Hemorrhoids (Piles)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Bhupinder Anand, MD
Hemorrhoids Slideshow Pictures

Quick GuideHemorrhoids: An Illustrated Guide to Treatment

Hemorrhoids: An Illustrated Guide to Treatment

How are hemorrhoids treated?

Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist.

Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. For patients with constipation, high fiber diet, adequate hydration and stool softeners may be required. For those with too frequent bowel movements, antidiarrheal medications and diet adjustments may be required. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling.

Once hemorrhoidal symptoms develop, a variety of treatment options exist, depending upon the situation and severity of the hemorrhoids.

Internal hemorrhoids are graded by the degree of prolapse below the pectinate line into the anal canal.

  • Grade 1: the internal hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
  • Grade 2: the hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
  • Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
  • Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.

OTC medications and home remedies for hemorrhoids

Grade 1 hemorrhoids are treated symptomatically. There can be some spasm of the anal muscles. Warm sitz baths, sitting in a warm tub for 20 minutes, two or three times a day may be helpful. Avoiding spicy food may also prevent anal itching. Over-the-counter medications may be helpful.

  • Medications are used to control symptoms by softening the stool, decreasing the inflammation of the hemorrhoids and treating the pain.
  • Stool softeners work by increasing the water and fat content within the stool allowing it to be passed more easily. Docusate sodium is most often recommended drug in this class (Colace, Surfak, Correctal).
  • Inflammation can be controlled with over-the-counter creams or suppositories. Some brand ingredients (Preparation H) include low dose topical anesthetics to help with symptoms. Others (Anusol, witch hazel) contain astringents that help shrink the swollen tissues. Both may contain low dose steroids (hydrocortisone) to decrease inflammation. People with diabetes should check with their pharmacist or health care professional before using OTC hemorrhoid treatments. If the medication contains a vasoconstrictor (for example, phenylephrine HCI, ephedrine, or epinephrine) it may elevate blood sugar levels if absorbed in large amounts.
  • Prescription strength lidocaine or hydrocortisone may be offered by the health care professional.
Medically Reviewed by a Doctor on 2/5/2015
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