What is the most effective topical treatment for external hemorrhoids?

From the Guidelines

Topical muscle relaxants, such as nitroglycerin ointment or topical nifedipine, are the most effective treatment for external hemorrhoids, particularly for thrombosed or strangulated hemorrhoids, as they help relieve pain and reduce anal tone 1.

Key Points

• Nitroglycerin ointment has been shown to relieve pain due to thrombosed external hemorrhoids by decreasing anal tone 1.
• Topical nifedipine has been studied in a prospective randomized study, which found a sharp increase in resolution rate of acute thrombosed external hemorrhoids after 14 days of therapy, without observing any systemic side effects 1.
• Flavonoids may also be beneficial in relieving symptoms of hemorrhoids, although the evidence is moderate and the definition of "symptomatic" hemorrhoids is unclear 1.
• Steroid creams should be used with caution and for no more than 7 days, as long-term use can lead to thinning of perianal and anal mucosa and increase the risk of injury 1.

Treatment Considerations

• Dietary and lifestyle changes, such as increased fiber and water intake, are recommended as first-line therapy for complicated hemorrhoids 1.
• Topical agents, such as NSAIDs, topical steroids, and other topical agents, have limited evidence supporting their use and are not recommended based on available literature 1.

From the Research

Topical Treatments for External Hemorrhoids

• There is limited evidence on the most effective topical treatment for external hemorrhoids 2, 3, 4, 5, 6.
• Topical remedies may provide symptomatic relief, but the evidence for their effectiveness is poor 3.
• Some studies suggest that topical treatments such as metronidazole and topical sphincter relaxants may help reduce pain and symptoms 3.
• A 2020 study discussed the potential of new oral and topical treatments, including a sublingual nanoemulsion and a liquid bandage, but more research is needed to confirm their effectiveness 6.

Alternative Treatments for External Hemorrhoids

• Excision is considered the most effective treatment for thrombosed external hemorrhoids 5.
• Rubber band ligation is effective for prolapsed internal hemorrhoids, but may not be suitable for external hemorrhoids 3, 5.
• Surgical intervention, such as conventional hemorrhoidectomy, may be necessary for severe or persistent cases 2, 3, 5.

Management of Hemorrhoidal Disease

• Fiber supplementation is often recommended as the primary treatment for hemorrhoids 4.
• Acutely thrombosed external hemorrhoids can be treated with excision or conservative management 2, 4, 5.
• Patients with large or high-grade hemorrhoids may require surgical referral 4.