From the Guidelines
The most effective treatment for external hemorrhoids involves a combination of home remedies, over-the-counter medications, and lifestyle changes, with the goal of reducing symptoms and preventing complications, as recommended by the most recent guidelines 1.
Key Recommendations
- Start with warm sitz baths for 15-20 minutes, 2-3 times daily to reduce swelling and discomfort.
- Apply over-the-counter creams or ointments containing hydrocortisone (0.5-1%) such as Preparation H or Anusol to reduce inflammation and itching, but limit use to 7 days to avoid potential side effects 1.
- Use witch hazel pads or wipes for cleaning and temporary relief.
- Take oral pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain.
- Increase fiber intake to 25-30 grams daily through foods or supplements like psyllium husk (Metamucil) 1 tablespoon 1-3 times daily, and drink 6-8 glasses of water daily to soften stools, as supported by a Cochrane review 1.
- Avoid straining during bowel movements and limit sitting on the toilet for extended periods.
Additional Considerations
- For patients with complicated hemorrhoids, non-operative management is recommended as first-line therapy, with dietary and lifestyle changes, and the use of flavonoids may be beneficial in relieving symptoms 1.
- In cases of thrombosed or strangulated hemorrhoids, the use of topical muscle relaxants may be considered, although the evidence is limited 1.
- Surgical options like hemorrhoidectomy or rubber band ligation may be necessary if symptoms persist or worsen, as recommended by the American Gastroenterological Association 1.
Important Notes
- The use of NSAIDs, topical steroids, and other topical agents is not recommended due to lack of evidence or potential side effects 1.
- Long-term use of high-potency corticosteroid preparations should be avoided due to potential harm 1.
From the FDA Drug Label
Warnings For external use only Use temporarily relieves minor pain Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily
The best treatment for external hemorrhoids is to apply a topical medication such as lidocaine to the affected area not more than 3 to 4 times daily. It is essential to follow the directions and warnings on the label, including avoiding contact with eyes and mucous membranes, and not bandaging or applying local heat to the area of use. If symptoms persist or worsen, consult a doctor 2, 2, 2.
From the Research
Treatment Options for External Hemorrhoids
- Medical management, including stool softeners and topical over-the-counter preparations, is often the first line of treatment for external hemorrhoids 3
- Topical hydrocortisone creams can be used to manage symptoms of external hemorrhoids 4
- A combination of tribenoside and lidocaine, available as a rectal cream or suppository, has been shown to be effective in treating hemorrhoids, including external hemorrhoids 5
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 3
- Topical nifedipine ointment has been shown to be effective in healing acute thrombosed external hemorrhoids, with significant relief of pain and reduction in the use of oral analgesics 6
Specific Treatments for External Hemorrhoids
- The Rectal Rocket, a suppository that delivers lidocaine and hydrocortisone directly to the site of inflammation, has been used to treat external hemorrhoids, as well as internal hemorrhoids and anal fissures 7
- Rubber band ligation is typically used to treat internal hemorrhoids, but other office-based procedures, such as infrared photocoagulation, may also be used to treat external hemorrhoids 3
- Hemorrhoidectomy, either open or closed, may be necessary for recurrent or higher-grade external hemorrhoids, but is typically reserved for more severe cases due to the associated pain and prolonged recovery time 3
Considerations for Treatment
- The severity of hemorrhoidal disease determines the proper therapy, and treatment options should be tailored to the individual patient's needs and symptoms 7, 4
- Patient preference and comorbidities should also be taken into account when determining the best course of treatment for external hemorrhoids 3