How Hemorrhoids Are Treated

As you may know, hemorrhoids can be the source of unrelenting aggravation or debilitating pain, and sometimes both.

The goal of treatment is threefold: to relieve the immediate symptoms, prevent them from getting worse, and resolve the underlying cause.

These goals are 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 a hemorrhoid.

This article explains how home remedies, lifestyle changes, and over-the-counter products can ease the pain and suffering that hemorrhoids bring. If these options fail, this article explains how specialist procedures and even surgery may solve the problem once and for all.

Home Remedies and Lifestyle

Hemorrhoids y are enlarged blood vessels in and around the anus and lower rectum that may bleed. Known as the "varicose veins of the anus and rectum,” hemorrhoids are among the most painful conditions someone can have.

To some extent, this depends on the type of hemorrhoid:

• External hemorrhoids form near the anus and are usually painless unless they become swollen or a blood clot forms.
• Internal hemorrhoids form in the anus, beneath the lining, and can be extremely painful.

Generations of hemorrhoid sufferers have relied on home remedies to shrink hemorrhoids and prevent them from returning. Some remedies target the hemorrhoid directly while others are aimed at alleviating the bowel irregularities that often caused the problem in the first place.

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

• 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 can be added to reduce inflammation.
• Aloe vera gel, vitamin E oil, and coconut oil are natural remedies that can help soothe and shrink minor hemorrhoids.
• Ice packs can relieve local inflammation and pain, but should never be placed directly on skin or left on for longer than 10 minutes. Put a lightweight towel on your skin and then an ice pack on top.
  
• 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.
  

Diet

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

Try to consume between 25 and 35 grams of fiber daily to keep your bowel movements regular. Excellent fiber sources include:

• Beans and legumes
• Dried fruit
• Fresh fruits (avoid bananas, which may be binding)
• Fresh vegetables, including greens, peas, and green beans
• 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 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.

There are exceptions. The products that may help are:

• Preparation-H, made with shark liver oil, is a topical ointment available over the counter that can help reduce bleeding and pain during defecation.
• Rectogesic ointment, made with 0.2% glyceryl trinitrate (nitroglycerin), is available by prescription and may ease 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 help relieve constipation.

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 starting a fiber-rich diet, stool softeners take at least a couple of days to take effect.

Specialist Procedures

Generally speaking, a conservative approach should provide relief of mild to moderate hemorrhoids. If not, more aggressive interventions may be needed to actively shrink or remove them.

Non-Surgical Procedures

Healthcare providers often suggest one of several minimally invasive procedures that can be performed in their office. Among them:

• 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.
• 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.
  

These procedures may be covered by your health insurance policy, so be sure to check.

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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 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 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 of recovery time.
• 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 acute and the recovery time shorter, hemorrhoid recurrence is possible. A general or ​regional anesthetic may be used during this procedure.
• 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.

Summary

Chances are good that if you're willing to experiment, you'll find the home remedy or lifestyle change that will bring relief from your hemorrhoid pain. If not, there are many over-the-counter products you can try but only two that are likely to work. Minimally invasive procedures—the kind that can be done in a doctor's office—might be a good choice before you consider the last resort: surgery.