What medication is used to treat hemorrhoids?

Medications for Treating Hemorrhoids

For hemorrhoids, flavonoids (particularly micronized purified flavonoid fraction) are recommended as the primary medication to relieve symptoms, with topical treatments including muscle relaxants, analgesics, and short-term corticosteroids providing additional symptomatic relief. 1, 2

First-Line Medications

• Flavonoids are suggested as the primary medication for hemorrhoid symptom relief, working by improving venous tone and reducing bleeding, pain, and swelling 1, 3
• Micronized purified flavonoid fraction (MPFF) is particularly effective for controlling acute bleeding in all grades of hemorrhoids 4
• Calcium dobesilate is another effective systemic medication option that has shown good results in hemorrhoid treatment 4

Topical Treatment Options

• Topical muscle relaxants are recommended for thrombosed or strangulated hemorrhoids to reduce pain and discomfort 1, 5
• Topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks is highly effective for external hemorrhoids by relaxing internal anal sphincter hypertonicity 2
• Topical analgesics provide symptomatic relief of local pain and itching associated with hemorrhoids 2, 6
• Corticosteroid creams can reduce local perianal inflammation but should be used for no more than 7 days to avoid thinning of perianal and anal mucosa 2, 5
• Topical nitrates have shown good results in relieving pain from thrombosed external hemorrhoids, though headaches may limit their use 2
• Topical heparin treatment has demonstrated significant improvement in healing and resolution of acute hemorrhoids 2

Suppositories

• Hemorrhoid suppositories provide symptomatic relief but lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion 2
• Over-the-counter topical agents and suppositories are widely used but have limited clinical data supporting their long-term effectiveness 2

Adjunctive Treatments

• Non-steroidal anti-inflammatory drugs (NSAIDs) are particularly effective for pain and edema in external hemorrhoid thrombosis 7
• Stool softeners and increased fiber intake should accompany medication therapy to prevent straining during defecation 2, 6, 3

Important Considerations

• Medication therapy primarily aims to control acute symptoms (especially bleeding) while waiting for definitive treatment, rather than curing hemorrhoids 4
• For thrombosed external hemorrhoids presenting within 72 hours, surgical excision provides faster symptom resolution than medication alone 2, 5
• For presentations beyond 72 hours, conservative management with medications is preferred 2, 5
• Simple incision and drainage of thrombosed hemorrhoids is not recommended due to persistent bleeding and higher recurrence rates 2, 5

Treatment Algorithm

• For all hemorrhoid grades, begin with increased fiber intake, adequate hydration, and flavonoids 2, 5, 3
• For symptomatic relief, add topical treatments based on symptoms:
  • For pain: Topical analgesics (lidocaine) 2, 6
  • For inflammation: Short-term corticosteroids (≤7 days) 2, 5
  • For thrombosed external hemorrhoids: Topical nifedipine with lidocaine 2
• If symptoms persist despite medical therapy, consider procedural interventions:
  • Grades 1-2: Rubber band ligation (success rate up to 89%) 2, 5, 3
  • Grades 3-4: Surgical options (hemorrhoidectomy or stapled hemorrhoidopexy) 6, 3