How are hemorrhoids treated?

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Hemorrhoids can be a source of constant aggravation for some and debilitating pain for others. Treatment has three goals: to relieve immediate symptoms ; to avoid further exacerbation of the injury and eliminate the underlying cause . This is often accomplished through high-fiber diets, stool softeners, and over-the- counter topical medications. However, in severe cases, surgical and non-surgical procedures can be used to remove hemorrhoids.

Illustration by Cindy Chang, Get Drug Information

Home remedies and lifestyle

Generations have used home remedies to reduce hemorrhoids and prevent them from recurring. Some treat hemorrhoids directly, while others aim to alleviate intestinal disorders that are often at the root of the problem.

The following remedies can significantly alleviate the symptoms of acute hemorrhoids :

  • Ice packs can relieve local inflammation and pain, but should not be placed directly on the skin or allowed to act for more than 10 minutes.
  • A sitz bath , in which a person sits in a warm bath for 10 to 20 minutes, can help relieve itching and irritation. Epsom salts or baking soda are often added to relieve inflammation.
  • Witch's mist can reduce bleeding and prevent infection by acting as an astringent. You can apply it gently with a cotton ball or even add a couple of tablespoons to your sitz bath.
  • Aloe vera gel , vitamin E oil, and coconut oil are natural remedies that can help soothe and reduce minor external hemorrhoids. Avoid creams or lotions that contain these products and opt for pure, refined oils.

Good anal hygiene is also important to avoid further injury and infection.

It can be a perianal wash bottle to squeeze warm water into the anus after a bowel movement or disposable baby wipes to gently dry the affected area.

Diet

A diet rich in insoluble fiber can help relieve constipation and prevent hemorrhoids from coming back. By gently softening the stool, hemorrhoids will heal better with less pain and less bleeding.

You should aim for 25 to 35 grams of fiber per day. Excellent sources include:

  • Beans and legumes
  • Dried fruit
  • Fresh vegetables, including greens, peas, and green beans.
  • Fresh fruit (avoid bananas, which can be binders)
  • Plum juice
  • Whole grains, including barley, bran, brown rice, and whole grain breads.

Supplements that contain psyllium, methylcellulose, inulin, polycarbophilic calcium, or wheat dextrin can also help.

Over-the-counter drugs and prescriptions

In terms of pain relief, non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil (ibuprofen) are very effective in reducing pain, swelling, and redness in mild to moderate hemorrhoids .

Hemorrhoid creams

Although NSAIDs are a good first-line defense against pain and inflammation in hemorrhoids, the same cannot be said for many topical medications and suppositories used to treat hemorrhoids. A 2012 review published in the World Journal of Gastroenterology concluded that the efficacy of these products remains largely unproven, including topical corticosteroids available both over-the-counter and prescription.

Medications that can help include:

  • Formulated with shark liver oil (a natural vasodilator), H is an over-the-counter topical ointment that can help reduce bleeding and pain during bowel movements.
  • Rectogenous ointment containing 0.2% glycerin trinitrate (nitroglycerin) is available by prescription and can relieve pain and discomfort in mild to moderate hemorrhoids. Headache is a common side effect.

Chair softeners

As the name suggests, stool softeners are over-the-counter products that soften hard stools and help relieve constipation.

Rather than inducing a bowel movement as a stimulating laxative , stool softeners (also known as emollient laxatives) work by reducing water absorption in the intestines, thereby increasing the volume of water in the stool. As a result, the stool becomes softer and easier to pass.

Stool softeners contain the active ingredient docusate sodium and are sold under a variety of brand names including Colace, Correctol, Diocto, Doxinate, Dulcoease, Ex-Lax Stool Softener, Fleet Sof-Lax, Modane Soft, Phillips' Stool Softener, and Surfak .

As with a high fiber diet, stool softeners are taken for at least a couple of days before the effects are felt.

Specialized procedures

In general, a conservative approach should provide adequate relief for mild to moderate hemorrhoids. If they don't, more aggressive interventions may be required to actively reduce or completely eliminate the hemorrhoids.

Non-surgical procedures

If the hemorrhoid is not severe and does not cause disabling pain, immediate surgery is not recommended. Instead, a healthcare provider may suggest one of several minimally invasive procedures that can be performed in their office. From them:

  • Elastic bandage: An elastic band is placed around the hemorrhoids, which blocks blood flow and causes the hemorrhoids to shrink, usually within a few days.
  • Sclerotherapy: A sclerosing (firming) agent is injected into the hemorrhoids, causing the vein wall to collapse and shrink.
  • Infrared coagulation: An intense beam of infrared light is used to destroy tissue within the anal canal to cut off blood flow to internal hemorrhoids.

Most of these procedures are covered by health insurance, according to the terms of your policy.

Guide to Discussing Hemorrhoids with Your Doctor

Get our printed guide to your next doctor's appointment to help you ask the right questions.

Operation

Surgery is intended for only the most serious cases, including thrombosed (bloody) hemorrhoids or prolapse (anal canal prolapse) that cause severe, unrelenting pain. In rare cases, these conditions can severely disrupt the blood supply and lead to tissue death and the development of gangrene .

If all other treatment options have failed, your healthcare provider may recommend one of several surgical procedures:

  • Excisional hemorrhoidectomy is an operation that is only used in severe cases. It is performed under general anesthesia and requires care not to damage the underlying sphincter muscle when removing the hemorrhoid. Although surgery is effective in preventing a recurrence of hemorrhoids, it can cause significant postoperative pain and usually takes two to four weeks to recover.
  • Stapled hemorrhoidectomy is an alternative to conventional hemorrhoidectomy. It involves the use of a circular device that fixes the prolapsed hemorrhoid to its original position, cutting off the blood supply. Although postoperative pain is generally less and recovery time is shorter, hemorrhoids may recur. General or regional anesthesia can be used.
  • Doppler -guided hemorrhoidal artery ligation is a minimally invasive procedure that uses ultrasound to determine arterial blood flow. The blood vessel is then ligated and the fallen tissue is sutured. There is no tissue removal. Local , regional, or general anesthesia can be used.

The cost of these procedures can vary, but typically ranges from $ 3,000 to more than $ 5,000. Depending on the diagnosis and the terms of your policy, the insurance may cover part of the cost of the operation.

Frequently asked questions

  • A warm sitz bath, with or without baking soda, can often provide relief. Health professionals also recommend applying a mixture of 2 tablespoons of Epsom salts and glycerin to painful areas; wash off after 15 minutes. To reduce inflammation, rub the area with witch hazel or apply ice every 10 minutes.

  • It depends on your symptoms and needs. Over-the- counter ointments with lidocaine and soothing ingredients can reduce hemorrhoids and relieve pain. Stool softeners can make a bowel movement easier so that existing hemorrhoids don't worsen. For itching, you can use anti-itch creams throughout the day.

  • Yes. Hemorrhoids, especially external hemorrhoids that do not have complications, will heal on their own. However, internal hemorrhoids may require medications or other treatments. If your hemorrhoids persist or come back, you should discuss lifestyle changes, in addition to medications or surgery, such as hemorrhoidectomy , to help you cope with the flare-ups.

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