From the Guidelines
For external hemorrhoids, I recommend non-operative management as first line therapy, with dietary and lifestyle changes, such as increased fiber and water intake, along with the administration of flavonoids to relieve symptoms, as suggested by the most recent guidelines 1. The use of flavonoids, such as oral micronized, purified flavonoid fraction (MPFF), has been shown to increase venous tone, lymphatic drainage, and capillary resistance, and normalize capillary permeability, leading to symptomatic improvement in patients with hemorrhoids 1. Some key points to consider when managing external hemorrhoids include:
- Increasing fiber intake to 25-30 grams daily to soften stools and prevent straining
- Drinking plenty of water to help prevent constipation
- Avoiding straining at stool
- Using topical agents, such as witch hazel pads or hydrocortisone cream, for temporary relief of symptoms
- Taking oral pain relievers, such as acetaminophen or ibuprofen, to manage discomfort
- Using sitz baths in warm water for 15 minutes, 2-3 times daily, to soothe the area and reduce inflammation It is essential to note that if symptoms do not improve within a week, or if severe pain or bleeding occurs, consultation with a healthcare provider is necessary, as prescription-strength medications or procedures may be required 1.
From the Research
Medication for External Hemorrhoids
- Topical nifedipine ointment has been shown to be effective in treating acute thrombosed external hemorrhoids, with a significant reduction in pain and symptoms compared to lidocaine ointment alone 2.
- Topical hydrocortisone creams can also be used to manage external hemorrhoids, although their effectiveness may vary 3.
- Stool softeners and increased fiber and water intake can help to reduce symptoms of external hemorrhoids by softening stool and reducing straining during bowel movements 4.
Surgical Treatment of External Hemorrhoids
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 4, 3.
- Surgical treatment options for external hemorrhoids, such as open or closed hemorrhoidectomy, may be considered for recurrent or severe cases, although these procedures can be more painful and have a longer recovery time 4, 5.
- Newer surgical techniques, such as stapled hemorrhoidopexy and hemorrhoidal artery ligation, may offer reduced pain and faster recovery times, but their effectiveness and cost-effectiveness compared to traditional treatments are still being evaluated 5, 6.
Treatment Considerations
- The choice of treatment for external hemorrhoids should be individualized based on patient factors, such as the severity of symptoms, medical history, and personal preferences 4, 6.
- A combination of medical and lifestyle treatments, such as topical creams, stool softeners, and increased fiber and water intake, may be effective in managing symptoms of external hemorrhoids 4, 3.