From the Guidelines
Treatment for internal hemorrhoids should prioritize non-operative management as first-line therapy, with dietary and lifestyle changes, and consider flavonoids to relieve symptoms, as recommended by the most recent guidelines 1.
Overview of Treatment Options
Treatment options for internal hemorrhoids range from conservative measures to medical and surgical interventions. The goal of treatment is to reduce symptoms, prevent complications, and improve quality of life.
Conservative Measures
For mild to moderate hemorrhoids, lifestyle changes are recommended first, including:
- Increasing fiber intake (25-30g daily)
- Drinking plenty of water (6-8 glasses daily)
- Avoiding straining during bowel movements These changes can help reduce symptoms and prevent further complications.
Medical Management
Over-the-counter medications like hydrocortisone creams or suppositories can reduce inflammation and discomfort, while oral pain relievers such as acetaminophen or ibuprofen can help manage pain.
Office-Based Procedures
For persistent symptoms, office-based procedures are available, including:
- Rubber band ligation (placing small bands around hemorrhoid tissue to cut off circulation)
- Sclerotherapy (injecting a chemical solution to shrink hemorrhoids)
- Infrared coagulation (using infrared light to harden and shrink hemorrhoids) However, no recommendation can be made regarding the role of office-based procedures in complicated hemorrhoids, based on the available literature 1.
Surgical Options
For severe or recurring hemorrhoids, surgical options include:
- Hemorrhoidectomy (surgical removal)
- Stapled hemorrhoidopexy (stapling hemorrhoids back into place)
- Hemorrhoid artery ligation These treatments work because they either reduce the swollen blood vessels that form hemorrhoids or remove the affected tissue entirely.
Proper Treatment Selection
Proper treatment selection depends on hemorrhoid severity, patient symptoms, and overall health status. Hemorrhoidectomy is generally reserved for the minority of patients who have large third-degree or fourth-degree hemorrhoids, acutely incarcerated and thrombosed hemorrhoids, hemorrhoids with an extensive and symptomatic external component, or patients who have undergone less aggressive therapy with poor results 1.
From the Research
Treatment Options for Internal Hemorrhoids
- Medical therapy should be initiated with stool softeners plus local therapy to relieve swelling and symptoms 2
- Rubber band ligation is the treatment of choice for grades 1 and 2 hemorrhoids 2, 3, 4
- For grade 3 hemorrhoids, rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy can be performed 2, 5
- Excisional hemorrhoidectomy or stapled hemorrhoidopexy is recommended for treatment of grade 4 hemorrhoids 2, 5
- Rubber band ligation causes less postoperative pain and fewer complications than excisional hemorrhoidectomy and stapled hemorrhoidopexy, but has a higher recurrence rate 2
- Stapled hemorrhoidopexy has a faster postoperative recovery, but a higher recurrence rate 2, 5
Non-Operative Measures
- Low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures such as rubber band ligation and injection sclerotherapy 5
- Dietary changes, stool softeners, and local hydrocortisone creams can be used to manage hemorrhoids conservatively 4
Surgical Interventions
- Excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids 5
- Minimally invasive operations such as Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy have been introduced to avoid post-hemorrhoidectomy pain 5
- Traditional hemorrhoidectomy is the best definitive treatment for prolapsed internal hemorrhoids 3