From the Guidelines
External hemorrhoids can be effectively treated with a combination of home remedies, over-the-counter medications, and, in some cases, surgical excision, with the decision between non-operative management and early surgical excision based on local expertise and patient preference 1.
Treatment Options
- Start with warm sitz baths for 15-20 minutes, 2-3 times daily to reduce swelling and discomfort.
- Apply over-the-counter creams or ointments containing hydrocortisone (such as Preparation H or Tucks) to reduce inflammation and itching, as suggested by the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1.
- Use witch hazel pads or medicated wipes after bowel movements for cleaning and soothing the area.
- Take oral pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) as needed for pain.
- Increase fiber intake to 25-30 grams daily and drink 6-8 glasses of water to soften stools and prevent straining, as recommended by the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1.
- Avoid sitting for prolonged periods and use a donut-shaped cushion to reduce pressure on the affected area.
Surgical Excision
- Surgical excision can be beneficial in selected patients with thrombosed external hemorrhoids, with a significantly shorter time to symptom resolution and reduced incidence of recurrence compared to conservative management 1.
- The decision to undergo surgical excision should be based on local expertise and patient preference, taking into account the potential risks and benefits of the procedure.
- Incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1.
Indications for Surgical Treatment
- Failure of medical and non-operative therapy.
- Symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids.
- Symptomatic hemorrhoids in the presence of a concomitant anorectal condition that requires surgery.
- Patient preference, after discussion of treatment options with the referring physician and surgeon 1.
From the Research
External Hemorrhoid Treatment Options
- Medical therapy for external hemorrhoids typically involves stool softeners and local therapy to relieve swelling and symptoms 2
- Thrombosed external hemorrhoids can be treated conservatively or excised, with excision often providing significant pain relief if performed within the first few days of symptoms 2, 3
- Conservative management of external hemorrhoids may include lifestyle modifications, fiber supplements, and topical preparations such as anti-inflammatory drugs and venotonic drugs 4, 5
- Surgical options for external hemorrhoids are typically reserved for cases where conservative management has failed or complications have occurred, and may include excisional hemorrhoidectomy or stapled hemorrhoidopexy 2, 4
Considerations for Treatment
- The choice of treatment for external hemorrhoids depends on the severity of symptoms, the presence of thrombosis, and the patient's overall health and preferences 3
- Medical treatment can be effective in relieving symptoms and minimizing anal discomfort, even in advanced cases of hemorrhoids 5
- Postoperative pain and complications can be significant with surgical treatments, and should be carefully considered when deciding on a treatment plan 2, 4