From the Guidelines
The treatment for a bleeding hemorrhoid is primarily non-operative management with dietary and lifestyle changes, including increased fiber and water intake.
Treatment Options
- Dietary and lifestyle changes: Increased fiber and water intake, along with adequate bathroom habits, are recommended as first-line therapy for complicated hemorrhoids 1.
- Flavonoids: May be used to relieve symptoms, as they increase venous tone, lymphatic drainage, and capillary resistance, and normalize capillary permeability 1.
- Topical agents: Topical analgesics and corticosteroid creams may bring symptomatic relief, but their use is not strongly supported by evidence, and long-term use of high-potency corticosteroid creams should be avoided 1.
Important Considerations
- Avoid straining at stool: Straining can exacerbate hemorrhoidal symptoms, and controlling diarrhea with fiber, anti-motility agents, and specific treatment of any underlying cause may be beneficial 1.
- Limit use of corticosteroids: Prolonged use of potent corticosteroid preparations can be harmful and should be avoided 1.
From the Research
Treatment Options for Bleeding Hemorrhoids
- Non-operative approaches include sclerotherapy and rubber band ligation, which can be effective in treating low-graded internal hemorrhoids 2, 3
- Medications such as fiber supplements, suppository-delivered anti-inflammatory drugs, and venotonic drugs can also be used to treat hemorrhoids 2
- Minimally invasive procedures like stapled hemorrhoidopexy, Ligasure hemorrhoidectomy, and doppler-guided hemorrhoidal artery ligation can be used to treat high-graded internal hemorrhoids or when non-operative approaches have failed 3, 4
- Surgical approaches like hemorrhoidectomy can be used to treat advanced hemorrhoids, but may cause postoperative pain and other complications 2, 3
Non-Surgical Management
- Rubber band ligation (RBL) can stop bleeding in up to 90% of cases and improve III degree hemorrhoids in 78%-83.8% of cases 5
- Injection sclerotherapy (IS) can bring about the resolution of prolapse in 90%-100% of II degree hemorrhoids and allow good results for III degree hemorrhoids 5
- Infrared coagulation (IRC) can improve I, II, and III degree hemorrhoids in 78%, 51%, and 22% of cases, respectively 5
Special Considerations
- Patients with special conditions such as pregnancy, immunosuppression, coagulopathy, cirrhosis with portal hypertension, and proctitis after radiotherapy require careful management and may need to be treated with caution 6
- Medical therapy is often recommended as the first-line treatment for patients with these special conditions, with surgical intervention reserved for highly selected and urgent cases 6