From the Guidelines
External hemorrhoids can be effectively treated with procedures such as excision under local anesthesia for thrombosed cases, as well as other methods like rubber band ligation, sclerotherapy, infrared coagulation, or surgical hemorrhoidectomy for more severe cases. For mild cases, conservative treatments like warm sitz baths, over-the-counter creams containing hydrocortisone, and oral pain relievers can provide relief 1. Dietary changes including increased fiber intake and adequate hydration help soften stool and reduce straining.
Treatment Options
- Conservative treatments: warm sitz baths, over-the-counter creams, oral pain relievers
- Medical procedures: rubber band ligation, sclerotherapy, infrared coagulation
- Surgical options: hemorrhoidectomy for severe or persistent cases
- Excision under local anesthesia for thrombosed external hemorrhoids, as recommended by the American Gastroenterological Association 1 According to the American Gastroenterological Association, hemorrhoidectomy is the most effective treatment but is associated with more pain and complications, and should only be recommended for a small minority of patients 1. Indications for elective hemorrhoidectomy include failure of medical and nonoperative therapy, symptomatic third-degree or fourth-degree hemorrhoids, and patient preference after discussion of treatment options 1. Excision under local anesthesia is a recommended procedure for thrombosed external hemorrhoids, especially if diagnosed early. Recovery times vary depending on the procedure, with minimally invasive options typically taking 1-2 weeks and surgical options taking 2-4 weeks, during which stool softeners are recommended to prevent straining.
From the Research
Types of Procedures to Treat External Hemorrhoids
- Excision of thrombosed external hemorrhoids is a treatment option, as it can greatly reduce pain if performed within the first two to three days of symptoms 2
- Conservative treatment, such as stool softeners and local therapy, can be used to relieve swelling and symptoms of external hemorrhoids 3
- Medical therapy, including stool softeners and topical preparations, can be used to treat external hemorrhoids 3, 4
Surgical Options
- Excisional hemorrhoidectomy is a surgical option for treating external hemorrhoids, particularly for grade 4 hemorrhoids 3, 4
- Stapled hemorrhoidopexy is another surgical option, which can be used to treat grade 3 and 4 hemorrhoids, and has a faster postoperative recovery, but a higher recurrence rate 3, 4
- Hemorrhoidal artery ligation may be useful in treating external hemorrhoids, particularly for grade 2 and 3 hemorrhoids, as it can reduce pain and promote quicker recovery 2
Other Treatment Options
- Rubber band ligation is a treatment option for internal hemorrhoids, but can also be used for external hemorrhoids in some cases 3, 4, 5, 2
- Sclerosing or infrared therapy are not recommended as treatment options for external hemorrhoids due to lack of efficacy 4
- Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy are considered obsolete treatment options for external hemorrhoids due to poor or missing data 4