From the Guidelines
External hemorrhoids can be effectively treated with a combination of non-operative management and pharmacological therapies, prioritizing dietary and lifestyle changes, and considering the use of flavonoids to relieve symptoms, as recommended by the most recent guidelines 1. The treatment of external hemorrhoids should focus on reducing inflammation, improving blood flow to the area, and preventing constipation, which can exacerbate hemorrhoids.
- Key recommendations include:
- Increasing fiber intake to 25-30 grams daily through foods or supplements like psyllium husk (Metamucil) to soften stools 1
- Drinking 6-8 glasses of water daily to help prevent constipation 1
- Avoiding straining during bowel movements and limiting sitting on the toilet for extended periods 1
- Using moist towelettes instead of dry toilet paper to minimize irritation 1
- Considering the use of flavonoids to relieve symptoms, as suggested by the guidelines 1
- Applying over-the-counter hemorrhoid creams or ointments containing hydrocortisone (such as Preparation H) to the affected area up to four times daily for temporary relief, although the evidence for their effectiveness is limited 1 In cases of thrombosed external hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient preference, with a suggestion against the use of incision and drainage of the thrombus due to higher incidence of bleeding and relapse of symptoms 1.
- Surgical treatment may be beneficial in selected patients, but the evidence is scarce, and the decision should be made on a case-by-case basis, considering the patient's overall health and preferences 1. It is essential to consult a healthcare provider if symptoms persist beyond one week, worsen, or include severe pain or bleeding, as more aggressive treatments like rubber band ligation or surgical removal might be necessary 1.
From the Research
Treatment Options for External Hemorrhoids
- External hemorrhoids usually require no specific treatment unless they become acutely thrombosed or cause patient discomfort 2
- Excision is the most effective treatment for thrombosed external hemorrhoids 3
- In case of thrombosed haemorrhoids, excision allows for fast symptom resolution, with a low incidence of recurrence and a long remission interval 4
Comparison of Treatment Options
- Rubber band ligation produces the lowest rate of recurrence among nonoperative techniques for prolapsed internal hemorrhoids, but its effectiveness for external hemorrhoids is not explicitly stated 3
- Endoscopic Rubber Band Ligation of hemorrhoids (ERBL) is a feasible, safe, and efficient method for the treatment of symptomatic hemorrhoidal disease grades II and III, but its application for external hemorrhoids is not clearly defined 5
Special Considerations
- Patients with special conditions such as inflammatory bowel diseases, pregnancy, immunosuppression, coagulopathy, cirrhosis with portal hypertension, and proctitis after radiotherapy require careful management and may not be suitable for certain treatments 4
- A conservative medical approach is recommended for patients with portal hypertension and cirrhosis, with hemorrhoidectomy considered only when other treatments fail 4