From the Guidelines
Internal hemorrhoids can be effectively treated with rubber band ligation, which is a recommended procedure for first-, second-, or third-degree hemorrhoids, with a success rate of up to 89% and a low complication rate 1.
Treatment Options
- For mild cases, lifestyle changes including increasing fiber intake (25-30g daily), drinking plenty of water (8-10 glasses daily), and avoiding straining during bowel movements can be effective.
- Over-the-counter treatments such as witch hazel pads (Tucks), hydrocortisone creams (0.5-1%), and oral pain relievers like acetaminophen or ibuprofen can provide relief.
- Sitz baths (warm water soaks for 10-15 minutes, 2-3 times daily) can also provide significant relief.
Medical Procedures
- Rubber band ligation is a commonly used procedure for internal hemorrhoids, with a success rate of up to 89% and a low complication rate 1.
- Other procedures such as sclerotherapy, infrared coagulation, or surgical removal (hemorrhoidectomy) may be necessary for persistent or severe cases.
Prevention and Management
- Addressing underlying causes such as constipation, prolonged sitting, obesity, or pregnancy is crucial for long-term management and prevention of recurrence.
- Dietary and lifestyle changes, such as increased fiber and water intake, can help prevent hemorrhoids 1.
- Flavonoids may be used to relieve symptoms in patients with complicated hemorrhoids 1.
From the Research
Internal Hemorrhoids Treatment Options
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for internal hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also help alleviate symptoms 2
- Office-based treatments, including rubber band ligation, are often used for grades I to III internal hemorrhoids that do not respond to initial therapy 2, 3
- Rubber band ligation has a lower failure rate than infrared photocoagulation, making it a preferred next step for grades I to III internal hemorrhoids 2
- Polidocanol sclerotherapy is a relatively new approach that may be associated with higher therapeutic success rates and lower post-procedure morbidity compared to rubber band ligation 3
Surgical Treatment Options
- Open or closed (conventional) excisional hemorrhoidectomy can lead to greater surgical success rates, but also incurs more pain and a prolonged recovery than office-based procedures 2
- Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain 2
- Stapled hemorrhoidopexy can elevate grade III or IV hemorrhoids to their normal anatomic position, but has several potential postoperative complications 2
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, as patients may experience less pain and recover more quickly 2