Hemorrhoids

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Treatment

Hemorrhoid treatment varies depending on the severity of the condition and includes self-care remedies, over-the-counter medications, non-surgical office procedures, and surgical treatments. Hemorrhoids can recur after they have been successfully treated—even after surgical removal, so hemorrhoid treatment also involves prevention strategies.

Self-care treatment techniques include adding more fiber to the diet and exercising daily to help prevent constipation and straining during bowel movements. Cold compresses (e.g., ice packs, medicated pads) applied to the anal area also may be helpful. Medicated pads (e.g., Tucks®, Preparation H®) may be stored in the refrigerator for a more soothing effect.

The anal area should be washed gently and kept clean. A warm sitz bath (i.e., sitting in a shallow basin or bathtub with a few inches of warm water for about 10 minutes) once per day also can help relieve hemorrhoid symptoms.

For short-term relief of hemorrhoid symptoms, such as pain and/or itching, over-the-counter medications (e.g., creams, ointments, gels, suppositories) may be helpful. The active ingredients in these medications vary and they should be used as advised by a health care provider. Over-the-counter hemorrhoid medications include Preparation H®, Tronolane®, Lanacane®, and hydrocortisone.

Most non-surgical hemorrhoid treatments involve using an agent, such as heat, cold, or a chemical, to distress hemorrhoidal tissue so that the tissue scars and falls away. These non-surgical techniques usually are performed on smaller internal hemorrhoids. They generally are performed in a physician's office using local anesthesia, if necessary.

Non-surgical hemorrhoid treatments include the following:

• Infrared light coagulation (IRC; involves using infrared light rays to cut off blood flow [circulation] to the hemorrhoid)
• Rubber band ligation (involves positioning one or more tiny rubber bands at the base of the hemorrhoid to cut off blood flow)
• Sclerotherapy (involves injecting a chemical into the base of the hemorrhoid to cause it to shrink)

Surgery to treat hemorrhoids is called hemorrhoidectomy. In this procedure, hemorrhoids are removed using a scalpel, a laser, or a cauterizing device. Hemorrhoidectomy usually is performed to treat larger internal hemorrhoids that protrude through the anus. It involves tying off the blood vessel leading into the hemorrhoid to prevent bleeding and removing the inflamed tissue.

Hemorrhoidectomy is performed under general anesthesia or spinal anesthesia. Patients who have this procedure usually can go home from the hospital or outpatient surgical center the same day; however, in some cases, a longer period of hospitalization is necessary. Pain after surgery is common and often requires an over-the-counter or prescription pain medication. Most patients recover from hemorrhoidectomy within 2–4 weeks.

Stapled hemorrhoidectomy is a surgical procedure that may be used to treat prolapsed hemorrhoids. This procedure involves removing and repositioning stretched tissue within the anal canal and rectum. In stapled hemorrhoidectomy, a thin tube is inserted into the anal canal and a piece a surgical thread (stitch or suture) is pulled through the tube, woven through the hemorrhoidal tissue, and pulled into a stapling device. The stapler is then fired, cutting off the hemorrhoidal tissue and stapling the edges of the remaining tissue together.

Like traditional hemorrhoidectomy, stapling requires general or spinal anesthesia. This procedure may result in less pain and faster recovery times; however, the long-term effectiveness of stapling hemorrhoidectomy is not yet known.

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