From the Guidelines
External hemorrhoids can be effectively managed with topical treatments, lifestyle modifications, and oral medications that reduce inflammation, improve blood flow, and prevent straining during bowel movements. The primary goal of treatment is to alleviate symptoms such as pain, itching, and bleeding, while also preventing further complications. According to the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1, medical treatment for external hemorrhoids often involves adding dietary fiber and avoiding straining at stool. Some key medications and treatments include:
- Topical analgesics to bring symptomatic relief of local pain and itching
- Corticosteroid creams to ameliorate local perianal inflammation, although long-term use of high-potency corticosteroid creams should be avoided due to potential deleterious effects 1
- Nitroglycerin ointment to relieve pain due to thrombosed external hemorrhoids by decreasing anal tone 1
- Oral micronized, purified flavonoid fraction (MPFF) to increase venous tone, lymphatic drainage, and capillary resistance, and normalize capillary permeability 1
- Fiber supplements such as psyllium husk to reduce hemorrhoidal bleeding and painful defecation 1 It is essential to note that while these treatments can provide relief, they should be used in conjunction with lifestyle changes, such as increasing water intake, eating more fiber, avoiding prolonged sitting, and using warm sitz baths, to significantly improve symptoms 1. If symptoms persist or are severe, medical evaluation is necessary to determine the best course of treatment, which may include prescription-strength medications or procedures 1.
From the Research
Medications for External Hemorrhoids
- Topical preparations, such as stool softeners and local therapy, can be used to relieve swelling and symptoms of external hemorrhoids 2
- Nonsteroidal anti-inflammatory drugs, narcotics, fiber supplements, and topical antispasmodics can be used to treat postoperative pain from excisional hemorrhoidectomy 2
- Topical nifedipine ointment can be used to treat acute thrombosed external hemorrhoids, with studies showing complete relief of pain in 86% of patients after 7 days of therapy 3
- Local hydrocortisone creams can be used to manage hemorrhoids conservatively 4
- Topical over-the-counter preparations and topical nitroglycerine can be used as part of medical management for hemorrhoids 5
Treatment Options for Thrombosed External Hemorrhoids
- Excision of the entire hemorrhoidal mass and the overlying skin can be performed to treat acutely thrombosed external hemorrhoids 4
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 5
- Conservative treatment with topical nifedipine ointment can be used to treat thrombosed external hemorrhoids, with a resolution rate of 92% after 14 days of therapy 3