From the Guidelines
Treatment for a child with hemorrhoids should start with conservative measures, focusing on increasing fiber intake, proper hydration, and avoiding straining during bowel movements, as recommended by the most recent guidelines 1. The goal is to reduce inflammation, soften stool, and promote healing of the irritated tissue.
- Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce symptoms.
- Proper hydration is essential to prevent constipation and reduce the risk of hemorrhoid recurrence.
- Avoiding harsh soaps in the anal area and encouraging the child not to strain during bowel movements can also help alleviate symptoms.
- Over-the-counter options like witch hazel pads for gentle cleaning and pediatric-appropriate creams containing hydrocortisone (0.5-1%) for short-term use (3-7 days) may provide relief.
- Acetaminophen can be given for pain according to weight-based dosing on the package.
- If constipation is present, pediatric stool softeners like Miralax (polyethylene glycol 3350) at 0.5-1.5 g/kg/day can help.
- Flavonoids have been suggested to relieve symptoms in patients with complicated hemorrhoids, as stated in the guidelines 1. It is essential to note that surgical intervention is rarely needed but sometimes required for severe cases, and medical evaluation is necessary if symptoms persist beyond two weeks, worsen, or if there's significant bleeding. Hemorrhoids in children are often related to constipation, so addressing the underlying cause is crucial for preventing recurrence. The most recent and highest quality study 1 provides a strong recommendation for non-operative management as first-line therapy, with dietary and lifestyle changes, and suggests the use of flavonoids to relieve symptoms.
From the Research
Treatment Options for Hemorrhoids in Children
- For children with hemorrhoids, the treatment approach is generally conservative, focusing on dietary modifications and behavioral changes to alleviate symptoms 2, 3.
- A fiber-enriched diet is often recommended as the primary treatment option, which can help soften stool and reduce straining during bowel movements 4, 2.
- Topical ointments or suppositories may be used to provide temporary relief from symptoms such as pain, itching, and bleeding 5, 3.
- In some cases, flavonoids may be prescribed to help control acute bleeding and reduce inflammation 5, 6.
- For more severe cases, office-based procedures like rubber band ligation may be considered, although this is typically reserved for older children and adults 2, 3.
Dietary and Lifestyle Modifications
- Increasing fiber intake through foods like fruits, vegetables, and whole grains can help prevent constipation and reduce symptoms of hemorrhoids 4, 2.
- Adequate hydration is also essential to soften stool and make bowel movements easier 4, 3.
- Teaching children to practice good bowel habits, such as responding to the urge to defecate and avoiding straining, can help prevent hemorrhoids from developing or worsening 4, 2.
Alternative and Complementary Therapies
- Some studies suggest that natural products like witch hazel, horse chestnut, and triphala may have anti-inflammatory and wound-healing properties that can help alleviate hemorrhoidal symptoms 6.
- However, more research is needed to fully understand the effectiveness and safety of these alternative therapies in children with hemorrhoids 6.