What are the treatment options for hemorrhoids?

From the Guidelines

Treatment for hemorrhoids should start with non-operative management as the first-line therapy, including dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as recommended by the World Journal of Emergency Surgery in 2021 1.

Key Considerations

• For mild hemorrhoids, lifestyle changes like increasing fiber intake (25-30g daily) and drinking plenty of water can help alleviate symptoms.
• Over-the-counter treatments, including witch hazel pads, hydrocortisone creams (0.5-1%, applied up to 3-4 times daily for no more than 7 days), and oral pain relievers like acetaminophen or ibuprofen, can provide relief.
• Warm sitz baths for 15-20 minutes several times daily can also help reduce discomfort.

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: using infrared radiation to shrink hemorrhoids.
  • Surgical options like hemorrhoidectomy for large, persistent hemorrhoids.

Surgical Intervention

• Surgical treatment may be considered for thrombosed hemorrhoids, with the decision between non-operative management and early surgical excision based on local expertise and patient preference, as suggested by the World Journal of Emergency Surgery in 2021 1.
• Incision and drainage of the thrombus are not recommended due to higher incidence of bleeding and relapse of symptoms.

Prevention of Recurrence

• Maintaining regular bowel habits, avoiding prolonged sitting on the toilet, and continuing a high-fiber diet after symptoms resolve can help prevent recurrence.
• Pregnant women should consult healthcare providers as some treatments may not be appropriate.

From the Research

Treatment Options for Hemorrhoids

The treatment of hemorrhoids can be divided into non-operative and operative approaches.

• Non-operative approaches include:
  • Lifestyle modification and fiber supplement 2, 3, 4, 5, 6
  • Suppository-delivered anti-inflammatory drugs 2
  • Administration of venotonic drugs 2
  • Sclerotherapy 2, 4, 6
  • Rubber band ligation 2, 4, 5, 6
• Operative approaches include:
  • Hemorrhoidectomy 2, 4, 5, 6
  • Stapled hemorrhoidopexy 2, 4, 5, 6
  • Minimally invasive treatments such as mucopexy with or without mucosal resection and hemorrhoid artery ligation 4, 5, 6

Conservative Treatment

Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease 3.

• Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool 3, 4
• Oral phlebotonic drugs can help to control symptoms 3
• Topical medications can also be beneficial for all patients complaining of hemorrhoidal disease 3

Surgical Treatment

Surgery is indicated when non-operative approaches have failed or complications have occurred 2, 4, 5, 6.

• Milligan-Morgan hemorrhoidectomy is considered to be the gold-standard approach for grade IV hemorrhoids 4
• Minimally invasive treatment options, including mucopexy with or without mucosal resection and hemorrhoid artery ligation, have been proposed for the management of grade III hemorrhoids 4, 5, 6