What medications are used to treat hemorrhoids?

Medications for Hemorrhoid Treatment

The most effective medications for treating hemorrhoids include mesalamine (5-ASA) suppositories for internal hemorrhoids, topical hydrocortisone preparations for inflammation and itching, and phlebotonics (flavonoids) for controlling bleeding and pain. 1

First-Line Medical Treatments

Conservative Measures (Before Medications)

• Increase fiber intake to 25-30g daily
• Ensure adequate hydration
• Take sitz baths 2-3 times daily
• Avoid straining during defecation
• Avoid prolonged sitting
• Maintain regular physical activity

Topical Treatments

• Hydrocortisone preparations:

  • First-line for reducing inflammation, itching, and discomfort
  • Safe for short-term use including in pregnant women
  • Patches (4-5% strength) are more effective than creams or ointments due to gradual delivery 1
  • Should be used for short periods due to potential long-term safety concerns

• Topical anesthetics:

  • 5% lidocaine for temporary pain relief
  • Caution: Avoid using with intravenous lidocaine to prevent toxicity 1

Oral Medications

• Phlebotonics (flavonoids):

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

• Micronized Purified Flavonoid Fraction (MPFF):

  • Particularly effective for controlling acute bleeding
  • Recommended for patients waiting for definitive outpatient treatment 3

Medications for Specific Patient Populations

Pregnant Women

• Bulk-forming agents:

  • Psyllium husk
  • Methylcellulose

• Osmotic laxatives (when necessary):

  • Polyethylene glycol (PEG)
  • Lactulose 1

• Topical hydrocortisone:

  • Safe and effective with no adverse events reported in a prospective study of 204 pregnant patients 1

Patients with Cirrhosis/Portal Hypertension

• Require special caution to distinguish anal varices from hemorrhoids
• Medical management preferred over surgical interventions 1

Treatment Algorithm Based on Hemorrhoid Grade

Grade I-II Hemorrhoids

1. First step: Conservative measures + topical treatments
2. If persistent: Add phlebotonics
3. If still symptomatic: Consider office-based procedures (rubber band ligation, sclerotherapy)

Grade III-IV Hemorrhoids

1. First step: Conservative measures + medications for symptom control
2. Definitive treatment: Procedural or surgical approaches are usually required

External Hemorrhoids (Thrombosed)

• Within 72 hours of onset: Clot evacuation + analgesics
• After 72 hours: Medical treatment with stool softeners, oral and topical analgesics (5% lidocaine) 2

Common Pitfalls and Caveats

• Topical treatments provide temporary relief but don't cure hemorrhoids
• Medications primarily control symptoms while awaiting definitive treatment
• Anorectal symptoms are often misattributed to hemorrhoids when other conditions may be present
• Phlebotonics show high recurrence rates after discontinuation
• Long-term use of topical steroids may cause local skin atrophy and should be avoided

Efficacy of Medical Treatment

Medical treatments are most effective for grade I-II hemorrhoids, with decreasing efficacy as grade increases. Grade III-IV hemorrhoids typically require procedural or surgical intervention, with medications serving primarily as adjunctive therapy for symptom control 1, 2.