From the Guidelines
For the treatment of hemorrhoids, the most effective approach is to start with lifestyle changes, including increasing fiber intake and drinking plenty of water, and then consider medical treatments such as rubber band ligation or surgical options like hemorrhoidectomy for more severe cases, as recommended by the most recent guidelines 1. The treatment of hemorrhoids depends on their severity, and medical therapy is most appropriate for first-degree hemorrhoids, with the cornerstone of medical therapy being adequate intake of fiber and water 1. Some key treatment options for hemorrhoids include:
- Lifestyle changes: increasing fiber intake (25-30g daily) and drinking plenty of water (8-10 glasses daily) to soften stool and reduce straining during bowel movements
- Over-the-counter treatments: topical creams containing hydrocortisone (0.5-1%) for inflammation, witch hazel pads for cleaning and soothing, and oral pain relievers like acetaminophen or ibuprofen
- Warm sitz baths for 15 minutes, 2-3 times daily to provide significant relief
- Medical treatments: rubber band ligation, sclerotherapy, infrared coagulation, or surgical options like hemorrhoidectomy for large, persistent hemorrhoids It's also important to note that for patients with complicated hemorrhoids, non-operative management as first line therapy, with dietary and lifestyle changes, is recommended, and flavonoids may be used to relieve symptoms 1. In cases of thrombosed hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, and incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1. Overall, the goal of treatment is to reduce symptoms, improve quality of life, and prevent complications, and the most effective approach will depend on the individual patient's needs and circumstances.
From the Research
Treatment Options for Hemorrhoids
- Non-surgical procedures for grade one and two hemorrhoids include rubber band ligation and sclerotherapy 2
- Sclerotherapy has been associated with fewer postoperative complications and more excellent patient response compared to rubber band ligation 2
- Alternative herbal remedies, such as witch hazel, horse chestnut, and triphala, have shown beneficial therapeutic effects on pain, bleeding, and swelling 3
- Micronized purified flavonoid fraction and sucralfate ointment have been used to treat symptoms of hemorrhoidal disease, including bleeding, pain, and itching 4
- Rubber band ligation is a safe and effective therapy for symptomatic internal hemorrhoids, with a success rate of 70.5% 5
- Injection sclerotherapy and rubber band ligation are efficient, inexpensive, and safe methods for the treatment of bleeding hemorrhoids, with a success rate of 85-90% 6
Medical Therapies
- Micronized purified flavonoid fraction (MPFF) has been proven to be effective in treating symptoms of hemorrhoidal disease 4
- Sucralfate ointment has shown good results in the reduction of hemorrhoidal pain and itching 4
- Corticosteroids, analgesics, and phlebotonics are commonly used to manage hemorrhoids, but have adverse side effects when used long-term 3
Natural Products
- Witch hazel (Hamamelis virginiana) has anti-inflammatory and astringent properties, making it a potential treatment for hemorrhoids 3
- Horse chestnut (Aesculus hippocastanum) has venotonic and anti-inflammatory properties, making it a potential treatment for hemorrhoids 3
- Triphala has anti-inflammatory and antioxidant properties, making it a potential treatment for hemorrhoids 3