How Hemorrhoids Are Treated

Hemorrhoids can be the source of unrelenting aggravation for some and the cause of debilitating pain in others. The aim of treatment is threefold: to alleviate the immediate symptoms; to prevent further exacerbation of the injury, and to resolve the underlying cause. This is often accomplished with high-fiber diets, stool softeners, and over-the-counter topical medications.

 In severe cases, however, surgical and non-surgical procedures may be used to remove the hemorrhoid.

Home Remedies and Lifestyle

Generations have used home remedies to shrink hemorrhoids and prevent them from returning. Some treat the hemorrhoid directly, while others are aimed at alleviating the bowel irregularities that are often at the heart of the problem.

The following remedies can provide significant relief of acute hemorrhoid symptoms:

• Ice packs can relieve local inflammation and pain, but should never be placed directly on skin or left on for longer than 10 minutes.
• A sitz bath, in which a person sits in a tub of warm water for 10 to 20 minutes, can help reduce itching and irritation. Epsom salts or baking soda is often added to help alleviate inflammation.
• Witch hazel may decrease bleeding and prevent infection by acting as an astringent. You can dab it on gently with a cotton ball or even add a couple of tablespoons to a sitz bath.

• Aloe vera gel, vitamin E oil, and coconut oil are natural remedies that can help soothe and shrink minor external hemorrhoids. Avoid creams or lotions that contain these products and opt instead for the pure refined oil. 

Good anal hygiene is also essential to avoid further injury and infection. This can include a perianal irrigation bottle to squeeze warm water onto the anus after a bowel movement and disposable baby wipes to gently dab the area clean.

Diet

A diet rich in insoluble fiber can help relieve constipation and prevent hemorrhoids from returning. By gently softening stools, hemorrhoids will be better able to heal with less pain and bleeding.

You should aim to consume between 25 and 30 grams of fiber daily. Excellent sources include:

• Beans and legumes
• Dried fruit
• Fresh vegetables, including greens, peas, and green beans
• Fresh fruits (avoid bananas, which may be binding)
• Prune juice
• Whole grains, including barley, bran, brown rice, and whole-grain bread

Fiber supplements containing psyllium, methylcellulose, inulin, calcium polycarbophil, or wheat dextrin can also help. 

OTC Therapies and Prescriptions

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

Hemorrhoid Creams

While NSAIDs are a good, first-line defense against hemorrhoid pain and inflammation, the same cannot be said for many of the topical and suppository preparation used to treat hemorrhoids. A 2012 review published in the World Journal of Gastroenterology concluded that the effectiveness of these products remains largely unproven.

This includes topical corticosteroids, available both over the counter and by prescription.

Among the medications that may help:

• Preparation-H, made with shark liver oil (a natural vasodilator), is a topical ointment available over the counter that can help reduce bleeding and pain during defecation.
• Rectogesic ointment, made with 0.2 percent glyceryl trinitrate (nitroglycerin), is available by prescription and may alleviate the pain and discomfort of mild to moderate hemorrhoids. A headache is a common side effect.

Stool Softeners

As their name suggests, stool softeners are over-the-counter (OTC) products that soften hard stools and helps relieve constipation.

Rather than inducing a bowel movement like a stimulant laxative, stool softeners (also known emollient laxatives) work by lowering the absorption of water in the intestine, thereby increasing the volume of water in the stool. This result is a softer, easier-to-pass stool.

Stool softeners contain the active ingredient, docusate sodium, and are offered under various 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 fiber-rich diet, stool softeners take at least a couple of days before the effects can be felt.

Specialist Procedures

Generally speaking, a conservative approach should provide ample relief of mild to moderate hemorrhoids. If they fail to do so, more aggressive interventions may be needed to actively shrink or entirely remove the hemorrhoid.

Non-Surgical Procedures

Unless the hemorrhoid is severe and causing disabling pain, surgery isn't immediately suggested. Instead, a doctor might suggest one of several minimally invasive procedures that can be performed in his or her office. Among them:

• Rubber band ligation: A rubber band is placed around the hemorrhoid, cutting off the blood flow and causing the hemorrhoid to shrink, usually within days.
• Sclerotherapy: A sclerosing (hardening) agent is injected into the hemorrhoid, causing the vein wall to collapse and shrivel up.
• Infrared coagulation: An intense beam of infrared light is used to destroy tissue inside the anal canal in order to cut off the blood flow to an internal hemorrhoid.

Depending on the terms of your policy, most of these procedures are covered by health insurance.

Surgery

Surgery is reserved for only the most severe cases, including hemorrhoids that have thrombosed (filled with blood) or those that have prolapsed (slipped outside of the anal canal) and are causing severe, unrelenting pain. In rare instances, these conditions can severely choke off the blood supply and lead to the tissue death and development of gangrene.

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

• Excisional hemorrhoidectomy is a type of surgery only used in severe cases. It is usually performed under general anesthesia and requires care to avoid damage to the underlying sphincter muscle as the hemorrhoid is removed. While the operation is effective in preventing hemorrhoid recurrence, it can cause significant post-operative pain and usually requires two to four weeks to recover.
• Stapled hemorrhoidopexy is an alternative to a conventional hemorrhoidectomy. It involves the use of a circular device that staples the prolapsed hemorrhoid back into its original position while cutting off the blood supply. While the post-operative pain tends to be less and the recovery time shorter, hemorrhoid recurrence is possible. A general or ​regional anesthetic may be used.
• Doppler-guided hemorrhoid artery ligation is a minimally invasive procedure in which an ultrasound is used to locate the arterial blood flow. The blood vessel is then tied off, and the prolapsed tissue is sutured back into place. There is no removal of tissue. A local, regional, or general anesthetic may be used.

The costs of these procedures can vary but typically range from $3,000 to well over $5,000. Depending on the diagnosis and terms of your policy, insurance may cover some of the costs of the surgery.

Sources:

Lohsiriwaat, V. "Hemorrhoids: From basic pathophysiology to clinical management." World J Gastroenterol. 2012; 18(7):2009-17. DOI: 10.3748/wjg.v18.2009.

Lohsiriwat, V. "Treatment of hemorrhoids: A coloproctologist’s view." World J Gastroenterol. 2015; 21(31):9245-52. DOI: 10.3748/wjg.v21.i31.9245.

Sun, Z. and Migaly, J. "Review of Hemorrhoid Disease: Presentation and Management." Clin Colon Rectal Surg. 2016; 29(1):22-29. DOI: 10.1055/s-0035-1568144.