From the Guidelines
For internal hemorrhoid bleeding, the use of oral micronized, purified flavonoid fraction (MPFF) is recommended, as it has been shown to increase venous tone, lymphatic drainage, and capillary resistance, and normalize capillary permeability, thereby reducing hemorrhoidal bleeding. According to a study published in Gastroenterology 1, MPFF has been found to be effective in reducing hemorrhoidal bleeding, especially when combined with fiber. The study by Ho et al. mentioned in the same publication 1 also reported that a combination of MPFF and fiber led to faster relief of hemorrhoidal bleeding than either fiber and rubber band ligation or fiber alone.
Some key points to consider when treating internal hemorrhoid bleeding include:
- Increasing dietary fiber to reduce straining during bowel movements and prevent further irritation
- Avoiding straining at stool to prevent exacerbating hemorrhoidal symptoms
- Staying hydrated to help soften stool and reduce the risk of constipation
- Considering the use of psyllium to reduce hemorrhoidal bleeding and painful defecation, as shown in a double-blind, placebo-controlled trial 1
It is also important to note that over-the-counter topical agents and suppositories, such as corticosteroid creams, may bring symptomatic relief of local pain and itching, but their long-term use can be deleterious and should be avoided 1. If bleeding persists or worsens after a week of treatment, it is essential to consult a healthcare provider for further evaluation.
From the Research
Treatments for Internal Hemorrhoid Bleeding
- Medication and non-operative measures, such as rubber band ligation and injection sclerotherapy, can be effective for low-graded internal hemorrhoids 2
- Surgery, including excisional hemorrhoidectomy, Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy, may be indicated for high-graded internal hemorrhoids or when non-operative approaches have failed 2
- Hemorrhoidectomy can be used to treat bleeding hemorrhoids that do not respond to other treatments 3
- Emborrhoid technique, a minimally invasive endovascular embolization of the superior rectal artery, is an effective treatment for internal hemorrhoid bleeding with no pain or ischemic complications 4
- Rectal suppositories containing a combined extract of Cissus quadrangularis Linn. and Acmella paniculata may alleviate hemorrhoidal symptoms, including bleeding, with a good safety profile 5
Special Considerations
- In patients with special conditions, such as pregnancy, immunosuppression, coagulopathy, cirrhosis with portal hypertension, and proctitis after radiotherapy, treatment of internal hemorrhoid bleeding requires caution and a conservative medical approach is often recommended 3
- In case of thrombosed hemorrhoids, excision can allow for fast symptom resolution with a low incidence of recurrence and a long remission interval 3