From the Guidelines
The best treatment for painful hemorrhoids is non-operative management as the first-line therapy, with dietary and lifestyle changes, including increased fiber and water intake, as well as adequate bathroom habits. This approach is supported by the most recent and highest quality study, which provides a strong recommendation based on moderate quality evidence 1.
Key Components of Treatment
- Increase fiber intake to 25-30 grams daily through foods or supplements like psyllium husk to soften stool
- Drink 6-8 glasses of water daily to prevent constipation
- Avoid straining during bowel movements and limit sitting on the toilet for extended periods
- Apply over-the-counter creams or ointments containing hydrocortisone to reduce inflammation and itching
- Take oral pain relievers like acetaminophen or ibuprofen to manage pain
Additional Considerations
- For severe or persistent hemorrhoids that don't respond to home treatment within 1-2 weeks, see a doctor as prescription medications or procedures like rubber band ligation or surgical removal may be necessary 1
- Flavonoids may be suggested to relieve symptoms, although the recommendation is weak and based on moderate quality evidence 1
- Topical muscle relaxants may be considered for thrombosed or strangulated hemorrhoids, but the evidence is low-quality and the recommendation is weak 1
Important Notes
- The use of NSAIDs, topical steroids, other topical agents, or injection of local anesthetics for complicated hemorrhoids is not recommended due to lack of evidence 1
- Surgical treatment may be considered for thrombosed hemorrhoids, but the decision should be based on local expertise and patient preference, and the evidence is scarce and of low quality 1
From the Research
Treatment Options for Painful Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for painful hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, can help alleviate symptoms 3, 4, 2
- Behavioral therapies, including sitz baths, can also provide relief 5, 2
- For internal hemorrhoids, rubber band ligation is a common office-based procedure that can be effective for grades I to III hemorrhoids 5, 3, 2
- Surgical options, such as open or closed excisional hemorrhoidectomy, may be necessary for higher-grade or recurrent hemorrhoids, but often result in more pain and a prolonged recovery 5, 4, 2
- Stapled hemorrhoidopexy and hemorrhoidal artery ligation are alternative surgical procedures that may be useful for certain cases of hemorrhoids, but have potential postoperative complications 3, 2
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 5, 2
Considerations for Treatment
- The size, location, and degree of thrombosis of the hemorrhoid can impact the extent of pain or discomfort 2
- Patient preferences, comorbidities, and risk factors should be taken into account when determining the best course of treatment 3, 2
- A thorough history and physical examination are necessary to assess for risk factors and clinical signs indicating more concerning disease processes 2