From the Guidelines
For patients with complicated hemorrhoids, I strongly recommend starting with non-operative management as first-line therapy, including dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as this approach has been shown to be effective in reducing symptoms and improving quality of life 1. This approach is supported by the World Journal of Emergency Surgery, which suggests that non-operative management is the preferred initial treatment for complicated hemorrhoids, with a strong recommendation based on moderate quality evidence, 1B 1. Some key lifestyle modifications that can help alleviate symptoms of hemorrhoids include:
- Increasing fiber intake to 25-30g daily
- Drinking plenty of water
- Avoiding straining during bowel movements
- Taking warm sitz baths for 10-15 minutes several times daily In addition to these lifestyle changes, flavonoids may be administered to relieve symptoms, although this is a weak recommendation based on moderate quality evidence, 2B 1. It is also important to note that topical muscle relaxants may be used in patients with thrombosed or strangulated hemorrhoids, although this is a weak recommendation based on low-quality evidence, 2C 1. Overall, the goal of treatment for complicated hemorrhoids is to reduce symptoms, improve quality of life, and prevent complications, and non-operative management with lifestyle changes and potentially flavonoids or topical muscle relaxants is the recommended initial approach 1.
From the Research
Treatment Options for Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for 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 common office-based treatment, with a lower failure rate than infrared photocoagulation 2
- Hemorrhoidectomy, either open or closed, may be necessary for recurrent or higher-grade disease, but it can be more painful and have a longer recovery time 2
- Stapled hemorrhoidopexy is another surgical option, which elevates grade III or IV hemorrhoids to their normal anatomic position, but it can have potential postoperative complications 2
Pharmacological Treatment
- Topical lidocaine or lidocaine/diltiazem ointment can be effective in reducing pain after rubber band ligation of hemorrhoids 3
- The combination of lidocaine and diltiazem may improve patient satisfaction and reduce the need for analgesia 3
- Phlebotonic drugs, such as those used to treat varicose veins, may also be useful in managing hemorrhoid symptoms 4, 5
- Hydrocortisone suppositories, like the Rectal Rocket, can deliver anti-inflammatory medication directly to the site of inflammation and promote healing 6
Conservative Management
- Lifestyle changes, such as increasing fiber intake and exercising regularly, can help prevent hemorrhoids and alleviate symptoms 4, 5
- Fiber supplements can help soften stool and reduce straining during bowel movements 4, 5
- Topical ointments and creams can provide temporary relief from symptoms like itching and pain 4, 5