From the Guidelines
Hemorrhoids typically last from a few days to several weeks, with most cases resolving within 1-2 weeks with proper treatment, and the most effective treatment is often a combination of lifestyle modifications and medical interventions, with rubber band ligation being a highly effective option for persistent or severe cases, as supported by studies such as 1 and 1.
Duration and Treatment of Hemorrhoids
The duration of hemorrhoids can vary depending on the severity and treatment approach. For mild cases, home treatments and lifestyle modifications can be effective in resolving symptoms within a few days to a week. However, for more severe cases, medical treatments such as rubber band ligation, sclerotherapy, or surgical removal may be necessary.
Lifestyle Modifications
Lifestyle modifications are crucial in the management of hemorrhoids and include:
- Increasing fiber intake to 25-30g daily
- Drinking plenty of water (8-10 glasses daily)
- Avoiding straining during bowel movements
- Regular exercise
Medical Treatments
For persistent or severe hemorrhoids, medical treatments may be necessary, including:
- Rubber band ligation: a highly effective option for persistent or severe cases, with success rates ranging from 88% to 100% in randomized trials, as reported in 1
- Sclerotherapy: a less invasive option, but with lower success rates compared to rubber band ligation
- Infrared coagulation: a non-invasive option, but with variable success rates
- Surgical removal: reserved for severe cases or those that do not respond to other treatments, with a higher risk of complications, as noted in 1 and 1
Importance of Medical Attention
If symptoms worsen, include significant bleeding, severe pain, or do not improve after a week of home treatment, medical attention should be sought promptly to prevent further complications and ensure proper management. As stated in 1, medical therapy is most appropriate for first-degree hemorrhoids, and the cornerstone of medical therapy is adequate intake of fiber and water.
From the Research
Duration of Hemorrhoids
- The duration of hemorrhoids can vary, but most patients experience mild symptoms that can be treated with nonprescription topical preparations 2.
- Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids, indicating that hemorrhoids can be a long-term condition 3.
- The duration of hemorrhoids is not explicitly stated in the studies, but it is implied that hemorrhoids can be a recurring condition that requires ongoing management.
Most Effective Treatment
- Rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids 3, 2.
- Surgical hemorrhoidectomy is indicated after failure of nonsurgical management and office-based procedures and also as initial management for grades III and IV hemorrhoids 3, 2.
- Excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids, but minimally invasive operations such as Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy have been introduced to avoid post-hemorrhoidectomy pain 4, 5.
- A meta-analysis of randomized controlled trials found that rubber-band ligation is recommended as the initial mode of therapy for grades 1 to 3 hemorrhoids, while hemorrhoidectomy should be reserved for patients whose hemorrhoids fail to respond to rubber-band ligation 6.
Treatment Options
- Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs 3.
- Medical therapy should be initiated with stool softeners plus local therapy to relieve swelling and symptoms 2.
- Topical remedies provide no more than symptomatic relief, and bulk laxatives alone may improve symptoms of both bleeding and prolapse 5.
- Rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy can be performed in patients with grade 3 hemorrhoids, while excisional hemorrhoidectomy or stapled hemorrhoidopexy is recommended for treatment of grade 4 hemorrhoids 2, 5.