loss | No | Go to the ER immediately |
| Fever with perianal pain, swelling, or redness | Possible perianal abscess | No | Urgent in-person or ER evaluation |
| New rectal bleeding in an adult 45 or older | Needs colorectal cancer screening | No | In-person evaluation and colonoscopy discussion |
| Symptoms lasting more than 4 weeks | May need specialist evaluation | No | Refer to colorectal surgery or gastroenterology |
Not every symptom is the same
Differential Diagnosis: Hemorrhoids vs Other Causes
Several conditions cause anal itching, pain, or bleeding that can be mistaken for hemorrhoids. TeleDirectMD screens for these to ensure the right level of care.
Sometimes Appropriate for Telehealth Guidance
- External uncomplicated hemorrhoids with itching, a lump, or mild pain
- Small bright red blood on toilet paper with known hemorrhoids
- Conservative-care guidance for fiber, fluids, and sitz baths
Often Requires In-Person Evaluation
- Thrombosed external hemorrhoid (firm, extremely painful bluish lump)
- Anal fissure with severe pain on defecation that needs exam to distinguish from hemorrhoids
- Perianal abscess or fistula (fever, throbbing pain, drainage)
- Rectal bleeding that needs workup to rule out colorectal causes
Hemorrhoids vs Anal Fissure
Hemorrhoids usually cause a lump, itching, and discomfort, with bleeding that is typically light and on toilet paper. An anal fissure is a small tear that causes sharp, severe pain during bowel movements and often a small streak of blood. Fissures usually need an exam to confirm and may warrant different treatment.
Hemorrhoids vs Perianal Abscess
A perianal abscess causes throbbing pain, swelling, redness, and often fever, and requires incision and drainage. Hemorrhoids do not cause fever or systemic symptoms. Fever with perianal pain is a red flag for abscess or sepsis and needs urgent in-person or emergency care.
Internal vs External Hemorrhoids
Internal hemorrhoids form inside the rectum, are usually painless, and may bleed or protrude during bowel movements. External hemorrhoids form under the skin around the anus and cause itching, discomfort, a tender lump, and sometimes mild pain. TeleDirectMD evaluates external uncomplicated hemorrhoids only; internal hemorrhoids and anything not visible or felt outside the anus need an in-person exam.
If your symptoms do not match a straightforward external hemorrhoid pattern, or if any red flags are present, TeleDirectMD will direct you to urgent in-person care, your primary care physician, or a colorectal specialist.
Treatment approach
Treatment Options
Treatment for external uncomplicated hemorrhoids is mostly conservative, with topical prescription options when over-the-counter care is not enough. Per ASCRS guidelines, first-line care centers on fiber, fluids, sitz baths, and avoiding straining, with topical steroids reserved for short-term symptom relief.
Conservative care (first-line)
Warm sitz baths (15 to 20 minutes, 2 to 3 times daily), 25 to 30 grams of fiber daily, at least 64 ounces of fluid daily, and avoiding straining or prolonged sitting on the toilet are the foundation of treatment. A stool softener such as docusate can help prevent straining.
Prescription topical treatment
When over-the-counter creams are not enough, prescription-strength hydrocortisone 2.5% cream or ointment (applied twice daily for up to 7 days) reduces inflammation and itching, and lidocaine 5% ointment provides pain relief. Hydrocortisone should not be used longer than 7 days to avoid skin thinning.
Over-the-counter options
Witch hazel pads, Preparation H (pramoxine or phenylephrine), and psyllium fiber supplements are reasonable first steps many patients can start before a visit. Your MD can help you choose between OTC and prescription care.
When referral is needed
Thrombosed hemorrhoids, prolapsed internal hemorrhoids, significant or persistent bleeding, and symptoms lasting more than 4 weeks require in-person evaluation by a primary care physician, gastroenterologist, or colorectal surgeon.
What we do not manage by video
- Internal or thrombosed hemorrhoids requiring exam or procedure
- Heavy or persistent rectal bleeding requiring workup
- Perianal abscess or fistula requiring drainage
- Fecal incontinence
- Controlled substance or opioid pain medications
- Nitroglycerin or nifedipine ointments (specialist-use prescriptions)
Decision guide
Should I Use TeleDirectMD for Hemorrhoids? Decision Guide
Do you have emergency warning signs?
