What medications are used to treat hemorrhoids?

Medications for Hemorrhoids

For hemorrhoid treatment, topical medications such as low-potency corticosteroids (hydrocortisone 1%) should be used for no more than 7 days, while phlebotonics (flavonoids) are recommended as first-line treatment for rectal itching and internal hemorrhoids, showing significant benefits for symptom improvement. 1

Medical Treatment Options

Topical Preparations

• Corticosteroids: Low-potency topical corticosteroids like hydrocortisone 1% can reduce inflammation and itching
  • Important limitation: Should be limited to a maximum of 7 days to prevent skin and mucosal atrophy 1
• Phlebotonics (Flavonoids): Demonstrate statistically significant benefits for:
  • Itching
  • Bleeding
  • Secretion
  • Overall symptom improvement 1
  • Available as micronized purified flavonoid fraction (MPFF) 2

Combination Therapies

• Combination of MPFF with topical preparations containing sucralfate and herbal extracts (calendula, witch hazel, chamomile) has shown good results for:
  • Pain control
  • Itching reduction
  • Edema reduction 2

Treatment Algorithm Based on Hemorrhoid Grade

First-Degree Hemorrhoids

1. Medical treatment with fiber and hydration as primary approach 1
2. Topical medications as adjunctive therapy
   • Phlebotonics (flavonoids)
   • Short-term topical corticosteroids (≤7 days)

Second-Degree Hemorrhoids

1. Start with medical treatment (as above)
2. If medical treatment fails, proceed to office procedures:
   • Rubber band ligation (preferred, 80% improvement rate) 1
   • Sclerotherapy (89.9% improvement/cure rate) 1

Third-Degree Hemorrhoids

• Office procedures or surgical intervention depending on severity 1

Fourth-Degree Hemorrhoids

• Surgical intervention is recommended 1

Supportive Conservative Measures

These should accompany medication use for all hemorrhoid grades:

• Dietary modifications:

  • High-fiber diet (25-30g daily)
  • Increased water intake (8-10 glasses daily) 1

• Lifestyle modifications:

  • Regular physical activity
  • Avoiding prolonged sitting on the toilet 1
  • Proper anal hygiene 1

Special Considerations

• Pregnancy: Conservative management preferred; defer surgical intervention until after delivery 1
• Immunocompromised patients: Require careful monitoring due to increased infection risk 1
• Patients on antithrombotic agents: May need medication adjustment before surgical intervention 1
• Patients with IBD: Extreme caution with surgical interventions due to high rate of complications 1

Common Pitfalls to Avoid

• Using topical corticosteroids for more than 7 days (can cause skin/mucosal atrophy) 1
• Relying solely on medications for high-grade hemorrhoids (grades III-IV) that require procedural intervention
• Failing to address underlying causes (constipation, straining) while using medications
• Using cryotherapy, which is no longer recommended due to prolonged pain and poor results 1

Remember that medications are most effective for lower-grade hemorrhoids (grades I-II), while higher-grade hemorrhoids (grades III-IV) typically require procedural or surgical intervention for definitive treatment 1, 3.