From the Guidelines
For acute hemorrhoids, I recommend starting with non-operative management as first line therapy, with dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as well as administering flavonoids to relieve symptoms. This approach is based on the most recent and highest quality study available, which provides a strong recommendation for non-operative management and a weak recommendation for the use of flavonoids 1.
The management of acute hemorrhoids involves several key components, including:
- Increasing fiber intake to 25-30g daily through foods or supplements like psyllium (Metamucil, 1 tablespoon in water 1-3 times daily) to soften stools and reduce straining during bowel movements 1
- Drinking 6-8 glasses of water daily to help soften stools and prevent constipation 1
- Avoiding straining during bowel movements and limiting sitting on the toilet for extended periods to reduce pressure on the hemorrhoids
- Considering the use of topical muscle relaxants for thrombosed or strangulated hemorrhoids, although the evidence for this is based on low-quality evidence 1
It is essential to note that while over-the-counter topical agents and suppositories are commonly used to treat hemorrhoidal symptoms, the data supporting their use is lacking 1. Additionally, long-term use of high-potency corticosteroid creams should be avoided due to potential deleterious effects 1.
If symptoms do not improve within 7-10 days, or if severe pain, bleeding, or fever occurs, it is crucial to seek medical attention for further evaluation and potential prescription treatments or procedures 1.
From the Research
Treatment Options for Acute Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is a common initial treatment for acute hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also help alleviate symptoms 2
- For internal hemorrhoids, rubber band ligation is a preferred next step if initial treatments are unsuccessful, due to its lower failure rate compared to infrared photocoagulation 2
- Topical lidocaine or lidocaine/diltiazem ointment can be effective in reducing pain and discomfort after rubber band ligation of hemorrhoids 3
- Tribenoside and lidocaine combination therapy has been shown to be a fast, effective, and safe option for the local treatment of low-grade hemorrhoids 4
- Nifedipine and lidocaine ointment is also effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy 5
Specific Treatments
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 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 potential postoperative complications 2
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, with patients experiencing less pain and recovering more quickly 2