- Heavy rectal bleeding that soaks a pad or drips continuously into the toilet
- Rectal bleeding with dizziness, lightheadedness, or fainting
- Severe perianal pain with fever (possible abscess or sepsis)
- A firm, extremely painful bluish lump (thrombosed hemorrhoid)
Yes: go to the ER or urgent in-person care now, depending on severity
No: continue to Step 2
Are you 18+ and currently in one of our covered states?
Yes: continue to Step 3
No: use in-person care as appropriate
Are your symptoms consistent with external, uncomplicated hemorrhoids?
- Perianal itching, discomfort, a lump, or mild pain
- Small amount of bright red blood on toilet paper only, not mixed with stool
- No firm bluish lump, heavy bleeding, fever, or fecal incontinence
- No history of colon cancer or IBD, and not on blood thinners with bleeding
- Under age 45, or 45 or older with a recent normal colonoscopy
Yes: continue to Step 4
No: in-person evaluation is needed to rule out other causes of bleeding
You are likely appropriate for a TeleDirectMD video visit
Recovery & prevention
Home Care, Prevention, and Follow-up
What to Do Now
- Take warm sitz baths for 15 to 20 minutes, 2 to 3 times daily
- Increase fiber to 25 to 30 g daily and fluids to at least 64 oz daily
- Use a stool softener if needed to avoid straining
- Apply topical treatment exactly as directed, and stop hydrocortisone after 7 days
- Avoid prolonged sitting on the toilet and straining during bowel movements
What to Watch For Over the Next 24 to 72 Hours
- New or worsening pain, especially a firm bluish lump, needs in-person evaluation
- Heavy bleeding, bleeding with dizziness, or blood mixed with stool needs urgent in-person or ER care
- Fever with perianal pain, swelling, or redness needs urgent evaluation (possible abscess)
- If symptoms do not improve in 7 to 14 days, schedule an in-person follow-up
Follow-up Timing
- Reassess if symptoms have not improved within 7 to 14 days
- Symptoms lasting more than 4 weeks require referral to colorectal surgery or gastroenterology
- Any new or recurrent rectal bleeding at 45 or older warrants colon cancer screening discussion
Safety first
When Not to Use TeleDirectMD for Hemorrhoids
TeleDirectMD treats external uncomplicated hemorrhoids only. We are direct about when telehealth is not the right fit.
You Should Not Use TeleDirectMD If
- You are under 18 years old
- You have a firm, extremely painful bluish lump (thrombosed hemorrhoid)
- You have heavy rectal bleeding, blood mixed with stool, or bleeding that soaks a pad
- You have fever with perianal pain, swelling, or redness
- You are 45 or older with new rectal bleeding and no recent colonoscopy
- You have a history of colorectal cancer or inflammatory bowel disease with bleeding
- You take blood thinners and have active rectal bleeding
- You have fecal incontinence
- Your symptoms have lasted more than 4 weeks without improvement
- You are not physically in one of our covered states at the time of visit
Alternative Care Options
- Emergency room: heavy rectal bleeding, bleeding with dizziness or fainting, or severe perianal pain with fever
- Urgent care: a firm painful bluish lump (thrombosed hemorrhoid) or symptoms needing a same-day exam
- Primary care or colorectal specialist: recurrent symptoms, new bleeding needing workup, or symptoms lasting more than 4 weeks
Common questions
Hemorrhoid Treatment FAQs
Can I get prescription hemorrhoid cream online?
Yes. If you are an adult 18+ with external uncomplicated hemorrhoid symptoms and no red flags, a TeleDirectMD physician can prescribe hydrocortisone 2.5% cream or ointment and lidocaine 5% by secure video visit. Prescription-strength cream is used when over-the-counter options are not enough, and hydrocortisone is limited to 7 days.
How much does online hemorrhoid treatment cost?
TeleDirectMD offers a transparent self pay option starting at $79 for an adult video visit. Insurance is not required. Prescription cream costs are separate and vary by pharmacy; the MD will help you decide between over-the-counter and prescription care.
