What medications are used to treat hemorrhoids (piles)?

Medications for Hemorrhoids (Piles)

Topical hydrocortisone preparations are the most effective first-line medication for treating hemorrhoids, with proven safety and efficacy even in pregnant women. 1

Classification of Hemorrhoids

Understanding the classification helps determine appropriate treatment:

• First degree: Bleed but don't protrude
• Second degree: Protrude with defecation but reduce spontaneously
• Third degree: Protrude and require manual reduction
• Fourth degree: Permanently prolapsed and cannot be reduced 1

Medical Treatment Options

First-Line Medications

1. Topical preparations:

   • Hydrocortisone creams/ointments: Reduce inflammation and itching; safe and effective even during pregnancy 1
   • Lidocaine (5%): Provides pain relief for acute symptoms, especially for thrombosed external hemorrhoids 2

2. Phlebotonics (flavonoids):

   • Improve venous tone and reduce bleeding, rectal pain, and swelling
   • Note: Symptom recurrence reaches 80% within 3-6 months after stopping treatment 2

Supportive Medications

1. Fiber supplements:

   • Bulk-forming agents (psyllium husk, methylcellulose)
   • Safe during pregnancy due to lack of systemic absorption
   • Improve stool viscosity and transit time 1

2. Stool softeners:

   • Osmotic laxatives (polyethylene glycol, lactulose) are safe even during pregnancy
   • Caution: May cause bloating 1
   • Avoid stimulant laxatives, especially during pregnancy 1

3. Analgesics:

   • NSAIDs for post-procedure pain management 1
   • Topical and oral analgesics for thrombosed external hemorrhoids 2

Treatment Algorithm Based on Hemorrhoid Grade

Conservative Management (All Grades)

1. Increase dietary fiber (25-30g daily)
2. Ensure adequate hydration
3. Sitz baths 2-3 times daily
4. Topical hydrocortisone preparations
5. Avoid straining during defecation
6. Avoid prolonged sitting 1

For Persistent Symptoms

• Grade I-III: Consider rubber band ligation (89% success rate) 1, 2
• Grade III-IV: Surgical options may be necessary when medications fail 1
• Thrombosed external hemorrhoids:
  • If within 72 hours of onset: Excision and evacuation of clot
  • If beyond 72 hours: Stool softeners, analgesics, sitz baths 3, 2

Special Considerations

• Pregnancy: Conservative management is strongly preferred; topical hydrocortisone has been proven safe in a study of 204 pregnant patients 1
• Immunocompromised patients: Higher infection risk with procedures; careful evaluation needed 1
• Liver cirrhosis/portal hypertension: Requires special caution to distinguish anal varices from hemorrhoids 1
• Patients on antithrombotic agents: Require careful management 4

Common Pitfalls to Avoid

1. Misdiagnosis: Rectal bleeding in adults over 50 requires colonoscopy to exclude colorectal cancer, even if hemorrhoids are visible 3

2. Overreliance on medications: For grade III-IV hemorrhoids, medications alone are often insufficient; procedural interventions may be necessary 1, 2

3. Inappropriate use of stimulant laxatives: These should be avoided, especially during pregnancy 1

4. Neglecting lifestyle modifications: Medications work best when combined with increased fiber, adequate hydration, and proper bowel habits 1, 2