From the Guidelines
For the treatment of hemorrhoids, the best cream to use is a hydrocortisone cream (0.5-1%), as it effectively reduces inflammation, itching, and discomfort, as seen in over-the-counter products like Preparation H with hydrocortisone 1. When using these creams, apply a small amount to the affected area up to four times daily, particularly after bowel movements, for up to one week. Additionally, witch hazel-containing creams can provide relief by shrinking swollen tissues and reducing irritation. For more severe cases, prescription-strength creams containing higher concentrations of hydrocortisone or combinations with lidocaine may be necessary, as they work by reducing inflammation in the swollen hemorrhoidal tissue and temporarily numbing pain 1. Some key points to consider when treating hemorrhoids include:
- Maintaining soft stools through adequate fiber intake (25-30g daily)
- Proper hydration (6-8 glasses of water)
- Regular physical activity to prevent constipation that can worsen hemorrhoids
- Non-operative management as the first-line therapy, with dietary and lifestyle changes (i.e., increased fiber and water intake together with adequate bathroom habits) 1. It's essential to consult a healthcare provider if symptoms don't improve within a week, or if you experience severe pain or bleeding, as these may indicate a need for different treatment approaches.
From the Research
Treatment Options for Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also help alleviate symptoms 2
- For internal hemorrhoids, office-based treatment with rubber band ligation is a preferred next step if initial therapy is unsuccessful 2
Topical Treatments for Hemorrhoids
- A combination of tribenoside and lidocaine, available as a suppository or rectal cream, has been shown to be effective in relieving symptoms caused by hemorrhoids 3
- The Rectal Rocket, a uniquely designed suppository, delivers lidocaine and hydrocortisone directly to the site of inflammation and can be used to treat internal and external hemorrhoids, as well as anal fissures 4
Surgical Treatment of Hemorrhoids
- Surgical treatment is typically reserved for grades 3 and 4 hemorrhoids, or for patients who are refractory to or unable to tolerate office procedures 5, 6
- Various surgical techniques, such as laser, infrared photocoagulation, stapling, and harmonic scalpel, have been compared in terms of clinical outcomes, including pain, recurrence, and postoperative complications 6