From the Guidelines
For elderly individuals with hemorrhoids, the best ointment option is not clearly defined by recent high-quality studies, but based on available evidence, over-the-counter hydrocortisone creams (0.5-1%) or preparations containing phenylephrine, such as Preparation H, may be considered for symptomatic relief, alongside dietary and lifestyle modifications. When considering treatment options for elderly patients with hemorrhoids, it's crucial to prioritize approaches that minimize morbidity, mortality, and improve quality of life. The use of topical agents should be guided by the principle of using the least potent treatment necessary to achieve symptom relief, given the potential for side effects with prolonged use, as noted in studies such as 1 and 1. Key considerations in managing hemorrhoids in the elderly include:
- Dietary changes to increase fiber and water intake, which can help soften stool and reduce straining during bowel movements, as suggested by 1 and 1.
- The use of moist wipes instead of dry toilet paper to reduce irritation.
- Warm sitz baths for 10-15 minutes several times daily to help relieve discomfort and itching.
- Limiting the use of hydrocortisone creams to 7 consecutive days to avoid skin thinning, as cautioned by 1 and 1. Given the lack of strong recommendations for specific ointments in the context of complicated hemorrhoids, as noted in 1, the approach should focus on symptom management and prevention of complications, with a low threshold for medical evaluation if symptoms persist, worsen, or are accompanied by bleeding, due to the higher risk of colorectal conditions in the elderly population.
From the FDA Drug Label
INDICATIONS AND USAGE Hydrocortisone acetate suppositories are indicated for use in inflamed hemorrhoids, post-irradiation (factitial) proctitis; as an adjunct in the treatment of chronic ulcerative colitis; cryptitis; and other inflammatory conditions of anorectum and pruritus ani. The best ointment for hemorrhoids in the elderly is hydrocortisone acetate as it is indicated for use in inflamed hemorrhoids 2.
- Key benefits of hydrocortisone acetate include its anti-inflammatory, anti-pruritic, and vasoconstrictive actions 2. The use of hydrocortisone acetate suppositories is a suitable option for elderly patients with hemorrhoids.
From the Research
Treatment Options for Hemorrhoids in the Elderly
- Medical management, including topical over-the-counter preparations, is a mainstay of initial therapy for hemorrhoids 3
- Topical nitroglycerine and stool softeners can also be used to manage hemorrhoids 3
- A combination of tribenoside and lidocaine has been shown to be effective in treating hemorrhoids, with rapid and comprehensive efficacy on symptoms 4
- This combination is available as a rectal cream and suppository, and can be safely administered in postpartum women and pregnant women after the first trimester 4
Topical Treatments for Hemorrhoids
- Topical ointments can be effective in managing early stages of hemorrhoid disease (I/II degrees) 5
- Phlebotonic drugs can also be used to treat hemorrhoids, particularly in combination with lifestyle changes and fiber supplements 5
- A sublingual nanoemulsion and a liquid bandage have been reported to be effective and safe in treating hemorrhoids, although more research is needed to confirm their efficacy 6
Considerations for Treatment
- The choice of treatment for hemorrhoids should be based on the grade and severity of the disease, as well as patient preference and comorbidities 3
- Surgical treatment is typically reserved for grades 3/4 hemorrhoids, while medical therapy can be used to minimize anal symptoms and as a bridge-to-surgery treatment 7, 5
- Open discussion between patients and physicians is necessary to guide individualized care and determine the best course of treatment 7