A Answers (10)
For the most part, the treatment of hemorrhoids involves treating signs and symptoms and eliminating discomfort until they are healed. Some ways to treat hemorrhoids include using proper bowel habits and going regularly, applying a suppository (usually tannic acid), ingesting one tablespoon of mineral oil each day to moisten or lubricate dry stool, and applying a local anesthetic such as dibucaine to help with pain and itching. (This answer provided for NATA by the University of Montana Athletic Training Education Program.)
First treatments of hemorrhoids are conservative, like warm baths, says Stephanie Wishnev, MD, a colorectal surgeon at MountainView Hospital. In this video, she says doctors also try to address issues that might be causing hemorrhoids.
Medical treatment of hemorrhoids is directed initially at relieving symptoms. Measures to reduce symptoms include: soaking in a bath several times a day in plain, warm water for about 10 minutes; application of a hemorrhoidal cream or suppository, such as hydrocortisone (Anusol-HC®), to the affected area; and application of witch hazel preparations (Tucks® medicated pads). If signs and symptoms do not improve within three to five days, medical attention may be necessary. Rubber band ligation:
During a rubber band ligation, a rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days. Pain is likely for 24-48 hours after rubber band ligation. Individuals may be instructed to use mild pain relievers (such as acetaminophen or Tylenol®) and sit in a shallow tub of warm water (sitz bath) for 15 minutes at a time to relieve discomfort. To reduce the risk of bleeding, it is best to avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin for four to five days both before and after rubber band ligation. Bleeding may occur seven to 10 days after surgery, when the hemorrhoid falls off. Bleeding is usually slight and stops by itself. Infrared coagulation:
During infrared coagulation, a special device using an infrared beam of light is used to burn hemorrhoidal tissue. Mild discomfort and pain may occur. This procedure is usually done on an out-patient basis with no hospital stay required. Hemorrhoidectomy:
A hemorrhoidectomy is surgery to remove hemorrhoids. Hemorrhoidectomy is often used when other procedures have not been successful or if the hemorrhoids are large. The surgery is done with either a local anesthetic combined with sedation, a spinal anesthetic, or a general anesthetic. Surgery can be performed on an outpatient basis or may require an overnight hospital stay. While the individual may experience discomfort after the procedure, medications can be used to relieve the pain. Soaking in a warm bath also can ease discomfort.
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Occasional rectal bleeding can be controlled by keeping the stools regular and soft. An examination is essential to rule out other causes of bleeding. Painful hemorrhoids can be treated with: Warm tub baths several times a day in plain, warm water for about 10 minutes.
In some cases, hemorrhoids must be treated surgically. Surgery is used to shrink and or excise (cut out) the hemorrhoidal tissue.
A number of methods might be used to remove or reduce the size of internal hemorrhoids. These techniques include:
- Rubber band ligation -- A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, causing the hemorrhoid to wither away within a few days. This can be done in an office setting and does not require anesthesia.
- Sclerotherapy -- A chemical solution is injected around the blood vessel to shrink the hemorrhoid. This is not done routinely for hemorrhoids.
- Infrared coagulation -- A special device is used to burn hemorrhoidal tissue. This can treat small hemorrhoids.
- Procedure for prolapsed hemorrhoids (PPH) -- This is done for hemorrhoids that come out of the anal canal. This is done under anesthesia and uses a device to fix the hemorrhoids at the position from where they came down.
- Hemorrhoidal arterial ligation -- This can be done for different grades of hemorrhoids and uses a Doppler probe to identify and tie the vessels feeding the hemorrhoid, thereby shrinking it.
- Hemorrhoidectomy -- Occasionally, extensive or severe internal or external hemorrhoids might require removal by a surgery known as a hemorrhoidectomy. This procedure involves excision of the hemorrhoid and the skin overlying it.
Medical treatment of hemorrhoids includes treatment of any underlying constipation, taking warm baths and applying an over-the-counter cream or suppository that may contain hydrocortisone. If medical treatment fails there are a number of ways to reduce the size or eliminate internal hemorrhoids. Each method varies in its success rate, risks and recovery time. Your doctor will discuss these options with you.
Rubber band ligation is the most common outpatient procedure for hemorrhoids in the United States. It involves placing rubber bands around the base of an internal hemorrhoid to cut off its blood supply. This causes the hemorrhoid to shrink, and in a few days both the hemorrhoid and the rubber band fall off during a bowel movement. Possible complications include pain, bleeding and infection. After band ligation, your doctor may prescribe medications, including pain medication and stool softeners, before sending you home. Contact your doctor immediately if you notice severe pain, fever or significant rectal bleeding.
