Why is my external hemorrhoid not reducing in size?

From the Guidelines

Your external hemorrhoid may not be shrinking due to inadequate dietary fiber intake and straining during bowel movements, and it is essential to add dietary fiber and avoid straining at stool to reduce its size. To address this, increasing fiber intake to 25-30 grams daily through foods like whole grains, fruits, and vegetables, or supplements like psyllium husk (1 tablespoon daily) is recommended, as shown in a study published in Gastroenterology 1. Additionally, drinking 8-10 glasses of water daily and avoiding straining during bowel movements can help alleviate symptoms.

Some key factors to consider when treating external hemorrhoids include:

• Increasing dietary fiber intake to reduce straining during bowel movements
• Avoiding over-the-counter topical agents and suppositories that lack data supporting their use, as mentioned in the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1
• Considering the use of oral micronized, purified flavonoid fraction (MPFF) (Daflon; Servier Laboratories, Neuilly-Sur-Seine, France), which has shown symptomatic improvement in some studies, including a placebo-controlled trial published in Gastroenterology 1
• Taking warm sitz baths for 15 minutes, 2-3 times daily, to help reduce discomfort and swelling

If the hemorrhoid is thrombosed (contains a blood clot), is very painful, bleeds frequently, or hasn't improved after 1-2 weeks of home treatment, it is crucial to see a healthcare provider, as they may recommend prescription-strength medications or procedures like rubber band ligation or surgical removal, as suggested in the american gastroenterological association medical position statement: diagnosis and treatment of hemorrhoids 1. Hemorrhoids often require consistent treatment and lifestyle changes to resolve completely, as the swollen blood vessels need time to heal and reduce in size.

From the Research

Possible Reasons for External Hemorrhoid Not Reducing in Size

• The external hemorrhoid may be thrombosed, causing painful swelling, and requires treatment such as conservative management or excision 2.
• The choice of treatment for external hemorrhoids remains controversial, and both conservative and surgical options have been proposed 2.
• Symptoms duration represents the discriminant in the choice between medical and surgical treatment, with surgical treatment recommended when symptoms onset falls within the last 48-72 hours 2.
• External hemorrhoids can be treated conservatively with options such as wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection, and topical application of 0.2% glyceryl trinitrate 2.
• If conservative management fails, surgical treatments such as drainage with radial incision, conventional excision, excision under local anesthesia, and stapled technique can be considered 2.

Treatment Options for External Hemorrhoids

• Conservative treatment is often the first-line approach for external hemorrhoidal thrombosis (EHT) 2, 3.
• Medical therapy can be initiated with stool softeners plus local therapy to relieve swelling and symptoms 4.
• Surgical intervention is warranted if medical therapy is inadequate 4.
• Excisional hemorrhoidectomy or stapled hemorrhoidopexy can be performed for advanced external hemorrhoids 4, 3, 5.

Factors Affecting Treatment Outcome

• The extent of the hemorrhoidal disease and the experience of the surgeon can influence the choice of procedure 6.
• The patient's symptoms and the grade of the hemorrhoids can also affect the treatment outcome 4, 5.
• Randomized clinical trials and structured consensus-based guidelines are warranted to determine the most effective treatment for external hemorrhoids 2.