From the Guidelines
Hemorrhoids should be treated with non-operative management as the first-line therapy, including dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as recommended by the World Journal of Emergency Surgery in 2021 1. The treatment of hemorrhoids involves a combination of home remedies and medical interventions.
- For mild hemorrhoids, increasing fiber intake to 25-30 grams daily through fruits, vegetables, and whole grains, or with supplements like psyllium (Metamucil) or methylcellulose (Citrucel) can help soften stool and reduce straining.
- Drinking plenty of water (6-8 glasses daily) and taking warm sitz baths for 10-15 minutes, 2-3 times daily can also help reduce inflammation and improve blood flow to the anal area.
- 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 1 week), and oral pain relievers like acetaminophen or ibuprofen, can provide symptomatic relief.
- For persistent or severe hemorrhoids, consulting a doctor may lead to recommendations for prescription-strength hydrocortisone, minimally invasive procedures like rubber band ligation, or surgical options.
- Lifestyle changes, such as avoiding straining during bowel movements, not sitting on the toilet for extended periods, exercising regularly, and maintaining a healthy weight, are crucial for prevention. The World Journal of Emergency Surgery recommends non-operative management as the first-line therapy for complicated hemorrhoids, with dietary and lifestyle changes being the cornerstone of treatment 1. In patients with thrombosed hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, as suggested by the World Journal of Emergency Surgery in 2021 1. However, the use of incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1.
From the Research
Treatment Options for Hemorrhoids
The treatment for hemorrhoids can be divided into non-prescription topical preparations, medical therapy, and surgical intervention.
- Non-prescription topical preparations can be used to treat mild symptoms of hemorrhoids 2.
- Medical therapy should be initiated with stool softeners plus local therapy to relieve swelling and symptoms 2.
- Surgical intervention is warranted if medical therapy is inadequate 2.
Surgical Intervention
Surgical intervention can be performed using various methods, including:
- Rubber band ligation, which is the treatment of choice for grades 1 and 2 hemorrhoids 2, 3.
- Excisional hemorrhoidectomy, which can be performed in patients with grade 3 hemorrhoids 2, 3.
- Stapled hemorrhoidopexy, which can be performed in patients with grade 3 hemorrhoids 2, 3.
- Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy, which are minimally invasive operations that can be used to treat hemorrhoids 4.
Treatment for Specific Types of Hemorrhoids
- Internal hemorrhoids can be treated with medication and non-operative measures, such as rubber band ligation and injection sclerotherapy 4.
- External hemorrhoids can be treated conservatively unless they become acutely thrombosed or cause patient discomfort 4.
- Thrombosed external hemorrhoids can be treated conservatively or excised 2.
Treatment for Hemorrhoids in Special Conditions
- Patients with inflammatory bowel diseases, such as Crohn's disease, may require special consideration when treating hemorrhoids 5.
- Patients with immunosuppression, coagulopathy, cirrhosis, or portal hypertension may require a conservative treatment approach 5.
- Patients with previous pelvic radiotherapy may require a conservative treatment approach to avoid severe complications 5.
- Patients in pregnancy can be effectively treated with medical therapy, reserving surgical intervention for highly selected and urgent cases 5.