Laser or infrared coagulation and sclerotherapy (injection of medicine directly into the hemorrhoids) are also office-based treatment procedures, although they are less common. Surgery to remove hemorrhoids may be required in severe cases or if symptoms persist despite rubber band ligation, coagulation or sclerotherapy.
There are many options available for treating your hemorrhoids. In many cases, your doctor can suggest simple changes in self-care - like taking warm baths or not straining during bowel movements - that may make a big difference. Sometimes, however, a more immediate treatment is required. This can include:
- Injection: Your doctor injects a substance into the hemorrhoid that causes it to shrink.
- Rubber Band Ligation: Rubber bands cut off the circulation to the hemorrhoid, causing it to fall off.
- Coagulation: Infrared light, laser, or electrical current is used to destroy the hemorrhoid.
- Surgery: The hemorrhoid is surgically removed.
I find that hemorrhoids respond best to bulking up the stool so it can be more easily expelled. This can be done by increasing your fiber intake with a goal of at least 30 grams a day, accompanied by a liter or more of water to keep the stool moist. Most patients benefit greatly from a fiber supplement like psyllium husk. In addition to aiding passage of the stool and shrinking hemorrhoids, the psyllium leads to what I like to call "the clean wipe" -- a big, bulky, magnificent stool that falls easily into the toilet and leaves no messy schmear on the toilet paper.
Treatment for hemorrhoids will depend on your age, health, your medical history, the extent of your condition, and your tolerance for certain treatments and medicines. Symptom relief usually includes taking warm sitz (tub) baths several times a day for 10-15 minutes to shrink blood vessels and soothe itching and irritation; using witch hazel wipes to reduce irritation; and using cream or suppository to help shrink hemorrhoids. Cortisone creams are not recommended. Ice packs can also help relieve inflammation.
Relieving or preventing constipation is important if you have hemorrhoids. This means drinking at least 6-8 glasses of water a day and increasing your dietary fiber – whole grains, vegetables, and fruits – and taking a stool softener or fiber supplement if necessary to eliminate straining and reduce pressure on hemorrhoids. Fiber is helpful for both constipation and diarrhea.
Infrequently, large or symptomatic hemorrhoids may need to be surgically removed. Our experts treat hemorrhoids using a number of techniques, including:
- Opening of acutely swollen external hemorrhoids. This may be done in the office and is only helpful if performed in the first couple of days after symptoms.
- Rubber band ligation – placing a rubber band around the bottom of the hemorrhoid inside the rectum, which cuts off blood flow to the hemorrhoid, causing it to slowly shrink and degenerate within a few days.
- Sclerotherapy – injecting a chemical solution around the blood vessel to shrink the hemorrhoid.
- Electrical, laser or infrared photo coagulation – using different sources of heat to destroy the hemorrhoid.
- Hemorrhoidectomy – removing hemorrhoids surgically.
- A new technique of stapling hemorrhoids may be appropriate with multiple internal hemorrhoids.
Following treatment for hemorrhoids, it is important to prevent recurrence by keeping stools soft so they pass without pressure and straining. Increased dietary fiber, exercise, and drinking 6-8 glasses of water a day can help reduce chances of a recurrence..
There’s a spectrum of possible treatment for a hemorrhoid disease. We start with stool softeners and bulking agents to decrease any straining on the stool. Many physicians recommend warm sitz baths in which the bottom is immersed in a basin of warm water for 15 minutes up to four times daily. Personally, I think our fast-paced society frowns on people who stop work to immerse their bottom.
A mainstay of treatment is immaculate anal hygiene. It is difficult to get the nooks and crannies around those suckers clear of fecal debris, and this residual poo leads to the equivalent of painful diaper rash. I recommend using no toilet tissue, just baby wipes, the hypoallergenic type with aloe, to clean the outlet area thoroughly. You should allow the affected region to dry, wearing breathable cotton clothing, and going around unclothed down below when socially acceptable.
After you’re clean down there, you’d like to shrink the enlarged hemorrhoids. Our best bet is desiccating witch hazel products, with an intent to turn a fat juicy grape into a dehydrated raison. I prefer Tucks pads, which include the witch hazel but no moisturizing cream or ointment.
The pain can be improved by occasional dabs of 2% lidocaine jelly, available at the pharmacy with a prescription. Steroid suppositories or creams, containing hydrocortisone, should not be used for longer than one week, as they cause skin rash or thinning of the skin with prolonged use.
If the hemorrhoids are huge or just won’t resolve, more aggressive management might be advised by your doctor. The techniques include banding (a rubber band is placed around the hemorrhoid causing it to fall off), sclerotherapy (a caustic agent is injected into the hemorrhoid to fibrose the tissue), and one of five surgical techniques.
Want to know how to get rid of those painful hemorrhoids?
Watch the video to learn more from Dr. Oz about the best treatment for hemorrhoids.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.