From the Guidelines
Treatments for hemorrhoids include non-operative management, nonoperative techniques, and surgery.
Non-Operative Management
- The first line of treatment is non-operative management, which includes dietary and lifestyle changes such as increased fiber and water intake, as well as adequate bathroom habits 1.
- Flavonoids may be administered to relieve symptoms, although the evidence is moderate 1.
- Topical muscle relaxants may be used for thrombosed or strangulated hemorrhoids, but the evidence is low-quality 1.
Nonoperative Techniques
- Nonoperative techniques include injection sclerotherapy, diathermy coagulation, bipolar coagulation, infrared coagulation, and rubber band ligation 1.
- These techniques are most appropriate for second- and third-degree hemorrhoids, but may also be used for first-degree hemorrhoids that have not responded to medical treatment 1.
- Rubber band ligation has the lowest recurrence rate, but may cause more discomfort than other techniques 1.
Surgery
- Hemorrhoidectomy is the most effective treatment, but is associated with more pain and complications than nonoperative techniques 1.
- Indications for elective hemorrhoidectomy include failure of medical and nonoperative therapy, symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids, and patient preference 1.
Medical Therapy
- Medical therapy is most appropriate for first-degree hemorrhoids and includes adequate intake of fiber and water 1.
- Topical corticosteroids and analgesics may be used to manage perianal skin irritation, but prolonged use of potent corticosteroid preparations should be avoided 1.
From the Research
Treatment Options for Hemorrhoids
The treatment of hemorrhoids can be divided into non-operative and operative approaches.
- Non-operative approaches include:
- Operative approaches include:
Specific Treatments for Internal and External Hemorrhoids
- Internal hemorrhoids can be treated with:
- Medication
- Non-operative measures such as rubber band ligation and injection sclerotherapy
- Surgery for high-graded internal hemorrhoids or when non-operative approaches have failed 6
- External hemorrhoids usually require no specific treatment unless they become acutely thrombosed or cause patient discomfort, in which case excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 5
Considerations for Treatment
- The choice of treatment depends on the grade of the hemorrhoid, patient preference, and the presence of any complications 3, 5
- Treatment outcomes and potential complications, such as postoperative pain, anal stricture, and incontinence, should be considered when selecting a treatment approach 2, 3, 6