From the Guidelines
The most effective inpatient treatment for bleeding hemorrhoids is rubber band ligation, which has been shown to be more effective than sclerotherapy and infrared photocoagulation, with a higher rate of efficacy and fewer additional treatments required 1.
Initial Management
Initial management of bleeding hemorrhoids includes conservative measures such as:
- Bed rest
- Warm sitz baths 2-3 times daily
- Stool softeners like docusate sodium (100mg twice daily)
- Topical treatments such as hydrocortisone cream or suppositories
- Pain management with acetaminophen or NSAIDs Intravenous fluids and blood transfusions might be required if significant bleeding has occurred.
Procedural Interventions
For persistent or severe bleeding, procedural interventions are often needed.
- Rubber band ligation is commonly performed for grade 1-3 hemorrhoids
- Surgical hemorrhoidectomy is typically reserved for grade 3-4 hemorrhoids with persistent bleeding Other options include sclerotherapy, infrared coagulation, or stapled hemorrhoidopexy. The choice of procedure depends on the severity of bleeding, grade of hemorrhoids, patient comorbidities, and surgeon expertise.
Long-term Management
Following treatment, patients should be advised to:
- Increase dietary fiber (25-30g daily)
- Maintain adequate hydration
- Avoid straining during bowel movements to prevent recurrence Hemorrhoids bleed due to rupture of the fragile vessels under pressure, often from straining or increased venous pressure, so addressing these underlying causes is essential for long-term management, as indicated by the american gastroenterological association medical position statement 1.
From the Research
Inpatient Treatment for Bleeding Hemorrhoids
- The best inpatient treatment for bleeding hemorrhoids depends on the severity of the condition and the patient's overall health 2, 3, 4, 5.
- For internal hemorrhoids, rubber band ligation is often the treatment of choice for grades 1 and 2, while excisional hemorrhoidectomy or stapled hemorrhoidopexy may be recommended for grade 3 and 4 hemorrhoids 2, 4.
- External hemorrhoids can be treated conservatively or excised, especially if they are thrombosed 2, 4.
- Surgical intervention is usually warranted when medical therapy is inadequate or when complications have occurred 2, 3, 5.
- Minimally invasive operations, such as Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy, have been introduced to reduce postoperative pain and complications 3, 4.
- The choice of treatment should be individualized based on the patient's symptoms, medical history, and preferences 3, 4, 6.
Treatment Options
- Rubber band ligation: a non-surgical procedure that involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply 2, 4.
- Excisional hemorrhoidectomy: a surgical procedure that involves removing the hemorrhoid tissue 2, 4, 5.
- Stapled hemorrhoidopexy: a surgical procedure that involves stapling the hemorrhoid tissue to its normal position 2, 3, 4.
- Hemorrhoidal artery ligation: a minimally invasive procedure that involves ligating the arteries that supply blood to the hemorrhoids 3, 4.
- Conservative treatment: includes dietary and lifestyle modifications, oral phlebotonic drugs, and topical medications 6.