From the Guidelines
Pediatric hemorrhoids should be managed with conservative approaches, prioritizing dietary modifications and topical treatments to reduce symptoms and prevent complications. Treatment should begin with increased fiber intake (15-30g daily depending on age) and adequate hydration to soften stools and reduce straining, as recommended by the American Gastroenterological Association 1, 2. Warm sitz baths for 10-15 minutes, 2-3 times daily can provide significant relief. Topical treatments may include witch hazel pads or petroleum jelly to soothe irritation. Over-the-counter hydrocortisone cream (0.5-1%) can be applied sparingly for short periods (3-5 days) to reduce inflammation, but prolonged use of potent corticosteroid preparations should be avoided 2.
Some key considerations in managing pediatric hemorrhoids include:
- Avoiding prolonged sitting, especially on hard surfaces
- Encouraging regular physical activity
- Considering polyethylene glycol (Miralax) at age-appropriate dosing (0.5-1.5g/kg/day) to establish regular bowel movements if constipation is contributing
- Monitoring for symptoms that persist beyond 2 weeks, worsen, or include significant bleeding, which may require medical evaluation to rule out other conditions 1.
It is essential to address the underlying cause of hemorrhoids in children, often constipation causing increased pressure in rectal veins, for both treatment and prevention. Surgical intervention is rarely needed in children, and a thorough medical evaluation should be performed before considering such options 1, 2.
From the Research
Treatment Options for Pediatric Hemorrhoids
There are no specific studies provided that directly address the treatment of pediatric hemorrhoids. However, the following general information on hemorrhoid treatment may be relevant:
- Medical treatment, including dietary fiber, should always be proposed as the first line of treatment 3
- Instrumental treatment, such as rubber band ligation, may be considered if medical treatment fails 4, 5
- Surgery should be reserved as a last resort, with the patient well-informed of the surgical alternatives and potential risks 3, 4, 5
- Postoperative pain should be prevented through the use of a pudendal block and multimodal analgesics 3
Non-Operative Approaches
Non-operative approaches to treating hemorrhoids include:
- Lifestyle modification
- Fiber supplement
- Suppository-delivered anti-inflammatory drugs
- Administration of venotonic drugs 4
- Sclerotherapy
- Rubber band ligation 4, 5
Surgical Approaches
Surgical approaches for treating hemorrhoids include:
- Hemorrhoidectomy
- Stapled hemorrhoidopexy
- Hemorrhoidal artery ligation 4, 5
- Excision of thrombosed external hemorrhoids 5
Medical Management
Medical management of hemorrhoids may include: