From the Guidelines
The most effective treatment for hemorrhoids is non-operative management as first-line therapy, with dietary and lifestyle changes, as recommended by the World Journal of Emergency Surgery in 2021 1.
Treatment Options
Treatment options for hemorrhoids range from home remedies to medical procedures depending on severity.
- For mild hemorrhoids, start with lifestyle changes like:
- Increasing fiber intake (25-30g daily)
- Drinking plenty of water (8-10 glasses daily)
- Avoiding straining during bowel movements
- Over-the-counter treatments include:
- Witch hazel pads
- Hydrocortisone creams (0.5-1%, apply up to 3-4 times daily for no more than 7 days)
- Oral pain relievers like acetaminophen or ibuprofen
- Warm sitz baths for 15-20 minutes several times daily can provide significant relief
Medical Treatments
For persistent or more severe hemorrhoids, medical treatments include:
- Rubber band ligation (placing small bands around hemorrhoids to cut off circulation)
- Sclerotherapy (injecting a solution to shrink hemorrhoids)
- Infrared coagulation
- Surgical options like hemorrhoidectomy for the most severe cases These treatments work by either reducing inflammation, shrinking the swollen vessels, or removing the hemorrhoidal tissue entirely.
Special Considerations
Pregnant women should consult their doctor before using medications, as some may not be safe during pregnancy. If you experience severe pain, heavy bleeding, or symptoms that don't improve with home treatment within a week, seek medical attention promptly. In patients with thrombosed hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, as suggested by the World Journal of Emergency Surgery in 2021 1.
From the Research
Treatment Options for Hemorrhoids
The treatment of hemorrhoids can be divided into conservative and surgical approaches.
- Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease, and includes dietary and lifestyle modifications, oral phlebotonic drugs, and topical medications 2.
- Medical management, such as stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is also a mainstay of initial therapy 3.
- Dietary modifications, including increased fiber and water intake, and behavioral therapies, such as sitz baths, can also help alleviate symptoms 3.
Surgical Treatment Options
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is a preferred next step if conservative treatment is unsuccessful, due to its lower failure rate compared to infrared photocoagulation 3.
- Open or closed (conventional) excisional hemorrhoidectomy can lead to greater surgical success rates, but also incurs more pain and a prolonged recovery than office-based procedures, and should be reserved for recurrent or higher-grade disease 3.
- Stapled hemorrhoidopexy can elevate grade III or IV hemorrhoids to their normal anatomic position, but has several potential postoperative complications 3.
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, as patients may experience less pain and recover more quickly 3, 4.
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 3.
Grade-Specific Treatment Options
- For grade I and II hemorrhoids, rubber band ligation and phlebotonic drugs can be effective treatments 4, 5.
- For grade III hemorrhoids, rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy can be performed 5.
- For grade IV hemorrhoids, excisional hemorrhoidectomy or stapled hemorrhoidopexy is recommended, with excisional hemorrhoidectomy being considered the gold-standard approach 4, 5.