From the Guidelines
For hemorrhoids, the best medication treatment typically involves administering flavonoids to relieve symptoms, as suggested by the most recent and highest quality study 1.
Medication Treatment
- Flavonoids have been shown to increase venous tone, lymphatic drainage, and capillary resistance, and normalize capillary permeability, leading to symptomatic improvement in patients with hemorrhoids 1.
- Topical muscle relaxants, such as topical nitrates and calcium channels antagonists, may also be used to relieve symptoms in patients with thrombosed or strangulated hemorrhoids, although the evidence is based on low-quality studies 1.
Lifestyle Changes
- Increasing dietary fiber intake to 25-30g daily and water intake to 6-8 glasses daily can help reduce symptoms of hemorrhoids 1.
- Avoiding straining during bowel movements and limiting sitting on the toilet for extended periods can also help prevent worsening of hemorrhoids 1.
Important Considerations
- No recommendation can be made regarding the role of NSAIDs, topical steroids, other topical agents, or injection of local anesthetics for complicated hemorrhoids, based on the available literature 1.
- Medical and pharmacological therapies are the most widely adopted therapy for complicated hemorrhoids, and are supported by several studies 1.
From the Research
Medication Treatment for Hemorrhoids
- The treatment of hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid, with external hemorrhoid usually requiring no specific treatment unless it becomes acutely thrombosed or causes patients discomfort 2.
- Low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures, such as rubber band ligation and injection sclerotherapy 2.
- A sublingual nanoemulsion and a liquid bandage have been reported to be effective and safe in the treatment of hemorrhoids, providing new opportunities in oral and topical treatment options 3.
- A medical preparation containing tribenoside + lidocaine, available as a rectal cream and a suppository, has been shown to be effective in the treatment of hemorrhoids, with rapid comprehensive efficacy on all the different symptoms of hemorrhoids 4.
Topical Treatments
- The Rectal Rocket, a uniquely designed suppository, delivers lidocaine and hydrocortisone directly to the site of inflammation and heals injured tissue, and can be used to treat internal and external hemorrhoids and anal fissures 5.
- Topical over-the-counter preparations, such as stool softeners and topical nitroglycerine, can be used as part of the initial therapy for hemorrhoids 6.
- A rectal cream containing tribenoside 5%/lidocaine 2% and a suppository containing tribenoside 400 mg/lidocaine 40 mg can be used for the symptomatic treatment of hemorrhoids, with fast onset of symptom relief and lasting up to 10-12 hours 4.
Treatment Options
- Medical management, dietary modifications, and behavioral therapies are the mainstays of initial therapy for hemorrhoids 6.
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is the preferred next step if initial therapy is unsuccessful 6.
- Surgery, such as open or closed excisional hemorrhoidectomy, may be necessary for high-graded internal hemorrhoids or when non-operative approaches have failed or complications have occurred 2, 6.