From the Guidelines
Management of bleeding hemorrhoids should prioritize non-operative management as first-line therapy, with dietary and lifestyle changes, and consider the use of flavonoids to relieve symptoms, as suggested by the most recent guidelines 1. The management of bleeding hemorrhoids involves both immediate measures and long-term strategies. For active bleeding, apply gentle pressure with clean toilet paper or a cold compress for 15-20 minutes. Over-the-counter treatments include witch hazel pads (Tucks), hydrocortisone creams (0.5-1%), or combination products like Preparation H to reduce inflammation and discomfort.
Key Considerations
- Sitz baths (warm water soaks) for 10-15 minutes, 2-3 times daily can provide significant relief.
- Oral pain relievers such as acetaminophen or ibuprofen can help manage pain.
- To prevent constipation, increase fiber intake to 25-30g daily through foods or supplements like psyllium (Metamucil, 1 tablespoon 1-3 times daily), drink 6-8 glasses of water daily, and exercise regularly.
- For persistent bleeding, prescription-strength hydrocortisone or steroid creams may be necessary.
Surgical Intervention
Surgical treatment may be considered in selected patients, but the decision should be based on local expertise and patient preference, as suggested by recent guidelines 1.
- Indications for elective hemorrhoidectomy include failure of medical and nonoperative therapy, symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids, and patient preference, after discussion of treatment options with the referring physician and surgeon 1.
- However, it is essential to note that hemorrhoidectomy is associated with significantly more pain and complications than nonoperative techniques, and therefore, should be recommended only for a small minority of patients.
From the Research
Management of Bleeding Hemorrhoids
- The management of bleeding hemorrhoids depends on the severity and location of the hemorrhoids, as well as the patient's overall health and medical history 2, 3, 4, 5, 6.
- For internal hemorrhoids, medical therapy can be initiated with stool softeners and local therapy to relieve swelling and symptoms 2.
- Rubber band ligation is a common treatment for grades 1 and 2 hemorrhoids, and can be performed in a doctor's office 2, 5, 6.
- For grade 3 hemorrhoids, rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy can be performed 2, 3, 4, 6.
- Excisional hemorrhoidectomy or stapled hemorrhoidopexy is recommended for treatment of grade 4 hemorrhoids 2, 3, 4, 6.
- Thrombosed external hemorrhoids can be treated conservatively or excised, and excision can greatly reduce pain if performed within the first two to three days of symptoms 2, 3, 6.
Treatment Options
- Non-operative approaches include sclerotherapy, rubber band ligation, and infrared photocoagulation 3, 4, 6.
- Surgical approaches include hemorrhoidectomy, stapled hemorrhoidopexy, and hemorrhoidal artery ligation 3, 4, 6.
- The choice of treatment depends on the severity of the hemorrhoids, the patient's overall health, and the presence of any complications 2, 3, 4, 5, 6.