From the Guidelines
Treatment for internal hemorrhoids typically begins with conservative measures such as increasing fiber intake, drinking more water, and using over-the-counter medications, as recommended by the most recent guidelines 1. The cornerstone of medical therapy is adequate intake of fiber and water, which helps soften stool and reduce straining, as noted in the american gastroenterological association medical position statement 1. Some key points to consider in the treatment of internal hemorrhoids include:
- Increasing fiber intake with supplements like psyllium (Metamucil) or methylcellulose (Citrucel), taken at 3-6 grams daily, to help soften stool and reduce straining 1
- Using over-the-counter creams containing hydrocortisone (0.5-1%) to reduce inflammation and itching when applied up to 3-4 times daily for short periods 1
- Taking warm sitz baths for 10-15 minutes, 2-3 times daily, to provide relief 1
- Considering medical procedures such as rubber band ligation, sclerotherapy, infrared coagulation, or surgical removal (hemorrhoidectomy) for persistent or severe cases, as outlined in the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1 and the american gastroenterological association medical position statement 1
- Maintaining good bowel habits, avoiding prolonged sitting on the toilet, and regular exercise to help prevent recurrence after treatment, as suggested by the anorectal emergencies: wses-aast guidelines 1 It's essential to note that the most recent guidelines recommend non-operative management as first-line therapy for complicated hemorrhoids, with dietary and lifestyle changes, and suggest the use of flavonoids to relieve symptoms 1.
From the Research
Treatment Options for Internal Hemorrhoids
The treatment for internal hemorrhoids depends on the severity of the condition and the patient's overall health. According to 2, medical management, dietary modifications, and behavioral therapies are the mainstays of initial therapy.
- Medical management includes:
- Stool softeners
- Topical over-the-counter preparations
- Topical nitroglycerine
- Dietary modifications include:
- Increased fiber intake
- Increased water intake
- Behavioral therapies include:
- Sitz baths
Office-Based Treatments
If initial therapy is unsuccessful, office-based treatments such as rubber band ligation may be considered. According to 2, rubber band ligation is the preferred next step for grades I to III internal hemorrhoids due to its lower failure rate compared to infrared photocoagulation.
Surgical Options
Surgical options such as open or closed excisional hemorrhoidectomy may be considered for recurrent or higher-grade disease. According to 2, closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain. Stapled hemorrhoidopexy is another surgical option that elevates grade III or IV hemorrhoids to their normal anatomic position by removing a band of proximal mucosal tissue, but it has several potential postoperative complications 2.
Other Treatment Options
Other treatment options for internal hemorrhoids include:
- Injection sclerotherapy: a non-operative approach that involves injecting a sclerosing agent into the hemorrhoid tissue 3
- Hemorrhoidal artery ligation: a procedure that involves ligating the arteries that supply blood to the hemorrhoids 4
- Transanal Haemorrhoidal Dearterialization: a non-excisional and less invasive procedure that has been promoted as an alternative to traditional hemorrhoidectomy 5
Considerations for Treatment
When considering treatment options for internal hemorrhoids, factors such as the degree of discomfort, bleeding, comorbidities, and patient preference should be taken into account 2. Additionally, the potential risks and benefits of each treatment option, including postoperative pain and recurrence rates, should be carefully considered 6, 5.