From the Guidelines
Strangulated hemorrhoids require immediate surgical intervention, typically an emergency hemorrhoidectomy, to prevent complications and alleviate pain. The primary goal of treatment is to remove the strangulated tissue, restore blood flow, and prevent tissue necrosis or infection 1. Before surgery, pain management with medications such as acetaminophen or prescribed opioids may be necessary, along with stool softeners like docusate sodium (100-300 mg daily) to prevent constipation. Sitz baths (warm water soaks for 10-15 minutes, 2-3 times daily) can provide temporary relief while awaiting treatment.
Following surgery, patients should maintain soft stools through adequate hydration (8-10 glasses of water daily), a high-fiber diet (25-30g daily), and possibly continued stool softeners for 1-2 weeks. Pain management post-surgery typically includes acetaminophen or NSAIDs, with prescription pain medication for severe cases. According to the guidelines, non-operative management with dietary and lifestyle changes is recommended as first-line therapy for complicated hemorrhoids, but in the case of strangulated hemorrhoids, surgical intervention is necessary 1. The use of topical muscle relaxants may also be suggested to relieve symptoms, although the evidence is based on low-quality studies 1.
Key considerations for treatment include:
- Prompt surgical intervention to prevent complications
- Pain management with medications and stool softeners before and after surgery
- Maintenance of soft stools through hydration, high-fiber diet, and stool softeners
- Possible use of topical muscle relaxants to relieve symptoms
- Importance of immediate medical care to prevent dangerous complications.
From the Research
Treatment Options for Strangulated Hemorrhoids
- Acutely strangulated hemorrhoids can be treated either conservatively or operatively 2, 3
- Early operative intervention for strangulated internal hemorrhoids is safe and effective 3, 4
- Urgent surgical treatment, performed within 72 hours of presentation, can prevent negative economic and psychological effects of a prolonged recovery 4
- Conservative management may still require definitive treatment at a later date 2
Comparison of Treatment Approaches
- Conventional haemorrhoidectomy remains the most effective treatment in the long term, but has the main limitation of post-operative pain 2
- Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful 2, 5, 6
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 6
Considerations for Treatment
- The choice of treatment should be based on the severity of symptoms, patient preference, and presence of complications 5, 6
- Medical management, dietary modifications, and behavioral therapies are the mainstays of initial therapy 6
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is a preferred next step if initial therapy is unsuccessful 6