From the Guidelines
Hemorrhoids should be managed with a combination of lifestyle modifications, including increasing fiber intake to 25-30 grams daily, drinking plenty of water, and avoiding straining during bowel movements, as well as medical treatments such as rubber band ligation or sclerotherapy for persistent or severe cases. According to the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1, hemorrhoids are found in the subepithelial space of the anal canal and consist of connective tissue cushions surrounding the direct arteriovenous communications between the terminal branches of the superior rectal arteries and the superior, inferior, and middle rectal veins.
Symptoms and Prevention
Symptoms attributed to hemorrhoids include bleeding, protrusion, itching, and pain 1.
- Increasing fiber intake to 25-30 grams daily through foods or supplements like psyllium (Metamucil) or methylcellulose (Citrucel) can help prevent and manage symptoms.
- Drinking plenty of water and avoiding straining during bowel movements can also help prevent hemorrhoids.
- Maintaining regular bowel habits, not delaying using the bathroom, exercising regularly, and avoiding sitting for long periods can also help prevent hemorrhoids.
Medical Treatments
For persistent or severe hemorrhoids, medical treatments include:
- Rubber band ligation (placing small bands around hemorrhoids to cut off circulation)
- Sclerotherapy (injecting a solution to shrink hemorrhoids)
- Infrared coagulation (using heat to harden hemorrhoids)
- Surgical removal for the most severe cases It is essential to consult a healthcare provider if you experience severe pain, heavy bleeding, or symptoms that don't improve with home treatment after a week.
From the Research
Definition and Symptoms of Hemorrhoids
- Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions 2
- The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement 2
- Hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid 3
Treatment Options for Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment 4
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, such as sitz baths, can also be effective 4
- Office-based treatments, including rubber band ligation and infrared photocoagulation, can be used for grades I to III internal hemorrhoids 4
- Surgical options, including excisional hemorrhoidectomy and stapled hemorrhoidopexy, are typically reserved for recurrent or higher-grade disease 4
- Novel techniques, such as Ligasure excision and hemorrhoidal artery ligation, aim to reduce harm while maintaining or improving outcomes 5
Factors to Consider in Treatment Decision-Making
- The extent of prolapse, degree of discomfort, bleeding, comorbidities, and patient preference should be taken into account when determining the order of treatments 4
- The individualization of treatment is important, as each patient is unique 6
- The cost and availability of treatments, as well as the potential for complications, should also be considered 5
Complications and Special Considerations
- Postoperative pain is a common complication of surgical treatments for hemorrhoids 2, 3
- Other potential complications include anal stricture and incontinence 2
- Special consideration should be given to patients with complicated situations, such as hemorrhoids in pregnancy, immunocompromised patients, or patients with cirrhosis or portal hypertension 3