Hemorrhoids medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

There is no medical treatment for hemorrhoids. The mainstay of therapy is local treatments such as warm sitz baths, using a bidet, using an extendable showerhead, cold compress, or topical analgesic (such as nupercainal), which can provide temporary relief.

• Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.
• Fiber is not digested in the GIT, but it helps in improving digestion and preventing constipation.^[1]
• Good sources of dietary fiber are fruits, vegetables, and whole grains.
• On average, Americans eat about 15 grams of fiber each day while the American Dietetic Association recommends 25 grams of fiber per day for women and 38 grams of fiber per day for men.
• Bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel) may be useful in the management of hemorrhoids.^[2]
• It is recommended to drink 5 to 6 glasses of water daily for good bowel movement.

• Lidocaine ointment 5% is used to relieve pain associated with complicated hemorrhoids.
• Lidocaine relieves pain through blocking Na channels in the sensory nerve endings thus inhibiting the propagation of the pain impulse.^[2]

• Topical anti-inflammatory agents mixed with cortisone may be used to relieve inflammation and shrink the size of the hemorrhoids.^[1]
• Cortisone-containing agents should not be used more than one month as prolonged use may be associated with depressed local immunity and the development of skin tags.

• Sitz baths can be helpful in alleviating pain and pruritus.
• Patient must sit in warm water for 10 to 20 minutes.

• Hydroxyethylrutoside is a venotonic agent that increases the tone in the rectal veins and improves the venous and lymphatic flow, thus improving symptoms and decreasing the incidence of bleeding.^[3]

• Local nitroglycerin can be used to alleviate the spasm associated with pain.