From the Guidelines
Treatment for internal hemorrhoids should begin with conservative measures, including increasing fiber intake and using over-the-counter medications, and may progress to medical procedures such as rubber band ligation or surgical removal if necessary, as recommended by the American Gastroenterological Association 1. The goal of treatment is to reduce symptoms and improve quality of life, while minimizing the risk of complications and mortality. Key considerations in the treatment of internal hemorrhoids include:
- Increasing fiber intake to 25-30 grams daily and drinking plenty of water (6-8 glasses daily) to soften stool and reduce straining during bowel movements 1
- Using over-the-counter medications, such as topical corticosteroids and analgesics, to manage perianal skin irritation and discomfort 1
- Considering medical procedures, such as rubber band ligation or sclerotherapy, for persistent or more severe hemorrhoids 1
- Reserving surgical removal, such as hemorrhoidectomy, for a small minority of patients with severe symptoms or failed medical and nonoperative therapy 1 It is essential to weigh the potential benefits and risks of each treatment option, taking into account the individual patient's symptoms, medical history, and preferences, to determine the most effective and safe approach. Some key points to consider when evaluating treatment options include:
- The effectiveness of each treatment in reducing symptoms and improving quality of life
- The potential risks and complications associated with each treatment, such as pain, bleeding, or infection
- The patient's overall health and medical history, including any underlying conditions that may impact treatment outcomes
- The patient's preferences and values, including their willingness to undergo invasive procedures or tolerate potential side effects.
From the Research
Treatment Options for Internal Hemorrhoids
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment for internal hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also be effective in managing internal hemorrhoids 2, 3
- Office-based treatments, including rubber band ligation, are preferred for grades I to III internal hemorrhoids due to their lower failure rate compared to infrared photocoagulation 2
- For high-graded internal hemorrhoids or when non-operative approaches have failed, surgery may be indicated, with options including excisional hemorrhoidectomy, Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy 4, 2
- Fiber supplements have been shown to improve internal bleeding hemorrhoids, although the effect may not be immediate 3
Surgical Interventions
- Excisional hemorrhoidectomy is a common surgical procedure for advanced hemorrhoids, but it can result in post-operative pain 4, 2
- Minimally invasive operations, such as Ligasure hemorrhoidectomy and stapled hemorrhoidopexy, have been developed to reduce post-operative pain and improve recovery times 4, 2
- Hemorrhoidal artery ligation is another surgical option that may be useful for grade II or III hemorrhoids, with potential benefits including less pain and quicker recovery 2
Emerging Technologies
- The CRH-O'Regan banding device is an emerging technology for the anoscopic treatment of symptomatic internal hemorrhoids, offering a new option for definitive therapy 5