From the Guidelines
Management options for external hemorrhoids in men should prioritize conservative measures as first-line treatment, with surgical interventions considered for thrombosed external hemorrhoids causing severe pain, particularly within 72 hours of symptom onset, based on the most recent guidelines from 2021 1. The conservative measures involve:
- Increasing dietary fiber intake to 25-30g daily
- Maintaining adequate hydration with 6-8 glasses of water daily
- Avoiding straining during defecation
- Topical treatments for symptomatic relief, including short-term use of over-the-counter preparations containing local anesthetics, mild astringents, or low-strength corticosteroids for up to 7 days
- Oral analgesics like paracetamol or ibuprofen for pain management
- Sitz baths for additional comfort These recommendations aim to reduce inflammation, alleviate discomfort, and prevent complications while addressing the underlying causes of hemorrhoid development. For 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 2021 guidelines 1. Surgical interventions, such as excision, may be considered for thrombosed external hemorrhoids causing severe pain, particularly within 72 hours of symptom onset, with the goal of providing rapid symptom resolution and reducing the risk of recurrence. It is essential to note that the evidence for surgical treatment of thrombosed hemorrhoids is scarce and of low quality, making it challenging to provide evidence-based recommendations, as highlighted in the 2021 guidelines 1.
From the Research
Management Options for External Hemorrhoids in Men
According to the provided studies, the management options for external hemorrhoids in men are as follows:
- For acutely thrombosed external hemorrhoids, excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management 2
- Excision of the entire hemorrhoidal mass and the overlying skin is also recommended for acutely thrombosed external hemorrhoids 3
- Outpatient excision of thrombosed external hemorrhoids under local anesthesia can be safely performed with a low recurrence and complication rate, and offers a high level of patient acceptance and satisfaction 4
- Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs 2
- If nonsurgical management is unsuccessful, rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids 2
Specific Considerations
Some key considerations for the management of external hemorrhoids in men include:
- The need for prompt treatment of acutely thrombosed external hemorrhoids to minimize complications and promote healing 2, 3
- The importance of patient education and follow-up care to prevent recurrence and manage symptoms 4
- The availability of various treatment options, including surgical and nonsurgical approaches, and the need to individualize treatment based on patient needs and preferences 5, 2