From the Guidelines
For external thrombosed hemorrhoids, the most effective ointment for shrinking the hemorrhoid is hydrocortisone 1% cream, which should be applied up to four times daily for no more than one week, as it provides symptom relief and reduces swelling, according to the most recent and highest quality study available 1. The use of hydrocortisone 1% cream is recommended as part of a non-operative management approach, which includes dietary and lifestyle changes such as increased fiber and water intake, and adequate bathroom habits 1. Some key points to consider when using hydrocortisone 1% cream for external thrombosed hemorrhoids include:
- Apply the cream up to four times daily for no more than one week
- Use in conjunction with other treatments such as cold compresses and sitz baths for additional relief
- Maintain soft stools through increased fiber intake, adequate hydration, and avoiding straining during bowel movements to help prevent recurrence
- Consider surgical removal (thrombectomy) if symptoms do not improve within 7-10 days, or if severe pain or bleeding occurs, especially if treated within 72 hours of onset 1. It is essential to note that while other treatments such as witch hazel (e.g., Tucks pads) and Preparation H with phenylephrine may provide some relief, hydrocortisone 1% cream is the most effective ointment for shrinking external thrombosed hemorrhoids, based on the available evidence 1.
From the Research
Effective Ointments for External Hemorrhoidal Thrombosis
- The use of topical nifedipine ointment has been shown to be effective in treating acute thrombosed external hemorrhoids, with a study demonstrating complete relief of pain in 86% of patients after 7 days of therapy 2.
- A mixture of 0.3% nifedipine and 1.5% lidocaine ointment has been specifically used in the treatment of external hemorrhoidal thrombosis, with results showing resolution of acute thrombosed external hemorrhoids in 92% of patients after 14 days of therapy 2.
- Other options such as topical application of 0.2% glyceryl trinitrate have been proposed, but the effectiveness of this treatment is not as well-established as that of nifedipine ointment 3.
Comparison of Treatment Options
- The choice of treatment for external hemorrhoidal thrombosis remains controversial, with both conservative and surgical options available 3, 4.
- Conservative treatment options, including the use of topical ointments, may be preferred for patients who are elderly or have comorbidities, due to the lower risk of complications 4.
- Surgical treatment options, such as excision of the hemorrhoid, may be more effective in the long term, but may be associated with a higher risk of complications and are often refused by elderly patients 4.
Treatment Guidelines
- There are currently no specific guidelines for the treatment of external hemorrhoidal thrombosis, and the choice of treatment is often based on individual patient factors and physician preference 3, 4.
- Further research is needed to establish evidence-based guidelines for the treatment of external hemorrhoidal thrombosis, including the use of topical ointments and other conservative and surgical options 3, 4.