From the Guidelines
Hemorrhoid management should begin with non-operative management as first-line therapy, with dietary and lifestyle changes, as recommended by the most recent guidelines 1. The management options for hemorrhoids include:
- Conservative measures such as increased dietary fiber, adequate hydration, and avoiding straining during bowel movements
- Non-operative techniques like rubber band ligation, sclerotherapy, or infrared photocoagulation for symptomatic hemorrhoids
- Surgical removal (hemorrhoidectomy) for persistent or severe hemorrhoids
- Topical treatments like flavonoids to relieve symptoms, although the evidence is moderate and the recommendation is weak 1 It's essential to note that the decision between non-operative management and early surgical excision for thrombosed hemorrhoids should be based on local expertise and patient preference, as suggested by the guidelines 1. The use of topical muscle relaxants may be considered for thrombosed or strangulated hemorrhoids, although the evidence is low-quality and the recommendation is weak 1. Regular bowel habits through proper diet and exercise are crucial for preventing recurrence, as hemorrhoids develop from increased pressure in the lower rectum, often due to straining or prolonged sitting. In terms of specific treatments, rubber band ligation is associated with the lowest recurrence rate among non-operative techniques, although it may cause more discomfort than other methods 1. Overall, the management of hemorrhoids should prioritize non-operative management as first-line therapy, with a focus on dietary and lifestyle changes, and consider other treatment options based on the severity of symptoms and patient preferences.
From the Research
Management Options for Hemorrhoids
The management options for hemorrhoids can be divided into non-surgical and surgical approaches.
- Non-surgical approaches include:
- Medical therapy with stool softeners and local therapy to relieve swelling and symptoms 2
- Rubber band ligation, which is the treatment of choice for grades 1 and 2 hemorrhoids 2, 3, 4
- Sclerotherapy, which can be used to treat grade 1 and 2 hemorrhoids 3, 5
- Phlebotonic drugs, which can be used to treat grade 1 and 2 hemorrhoids 4
- Surgical approaches include:
- Excisional hemorrhoidectomy, which is recommended for treatment of grade 4 hemorrhoids 2, 4
- Stapled hemorrhoidopexy, which can be performed in patients with grade 3 hemorrhoids and has a faster postoperative recovery, but a higher recurrence rate 2, 6, 4
- Milligan-Morgan haemorrhoidectomy, which is considered to be the gold-standard approach for grade IV haemorrhoids 4
- Minimally invasive treatment options, such as mucopexy with or without mucosal resection and haemorrhoid artery ligation, which can be used to treat grade III haemorrhoids 6, 4
- Ligasure hemorrhoidectomy and doppler-guided hemorrhoidal artery ligation, which are minimally invasive operations that can be used to treat hemorrhoids 6
Treatment of External Hemorrhoids
- External hemorrhoids can be treated conservatively or excised, especially if they become acutely thrombosed or cause patient discomfort 2, 6
- Thrombosed external hemorrhoids can be treated with excision or conservative management 2