From the Guidelines
The treatment of hemorrhoids should begin with non-operative management as first line therapy, including dietary and lifestyle changes, and flavonoids may be administered to relieve symptoms, as recommended by the most recent guidelines 1. The treatment protocol for hemorrhoids typically involves a step-wise approach, starting with conservative measures to manage symptoms and prevent recurrence.
- Increasing fiber intake to 25-30 grams daily and drinking plenty of water can help soften stool and reduce straining during bowel movements.
- Avoiding straining during bowel movements and avoiding prolonged sitting can also help reduce pressure on the veins in the rectum.
- Topical creams and suppositories may be used to relieve symptoms, but their effectiveness is not well supported by evidence 1.
- For persistent symptoms, prescription medications like stronger corticosteroids or combination products containing anesthetics may be necessary.
- Physical treatments for more severe cases include rubber band ligation, sclerotherapy, or surgical options such as hemorrhoidectomy for large, persistent hemorrhoids.
- Surgery is typically reserved for grade III or IV hemorrhoids that don't respond to other treatments, and the decision to operate should be based on local expertise and patient preference 1.
- Lifestyle modifications remain crucial for prevention and long-term management, as hemorrhoids often recur without addressing underlying causes like constipation and straining. The use of flavonoids, such as micronized, purified flavonoid fraction (MPFF), has been shown to be effective in relieving symptoms of hemorrhoids, and may be considered as an adjunct to dietary and lifestyle changes 1. It's worth noting that the evidence for the treatment of hemorrhoids is not always consistent, and more research is needed to determine the most effective treatments for different types and severity of hemorrhoids.
- However, based on the most recent guidelines, non-operative management, including dietary and lifestyle changes, and flavonoids, should be the first line of treatment for hemorrhoids 1.
From the Research
Treatment Options for Hemorrhoids
The treatment protocol for hemorrhoids typically involves a combination of conservative management, interventional procedures, and surgery, depending on the severity of the condition.
- Conservative management is usually the first line of treatment, which includes a fiber-enriched diet, increased fluid intake, and topical ointments or suppositories 2, 3, 4, 5.
- Interventional procedures, such as rubber band ligation, are often used for grade I-II hemorrhoids that do not respond to conservative management 2, 4, 6.
- Surgery is typically reserved for grade III-IV hemorrhoids or those that are persistently symptomatic despite other treatments 2, 3, 5.
Surgical Options
Several surgical options are available for the treatment of hemorrhoids, including:
- Excisional hemorrhoidectomy, which is considered the gold standard for surgical procedures 2.
- Stapled hemorrhoidopexy (Longo), which is associated with reduced postoperative pain and faster recovery, but may have a higher recurrence rate 2.
- Hemorrhoidal Artery Ligation (HAL), which may be used in combination with Recto-Anal Repair (RAR) and is associated with better tolerance and faster recovery, but may also have a higher recurrence rate 2.
Postoperative Care
Postoperative care is an important aspect of hemorrhoid treatment, and may include: