From the Guidelines
The most effective treatment for bleeding hemorrhoids is non-operative management as first-line therapy, with dietary and lifestyle changes, as recommended by the World Journal of Emergency Surgery in 2021 1. This approach includes increasing fiber intake to 25-30 grams daily through foods or supplements like psyllium husk, and drinking 6-8 glasses of water daily to soften stool and reduce straining.
- For immediate relief, over-the-counter medications like hydrocortisone creams (0.5-1%) or suppositories can reduce inflammation and bleeding.
- Witch hazel pads or medicated wipes containing witch hazel can also help constrict blood vessels and reduce bleeding.
- Taking warm sitz baths for 10-15 minutes, 2-3 times daily, soothes the area and reduces swelling.
- Oral pain relievers such as acetaminophen or ibuprofen can help manage discomfort. For persistent bleeding, prescription-strength medications like hydrocortisone or procedures such as rubber band ligation may be necessary, as suggested by the American Gastroenterological Association in 2004 1. It is essential to note that bleeding hemorrhoids occur when swollen anal veins rupture due to pressure from straining, constipation, or prolonged sitting, and if bleeding is severe, persistent, or accompanied by severe pain, dizziness, or lightheadedness, immediate medical attention is required as these may indicate a more serious condition. The use of flavonoids to relieve symptoms is also suggested by the World Journal of Emergency Surgery in 2021 1, although the evidence is moderate and the recommendation is weak. Surgical treatment may be considered in selected patients with complicated hemorrhoids, but the decision should be based on local expertise and patient preference, as stated by the World Journal of Emergency Surgery in 2021 1.
From the Research
Treatment Options for Bleeding Hemorrhoids
- Medical management, such as stool softeners and topical preparations, is often the initial treatment approach for bleeding hemorrhoids 2
- Rubber band ligation is a common office-based treatment for grades I to III internal hemorrhoids, with a lower failure rate than infrared photocoagulation 2
- Excisional hemorrhoidectomy is a more invasive procedure that can be effective for recurrent or higher-grade disease, but is often associated with more pain and a prolonged recovery 2
- Stapled hemorrhoidopexy and hemorrhoidal artery ligation are alternative procedures that may be less painful, but have varying success rates and potential complications 2, 3
- A novel technique called emborrhoid, which involves embolization of the superior rectal arteries, has shown promise in treating severe bleeding hemorrhoids with minimal post-procedural pain 4
- Another endoscopic device, the HET Bipolar System, has been shown to be effective in eliminating bleeding in grade I and II internal hemorrhoids with minimal complications 5
Effectiveness of Treatment Options
- Conventional haemorrhoidectomy remains the most effective treatment in the long term, despite post-operative pain being a significant limitation 6
- Rubber band ligation is effective in 75% of patients in the short term, but may not be suitable for prolapsed hemorrhoids or those with a significant external component 6
- Bulk laxatives alone may improve symptoms of both bleeding and prolapse, and seem as effective as injection sclerotherapy 6
- The emborrhoid technique has been shown to be safe and effective in reducing rectal bleeding and improving quality of life in patients with severe bleeding hemorrhoids 4
Considerations for Treatment
- Treatment should be tailored to the individual based on patient choice, convenience, and degree of hemorrhoids 3
- The choice of treatment may depend on factors such as hemorrhoidal size, thrombosis, and location, as well as patient comorbidities and preferences 2
- Novel techniques, such as the emborrhoid technique and the HET Bipolar System, may offer alternative treatment options for patients who are not eligible for conventional surgery or have failed other treatments 4, 5