From the Guidelines
Treatment for external hemorrhoids typically involves a combination of home remedies and over-the-counter medications, with surgical procedures considered for severe or persistent cases, as suggested by the most recent guidelines 1. When managing external hemorrhoids, it's essential to prioritize measures that reduce discomfort, inflammation, and the risk of complications.
- Start with warm sitz baths for 15-20 minutes, 2-3 times daily to reduce swelling and discomfort.
- Apply over-the-counter creams containing hydrocortisone (0.5-1%) or witch hazel pads to reduce inflammation and itching, as these may provide symptomatic relief 1.
- Take oral pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) as needed for pain.
- Increase fiber intake to 25-30 grams daily through foods or supplements like psyllium husk (Metamucil, 1 tablespoon in water 1-3 times daily) to soften stool, which can help prevent straining during bowel movements 1.
- Drink 6-8 glasses of water daily to prevent constipation.
- Avoid straining during bowel movements and limit sitting on the toilet for extended periods.
For severe or persistent hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient preference, with surgical excision potentially offering more rapid symptom resolution and lower incidence of recurrence 1.
- Surgical excision is considered beneficial in selected patients, especially those with thrombosed hemorrhoids, where it may provide faster relief and reduce the risk of recurrence 1. However, the use of incision and drainage of the thrombus is not recommended due to higher incidence of bleeding and relapse of symptoms 1. It's also important to note that the evidence regarding the role of surgery for bleeding hemorrhoids is scarce, and thus, no specific recommendations can be made for this condition 1.
From the Research
Treatment Options for External Hemorrhoids
- External hemorrhoids usually require no specific treatment unless they become acutely thrombosed or cause patient discomfort 2
- Excision is the most effective treatment for thrombosed external hemorrhoids 3, 4
- Acutely thrombosed external hemorrhoids require excision of the entire hemorrhoidal mass and the overlying skin 4
- Incision is a primary treatment option for thrombosed external hemorrhoids, with excision as a secondary option 5
Non-Surgical Management
- Dietary changes, stool softeners, and local hydrocortisone creams can be used for conservative management of hemorrhoids 4, 6
- Increasing intake of fluids and fiber can help manage early symptoms of hemorrhoids 6
- Rubber band ligation is a treatment option for small or moderate sized internal hemorrhoids with minimal prolapse, but not typically used for external hemorrhoids 3, 6
Surgical Interventions
- Hemorrhoidectomy is a surgical option for advanced or complicated hemorrhoids, including external hemorrhoids that are severely thrombosed 5, 2, 6
- Closed hemorrhoidectomy is a technique that is effective and safe for managing large prolapsing or acutely thrombosed hemorrhoids 6
- Minimally invasive operations, such as Ligasure hemorrhoidectomy and stapled hemorrhoidopexy, have been introduced to reduce post-hemorrhoidectomy pain 2