What is the treatment for infected hemorrhoids?

From the Guidelines

Infected hemorrhoids should be managed with non-operative treatment as the first line of therapy, focusing on dietary and lifestyle changes, such as increased fiber and water intake, along with adequate bathroom habits. This approach is based on strong recommendations from recent guidelines 1. The management of infected hemorrhoids prioritizes relieving symptoms and preventing further complications.

Key Components of Management:

• Dietary and lifestyle modifications are crucial, including increased fiber and water intake to soften stools and ease bowel movements.
• Administering flavonoids may be suggested to relieve symptoms, although the evidence is moderate and the recommendation is weak 1.
• Topical muscle relaxants might be considered for thrombosed or strangulated hemorrhoids, but the evidence supporting this is of low quality 1.

Considerations:

• There is no clear recommendation for the use of NSAIDs, topical steroids, other topical agents, or injection of local anesthetics in the management of complicated hemorrhoids due to the lack of strong evidence 1.
• The primary goal is to manage symptoms effectively and prevent the progression of the condition, emphasizing the importance of early and appropriate intervention.

Monitoring and Follow-Up:

It is essential to monitor the patient's response to treatment and adjust the management plan as necessary. If there is no improvement or if symptoms worsen, further evaluation and potential surgical intervention may be required. Prompt recognition and treatment of infected hemorrhoids are critical to prevent morbidity and potential mortality, and to improve the quality of life for affected individuals.

From the Research

Infected Hemorrhoids Treatment

• The treatment for infected hemorrhoids typically involves a combination of medical management, dietary modifications, and behavioral therapies 2.
• Medical management may include the use of stool softeners, topical over-the-counter preparations, and topical nitroglycerine 2.
• Dietary modifications, such as increased fiber and water intake, can help to soften stool and reduce the risk of constipation, which can exacerbate hemorrhoids 2.
• Behavioral therapies, such as sitz baths, can help to reduce pain and discomfort associated with hemorrhoids 2.

Office-Based Treatments

• If initial therapies are unsuccessful, office-based treatments, such as rubber band ligation, may be considered for grades I to III internal hemorrhoids 2.
• Rubber band ligation has a lower failure rate than infrared photocoagulation and is generally considered the preferred next step for office-based treatment 2.

Surgical Options

• For more severe or recurrent cases of hemorrhoids, surgical options, such as open or closed excisional hemorrhoidectomy, may be necessary 2.
• Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain associated with the procedure 2.
• Stapled hemorrhoidopexy is another surgical option that may be considered for grade III or IV hemorrhoids, although it has several potential postoperative complications 2.

Drug Treatment

• Drug treatment, such as flavonoids, calcium dobesilate, nitrates, and nifedipine, may be used to control acute symptoms, such as bleeding and pain, associated with hemorrhoids 3.
• Topical application of isosorbide dinitrate ointment has been shown to be effective in reducing pain and promoting healing in patients with acute strangulated internal hemorrhoids 4.
• Nitroglycerin ointment has also been shown to reduce pain after hemorrhoidectomy, although it may be associated with side effects, such as headaches 5.

Antibiotic Treatment

• There is limited evidence to support the use of antibiotics, such as amoxicillin-clavulanate, for the treatment of infected hemorrhoids 6.
• In fact, one study found that amoxicillin-clavulanate was not as effective as ciprofloxacin for the treatment of acute uncomplicated cystitis, even in women infected with susceptible strains 6.