From the Guidelines
For painful hemorrhoids, topical treatments containing flavonoids are suggested as a first-line pharmacological regimen to relieve symptoms, as recommended by the most recent guidelines 1. When considering treatment options for painful hemorrhoids, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. The available evidence suggests that non-operative management, including dietary and lifestyle changes, should be the first line of therapy 1. Some key points to consider when treating painful hemorrhoids include:
- Increasing fiber and water intake to alleviate symptoms
- Maintaining good hygiene and avoiding straining during bowel movements
- Considering the use of topical muscle relaxants for thrombosed or strangulated hemorrhoids, although the evidence for this is low-quality 1
- Avoiding prolonged use of potent corticosteroid preparations, as they can be harmful 1 It's also important to note that the evidence for the use of NSAIDs, topical steroids, and other topical agents is limited, and no recommendation can be made regarding their role in treating complicated hemorrhoids 1. Overall, a comprehensive approach that incorporates lifestyle changes and careful consideration of pharmacological options is necessary to effectively manage painful hemorrhoids and improve patient outcomes.
From the Research
Topical Treatments for Painful Hemorrhoids
- The tribenoside + lidocaine combination, available as a rectal cream or suppository, has been shown to be effective in treating hemorrhoids, with fast onset of symptom relief and a duration of up to 10-12 hours 2.
- Local hydrocortisone creams are also commonly used to manage hemorrhoids conservatively 3.
- A uniquely designed suppository, known as the Rectal Rocket, delivers lidocaine and hydrocortisone directly to the site of inflammation and has been used to treat internal and external hemorrhoids, as well as anal fissures 4.
- Topical over-the-counter preparations, including those containing nitroglycerine, are also used in the medical management of hemorrhoids 5.
- The use of a heparin-enzyme paste, applied directly to the inflamed pile mass, has been shown to significantly improve healing and resolution of acutely inflamed hemorrhoids, reducing local pain, discomfort, and pruritus 6.
Key Characteristics of Effective Topical Treatments
- Rapid onset of symptom relief
- Duration of action of up to 10-12 hours
- Ability to reduce local pain, discomfort, and pruritus
- Safety and efficacy in various patient populations, including pregnant and postpartum women
- Availability as a rectal cream, suppository, or other topical formulation
Comparison of Topical Treatments
- The tribenoside + lidocaine combination has been formally evaluated in several well-conducted studies and has been shown to be effective and safe in treating hemorrhoids 2.
- The Rectal Rocket has been used to treat internal and external hemorrhoids, as well as anal fissures, but its efficacy and safety have not been as extensively studied as the tribenoside + lidocaine combination 4.
- Local hydrocortisone creams and topical over-the-counter preparations are commonly used to manage hemorrhoids conservatively, but their efficacy and safety may vary depending on the specific product and patient population 3, 5.