What is the best cream for hemorrhoids?
For most people, conservative care and an over-the-counter option such as witch hazel pads or a pramoxine-and-phenylephrine product is a reasonable first step. When more relief is needed, prescription-strength hydrocortisone 2.5% reduces inflammation and lidocaine 5% relieves pain. The best choice depends on your symptoms and medical history, which an MD can assess by video visit.
What causes hemorrhoids?
Hemorrhoids are caused by increased pressure on the veins around the anus. Common triggers include straining during bowel movements, chronic constipation, a low-fiber diet, sitting for long periods on the toilet, pregnancy, obesity, and heavy lifting.
How long do hemorrhoids last?
External uncomplicated hemorrhoids often improve within 7 to 14 days with conservative care such as fiber, fluids, and sitz baths, and many resolve on their own without further treatment. If symptoms do not improve within that window or last more than 4 weeks, an in-person evaluation is recommended to rule out other causes.
How do I get rid of hemorrhoids fast?
There is no instant cure, but you can reduce symptoms quickly with warm sitz baths, 25 to 30 grams of fiber daily, at least 64 ounces of fluid, avoiding straining and prolonged toilet sitting, and topical treatment for itching and pain. Set realistic expectations: most external hemorrhoids resolve over days to a couple of weeks, not hours.
Are hemorrhoids dangerous?
Most hemorrhoids are not dangerous and improve with conservative care. However, rectal bleeding can be a sign of something other than hemorrhoids, so significant bleeding, blood mixed with stool, new bleeding at 45 or older without a recent colonoscopy, or bleeding with dizziness should be evaluated in person or at the ER.
When should I go to the emergency room for hemorrhoids?
Go to the ER for heavy rectal bleeding that soaks a pad or drips continuously, rectal bleeding with dizziness or fainting, or severe perianal pain with fever (a possible abscess). A firm, extremely painful bluish lump (thrombosed hemorrhoid) needs urgent in-person evaluation, not the ER unless symptoms are severe.
Can TeleDirectMD treat internal or thrombosed hemorrhoids?
No. TeleDirectMD treats external uncomplicated hemorrhoids only. Internal hemorrhoids, thrombosed hemorrhoids (a firm, extremely painful bluish lump), and anything requiring a procedure or exam need in-person evaluation by a primary care physician, gastroenterologist, or colorectal surgeon.
Do hemorrhoids go away on their own?
Yes, external uncomplicated hemorrhoids often resolve on their own within days to a couple of weeks with conservative care. If they do not improve or keep returning, an in-person evaluation is warranted.
What is the difference between internal and external hemorrhoids?
Internal hemorrhoids form inside the rectum, are usually painless, and may bleed or protrude during bowel movements. External hemorrhoids form under the skin around the anus and cause itching, discomfort, a tender lump, and sometimes mild pain. TeleDirectMD evaluates external uncomplicated hemorrhoids only; internal hemorrhoids need an in-person exam.
What do hemorrhoids look and feel like?
An external hemorrhoid usually feels like a small, soft or firm lump under the skin near the anus, with itching, discomfort, or mild pain, and sometimes a little bright red blood on toilet paper. An internal hemorrhoid is usually not visible from outside; it may be painless and can appear as painless bleeding or a feeling of fullness inside the rectum.
When should I worry about hemorrhoids or see a doctor?
See a doctor or go to urgent or emergency care if you have heavy or recurrent rectal bleeding, blood mixed into stool, new bleeding at 45 or older without a recent colonoscopy, fever with perianal pain or swelling, a firm extremely painful bluish lump (thrombosed hemorrhoid), fecal incontinence, or symptoms lasting more than 4 weeks without improvement.
Does your state allow telemedicine for this kind of visit?
Yes. Your state allows licensed professionals to provide telemedicine within their scope when appropriate and according to accepted standards of care.
Can TeleDirectMD provide hemorrhoid care in other states?
Yes. TeleDirectMD offers adult evaluations via video visits across multiple states where our physicians are licensed. You must be physically located in the state where you are requesting care at the time of your video visit.
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