From the Guidelines
For acute hemorrhoids, I recommend starting with non-operative management as the first-line therapy, with dietary and lifestyle changes, such as increased fiber and water intake, along with adequate bathroom habits, as suggested by the World Journal of Emergency Surgery in 2021 1. This approach is supported by the World Journal of Emergency Surgery, which recommends non-operative management as the first-line therapy for complicated hemorrhoids, with a strong recommendation based on moderate quality evidence, 1B 1. Some key points to consider when managing acute hemorrhoids include:
- Increasing fiber intake to 25-30g daily through foods or supplements like psyllium husk (Metamucil) to soften stools
- Drinking 6-8 glasses of water daily to prevent constipation
- Avoiding straining during bowel movements and limiting sitting on the toilet
- Using over-the-counter treatments like witch hazel pads (such as Tucks) or hydrocortisone creams (0.5-1%) to reduce inflammation and discomfort
- Taking oral pain relievers like acetaminophen or ibuprofen to manage pain
- Using sitz baths (sitting in warm water for 10-15 minutes) 2-3 times daily to reduce inflammation and relax spasms It's essential to note that if symptoms don't improve within 1-2 weeks, or if there's severe pain or bleeding, medical attention is needed as prescription-strength medications or procedures may be required, as suggested by the American Gastroenterological Association in 2004 1. Additionally, the use of flavonoids to relieve symptoms is suggested, with a weak recommendation based on moderate quality evidence, 2B, as stated in the World Journal of Emergency Surgery in 2021 1.
From the Research
Treatment Options for Hemorrhoids
- Medical management, including stool softeners and topical over-the-counter preparations, is often the first line of treatment for hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, can also help alleviate symptoms 2
- Behavioral therapies, including sitz baths, may be recommended to help manage discomfort and pain 2
Non-Surgical Treatments
- Rubber band ligation (RBL) is a common non-surgical treatment for internal hemorrhoids, with a success rate of up to 90% in stopping bleeding and improving symptoms 3
- Injection sclerotherapy (IS) and infrared coagulation (IRC) are also used to treat hemorrhoids, with varying success rates and potential complications 3
- These non-surgical treatments can be effective for mild to moderate hemorrhoids, but may not be suitable for more severe cases 3
Surgical Options
- Excisional hemorrhoidectomy is a surgical procedure that can be used to treat more severe or persistent hemorrhoids, but it can be painful and requires a longer recovery time 4, 2
- Minimally invasive procedures, such as stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation, may be used to treat hemorrhoids with less pain and faster recovery times 4, 2
- The choice of surgical procedure depends on the severity of the hemorrhoids, as well as the patient's overall health and preferences 4, 2