What medication helps to shrink hemorrhoids?

Medication to Shrink Hemorrhoids

Flavonoids (specifically diosmin) are the most effective medication for shrinking hemorrhoids, with evidence showing they reduce bleeding, pain, and swelling by improving venous tone and reducing inflammation. 1, 2, 3

First-Line Pharmacological Treatment

Flavonoids (Phlebotonics) - The Primary Medical Treatment

• Diosmin 450 mg (2 tablets twice daily for 4 days, then 2 tablets twice daily for 3 days for acute hemorrhoids) is the most evidence-based medication for shrinking hemorrhoids 2, 3, 4
• These medications work by improving venous tone, reducing capillary hyperpermeability, and enhancing lymphatic drainage - directly addressing the vascular pathology that causes hemorrhoid enlargement 3, 4, 5
• Clinical trials demonstrate 30-60% superiority over placebo for reducing edema, bleeding, and overall hemorrhoid symptoms 3
• For acute hemorrhoidal episodes, diosmin significantly reduces discomfort, edema, and bleeding within 7 days, with 79% reduction in pain and 67% reduction in bleeding in the first week 6
• Critical limitation: Symptom recurrence reaches 80% within 3-6 months after stopping the medication, so this is not a permanent solution 2, 7

Dosing Regimen for Diosmin:

• Acute hemorrhoids: 3 tablets (1350 mg) twice daily for 4 days, then 2 tablets (900 mg) twice daily for 3 days 4
• Chronic hemorrhoids: 2 tablets (900 mg) daily for 60-83 days 4
• Maintenance: 1 tablet (450 mg) twice daily for up to 2 months 6

Topical Medications (Primarily for Symptom Relief, Not Shrinking)

Important Distinction: Most topical medications provide symptom relief but do NOT actually shrink hemorrhoid tissue 2

• Topical nifedipine 0.3% with lidocaine 1.5% applied every 12 hours for 2 weeks achieves 92% resolution for thrombosed external hemorrhoids (versus 45.8% with lidocaine alone) by relaxing internal anal sphincter hypertonicity 2, 8, 9
• Topical corticosteroids may reduce local inflammation but MUST be limited to ≤7 days maximum to avoid thinning of perianal and anal mucosa 1, 2, 8
• Topical lidocaine (1.5-2% ointment) provides symptomatic pain relief but does not shrink hemorrhoids 2, 8
• Topical heparin has shown promise in improving healing of acute hemorrhoids in small studies, though evidence is limited 2, 8
• Topical nitrates can relieve pain from thrombosed hemorrhoids but are limited by high incidence of headaches (up to 50% of patients) 2, 8

Treatment Algorithm Based on Hemorrhoid Type

For Internal Hemorrhoids (Grades I-III):

1. Start with diosmin 900 mg twice daily plus dietary fiber (25-30 grams daily) and increased water intake 2, 9
2. Continue for at least 7 days for acute symptoms, up to 2 months for chronic symptoms 6
3. If bleeding persists despite 1-2 weeks of treatment, proceed to rubber band ligation 2, 8

For External Hemorrhoids (Non-thrombosed):

1. Topical nifedipine 0.3% with lidocaine 1.5% every 12 hours for 2 weeks 2, 8
2. Short-term topical corticosteroids (≤7 days) for inflammation 2, 8
3. Diosmin can be added for additional symptom control 2

For Thrombosed External Hemorrhoids:

• Within 72 hours of onset: Surgical excision is superior to medical management 8, 7
• Beyond 72 hours: Conservative management with topical nifedipine/lidocaine, oral analgesics, stool softeners, and diosmin 8, 7

Essential Adjunctive Measures (Always Required)

• Increase dietary fiber to 25-30 grams daily (can use psyllium husk 5-6 teaspoonfuls with 600 mL water daily) 1, 9
• Increase water intake to soften stool 1, 9
• Avoid straining during defecation 2, 8
• Sitz baths for symptomatic relief 2

Critical Pitfalls to Avoid

• Never use corticosteroid creams for more than 7 days - prolonged use causes thinning of perianal and anal mucosa, increasing risk of injury 1, 2, 8, 9
• Do not rely on over-the-counter suppositories - they lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion 8
• Never attribute anemia to hemorrhoids without colonoscopy - hemorrhoids alone do not cause positive stool guaiac tests 8, 9
• Avoid simple incision and drainage of thrombosed hemorrhoids - this leads to persistent bleeding and higher recurrence rates 8

When Medications Fail

• If symptoms persist or worsen after 1-2 weeks of medical treatment, procedural interventions are indicated 2, 8
• Rubber band ligation is first-line procedural treatment with 70.5-89% success rates for grades I-III internal hemorrhoids 2, 8, 9
• Excisional hemorrhoidectomy is most effective for grade III-IV hemorrhoids or mixed disease, with only 2-10% recurrence but longer recovery (9-14 days) 8, 7