From the Guidelines
Treatment for bleeding hemorrhoids typically involves a combination of home remedies and medical interventions, with a focus on non-operative management as the first-line therapy, including dietary and lifestyle changes, as recommended by the most recent guidelines 1. To manage bleeding hemorrhoids, start with the following home remedies:
- Sitz baths (warm water soaks) for 15-20 minutes, 2-3 times daily to reduce inflammation and pain
- Over-the-counter medications like hydrocortisone creams (0.5-1%) to reduce inflammation
- Witch hazel pads for cooling relief
- Oral pain relievers such as acetaminophen or ibuprofen to manage discomfort
- Increase fiber intake to 25-30 grams daily through foods or supplements like psyllium husk (Metamucil, 1 tablespoon in water 1-3 times daily) to soften stool
- Drink 6-8 glasses of water daily to prevent constipation
- Avoid straining during bowel movements and limit sitting on the toilet to 5 minutes For persistent bleeding, doctors may perform procedures like rubber band ligation, sclerotherapy, or infrared coagulation to cut off blood supply to the hemorrhoid, with rubber band ligation being a commonly used and effective treatment option 1. It is essential to seek immediate medical attention if bleeding is heavy or doesn't improve within a week with home treatment, as indicated by the guidelines 1.
Some key points to consider:
- Non-operative management is the first-line therapy for complicated hemorrhoids, including dietary and lifestyle changes 1
- Rubber band ligation is a commonly used and effective treatment option for bleeding hemorrhoids 1
- Surgical treatment may be considered for thrombosed hemorrhoids, but the decision should be based on local expertise and patient preference 1
- There is limited evidence on the role of surgery for bleeding hemorrhoids, and therefore, no recommendations can be made 1
From the Research
Treatment Options for Bleeding Hemorrhoids
The treatment for bleeding hemorrhoids can vary depending on the severity and location of the hemorrhoids.
- Medical management, such as stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment 2.
- Dietary modifications, including increased fiber and water intake, and behavioral therapies, such as sitz baths, can also be effective in managing symptoms 2.
- For internal hemorrhoids, office-based treatment with rubber band ligation is a preferred next step if initial therapy is unsuccessful, due to its lower failure rate compared to infrared photocoagulation 2.
- Other treatment options include:
- Open or closed excisional hemorrhoidectomy, which has a higher success rate but also incurs more pain and a prolonged recovery 2.
- Stapled hemorrhoidopexy, which elevates grade III or IV hemorrhoids to their normal anatomic position but has potential postoperative complications 2.
- Hemorrhoidal artery ligation, which may be useful in grade II or III hemorrhoids with less pain and quicker recovery 2.
- Sclerotherapy, which has been compared to rubber band ligation in a randomized controlled trial, with results indicating that sclerotherapy may be a viable alternative 3.
- The emborrhoid technique, which involves embolization of the superior rectal arteries branches, has shown promising results in a small study, with reduction of rectal bleeding and improvement of quality of life in 87.5% of patients 4.
Considerations for Treatment
When choosing a treatment option, factors such as the degree of discomfort, bleeding, comorbidities, and patient preference should be taken into account 2.