From the Guidelines
For external hemorrhoid treatment, topical nifedipine ointment is the most effective option, as it has been shown to increase the resolution rate of acute thrombosed external hemorrhoids. This is based on a prospective randomized study by Perrotti et al. 1 that found a sharp increase in resolution rate of acute thrombosed external hemorrhoids after 14 days of therapy with topical Nifedipine. The study enrolled 98 patients with thrombosed hemorrhoids and found a 92% resolution rate in the study group compared to 45.8% in the control group.
Some key points to consider when using topical nifedipine ointment for external hemorrhoid treatment include:
- Apply a small amount to the affected area after gentle cleaning and drying, especially following bowel movements
- Use the ointment 2-3 times daily for up to 2 weeks
- Increase fiber intake to 25-30g daily and drink plenty of water to prevent worsening symptoms
- Avoid straining during bowel movements to prevent further irritation
It's also important to note that other topical agents, such as hydrocortisone cream, may be beneficial in reducing inflammation and soothing irritation, but their effectiveness is not as well-established as topical nifedipine ointment for acute thrombosed external hemorrhoids 1. Additionally, prolonged use of potent corticosteroid preparations should be avoided due to the risk of harmful side effects 1.
In terms of other treatment options, flavonoids and phlebotonics have been shown to have a beneficial effect on hemorrhoidal symptoms, including pruritus, bleeding, and overall symptom improvement 1. However, their role in the treatment of acute thrombosed external hemorrhoids is not as well-established as topical nifedipine ointment.
Overall, the most effective treatment for external hemorrhoids will depend on the individual patient's symptoms and medical history, and may involve a combination of topical agents, lifestyle modifications, and medical therapies.
From the Research
Topical Ointments for External Hemorrhoids
- The most effective topical ointment for the treatment of external hemorrhoids is not explicitly stated in most studies, but some studies suggest the use of local hydrocortisone creams 2 or tribenoside + lidocaine combination 3.
- The tribenoside + lidocaine combination, available as a rectal cream or suppository, has been shown to have rapid and comprehensive efficacy on symptoms of hemorrhoids, with a fast onset of symptom relief and a duration of up to 10-12 hours 3.
- This combination has been formally evaluated in several well-conducted studies, including some specifically conducted in women, and has been found to be safe and effective in postpartum women and in pregnant women after the first trimester of pregnancy 3.
Treatment of External Hemorrhoids
- Excision is the most effective treatment for thrombosed external hemorrhoids 4.
- For non-thrombosed external hemorrhoids, conservative treatment with stool softeners, fiber supplements, and local therapy to relieve swelling and symptoms is recommended 5, 6.
- If medical therapy is inadequate, surgical intervention may be warranted, with options including rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy 5, 6.