From the Guidelines
Suppressive hemorrhoid treatment should start with non-operative management as the first-line therapy, including dietary and lifestyle changes, such as increased fiber and water intake, as well as adequate bathroom habits, as recommended by the World Journal of Emergency Surgery 1.
Key Recommendations
- Dietary changes: increased fiber intake (25-30g daily) and adequate hydration (8-10 glasses of water daily) to soften stools and reduce straining.
- Lifestyle modifications: adequate bathroom habits, avoiding prolonged sitting, and not straining during bowel movements.
- Over-the-counter medications: flavonoids to relieve symptoms, as suggested by the World Journal of Emergency Surgery 1.
Additional Considerations
- For patients with thrombosed or strangulated hemorrhoids, topical muscle relaxants may be considered, although the evidence is based on low-quality evidence 1.
- Surgical treatment may be considered for patients with complicated hemorrhoids, but the decision should be based on local expertise and patient preference, as suggested by the World Journal of Emergency Surgery 1.
Important Notes
- The use of incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1.
- The evidence for stapled hemorrhoidectomy in the acute care setting is scarce, and its use is not recommended due to the potential for life-threatening complications 1.
From the Research
Suppressive Hemorrhoid Treatment Options
- Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease, including dietary and lifestyle modifications, oral phlebotonic drugs, and topical medications 2, 3
- Medical management, such as stool softeners, topical over-the-counter preparations, and topical nitroglycerine, can be used as initial therapy 4
- Rubber band ligation is a preferred next step for grades I to III internal hemorrhoids, with a lower failure rate than infrared photocoagulation 4
- Surgical options, such as open or closed excisional hemorrhoidectomy, stapled hemorrhoidopexy, and hemorrhoidal artery ligation, are available for more advanced or recurrent cases 4, 5, 6
Non-Surgical Interventions
- Dietary modifications, including increased fiber and water intake, can help achieve regular defecation with soft stool 2, 4
- Topical medications, such as ointments and creams, can be beneficial for symptom relief 2, 3
- Phlebotonic drugs can help control symptoms in early stages of the disease 2, 3
- Sitz baths and other behavioral therapies can also be used as part of initial therapy 4
Surgical Interventions
- Excisional hemorrhoidectomy is considered the gold-standard approach for grade IV hemorrhoids 6
- Minimally invasive treatment options, such as mucopexy with or without mucosal resection and hemorrhoid artery ligation, are available for grade III hemorrhoids 5, 6
- Stapled hemorrhoidopexy can be used to elevate grade III or IV hemorrhoids to their normal anatomic position 4, 5