From the Guidelines
For patients with hemorrhoids, the most effective treatment approach is to start with non-operative management, including dietary and lifestyle changes, as first-line therapy, as recommended by the most recent guidelines 1. This approach includes increasing fiber intake, drinking plenty of water, and avoiding straining during bowel movements.
- Over-the-counter treatments such as witch hazel pads, hydrocortisone creams (0.5-1%, apply up to 3-4 times daily for no more than 7 days), and oral pain relievers like acetaminophen or ibuprofen can provide symptomatic relief.
- Warm sitz baths for 15 minutes, 2-3 times daily can also provide significant relief. For persistent or more severe hemorrhoids, a doctor may recommend prescription-strength hydrocortisone (2.5%) or procedures such as rubber band ligation, sclerotherapy, infrared coagulation, or surgical hemorrhoidectomy for the most severe cases, as suggested by older studies 1. However, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, as indicated by the most recent guidelines 1. Additionally, flavonoids may be administered to relieve symptoms, as recommended by the guidelines 1. It is essential to note that pregnant women should focus on non-medicinal approaches first and consult their doctor before using any medications. Maintaining regular bowel habits and avoiding prolonged sitting can help prevent recurrence after successful treatment.
From the Research
Treatment Options for Hemorrhoids
The treatment options for hemorrhoids can be categorized into non-surgical and surgical methods.
- Non-surgical methods include:
- Increased fiber intake to soften stool and reduce straining during bowel movements 2
- Sitz baths to relieve pain and discomfort 2
- Medications to reduce pain and inflammation 2
- Rubber band ligation, which is the most effective office-based procedure for grades I, II, and III hemorrhoids 2, 3, 4, 5
- Infrared coagulation for internal hemorrhoids 3
- Surgical methods include:
- Surgical hemorrhoidectomy, which is indicated after failure of non-surgical management and office-based procedures, and also as initial management for grades III and IV hemorrhoids 2, 3, 4, 5
- Stapled hemorrhoidopexy, which treats symptomatic internal hemorrhoids and should be employed with care and only after thorough training of the surgeon 3, 6
- Hemorrhoidal Artery Ligation (HAL), which demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate 6
- Recto-Anal Repair (RAR), which can be combined with HAL for the treatment of grade III and IV hemorrhoids 6
Specific Treatment Options for Different Types of Hemorrhoids
- For acutely thrombosed external hemorrhoids, excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management 2
- For prolapsed and strangulated hemorrhoids, treatment includes stool softeners, analgesics, rest, warm soaks, and ice packs until recovery, with residual hemorrhoids being banded or excised later 2
- For grade III and IV hemorrhoids, surgical hemorrhoidectomy or stapled hemorrhoidopexy may be employed 2, 3, 6