Hemorrhoids are a common problem causing pain, itching and bleeding in the rectum and/or anus.
While they often resolve on their own, many seek medical or home-remedies to improve their hemorrhoids quicker. This article reviews hemorrhoid treatment options so you can decide the best option for you.
What are Hemorrhoids?
Hemorrhoids are pillow-like clusters of veins in the smooth muscle walls of the anus and/or lower rectum.
While everyone has hemorrhoids, about 1 in 4 experience swelling and distension of these veins, causing symptoms and warranting management.
Hemorrhoids are classified as either internal or external depending on their location and the type of cells surrounding them. Typically, external hemorrhoids are the most bothersome.
Signs & Symptoms
There are a variety of symptoms indicating you may have hemorrhoids.
- Extreme itching around the anus
- Irritation and pain around the anus
- Pain during bowel movements
- Blood on tissue after bowel movements
- Mucus and/or fecal leakage
- Hard, painful lumps felt at the anus
It’s important to find out if symptoms are related to hemorrhoids or other, more serious gut disorders like tumors or IBD.
Hemorrhoids are diagnosed by your doctor using your medical history, symptoms, and a physical exam.
During the physical exam, your doctor checks for abnormalities in the anus known as a digital rectal exam. If abnormalities such as lumps or masses are found, he/she may warrant additional testing called a sigmoidoscopy. More serious issues should be ruled out.
Once hemorrhoids are identified, they are graded using the I through IV system (1):
- I- hemorrhoids bleed, but do not prolapse
- II- hemorrhoids prolapse, but spontaneously reduce
- III- hemorrhoids prolapse, but must be manually reduced
- IV- hemorrhoids prolapse, but cannot be reduced
Summary: While everyone has hemorrhoids, or pillow-like clusters of veins in the anus or rectum, they only cause problems once inflamed. Symptoms like anal itching, pain, and irritation often result.
Symptomatic hemorrhoids develop with increases in pressure to the blood vessels in the anus/rectum.
Numerous factors can potentially cause more pressure including:
- Low fiber diets: causes denser, drier stool that causes more straining during bowel movements
- Pregnancy: enlarged uterus puts pressure on the rectum/anus, weakening of rectum/anus muscles with hormonal changes
- Obesity: excessive weight produces more pressure
- Prolonged sitting or standing: blood may pool in the anal canal while in these stationary positions
Other risk factors for hemorrhoids:
- History of rectal surgery
- Spinal cord injury
- Lifting heavy weight
- Anal intercourse
- Aging (most common in adults aged 45-65)
- Family history of hemorrhoids
- Colon cancer
Summary: Hemorrhoids are caused by any state placing more pressure on the anus/rectum. Family history and aging are two uncontrollable risk factors, while low fiber diets and obesity are two controllable.
How to Treat Hemorrhoids
While hemorrhoids often resolve on their own after a few days, many turn to treatment options for faster symptom relief.
Easy and safe methods to reduce pain, inflammation and irritation of hemorrhoids involve applying wrapped ice packs to the painful area, using alcohol-free baby wipes over dry toilet paper, and sitting on cushions rather than hard surfaces.
However, for more frequent hemorrhoid reoccurrence or more serious symptoms you must consider treatment.
Low grade hemorrhoids may improve with the help of various at-home remedies.
- Epsom salts & glycerin: Two tablespoons of Epsom salts mixed with 2 tablespoons of glycerin can be topically applied to the painful area with a gauze. Apply the treatment for 15-20-minutes and repeat every 4 to 6 hours.
- Myrtus communis essential oil: This has been clinically studied to improve bleeding, pain, irritation and itching for type I hemorrhoids. It can be applied in lotion or ointment formulations (2).
- Sitz bath: Sit in a warm bath for 15-20-minutes, 2 to 3 times per day. This technique helps calm spasms in sphincter muscles and relieves itching and irritation.
- Witch hazel: This is an astringent herbal compound often used for skin conditions, helps reduce pain and swelling of hemorrhoids when applied topically due to its antioxidant and anti-inflammatory properties. However, its therapeutic use is theoretical as it currently hasn’t been clinically studied for hemorrhoid treatment (3).
Other remedies such as coconut oil, aloe vera, goldenrod, and yarrow have been touted to help with hemorrhoids. It is not clear whether these treatments are effective and safe for all populations due to lack of research.
Keep in mind that many of these remedies haven’t been well-studied and could potentially exacerbate symptoms. For instance, apple cider vinegar and tea tree oil are often recommended for hemorrhoids, but should be avoided.
Softer stool is easier and pass and less likely to irritate hemorrhoids.
Fiber is a well-known stool softener that has been shown in seven clinical trials to relieve symptoms of hemorrhoids by about 50%. While eating more fiber preventatively is helpful, using fiber supplements like psyllium and methylcellulose are effective if you’re constipated (4).
Creams and suppositories also help treat hemorrhoid symptoms.
Creams like Preparation H include topical anesthetics that help numb the pain hemorrhoids cause. Other products use astringents and low dose steroids to decrease inflammation and shrink swollen tissues. Higher strength products are also available by prescription from a health care provider like lidocaine or hydrocortisone.
Pain relievers like acetaminophen and ibuprofen can be used to manage pain, but avoid using aspirin if you have bleeding hemorrhoids.
Summary: Various remedies are available for hemorrhoids based on their severity. Most treatments work to control symptoms.
Severe Hemorrhoid Cases
When conservative management doesn’t work or if hemorrhoid symptoms are severe, prescription medication and medical procedures are additional treatment options.
Medication treatment is often used to address bleeding associated with hemorrhoids.
Micronised purified flavonoid fraction (MPFF), calcium dibisilate, nitrates and nifedipine have all been used effectively for acute symptoms with good tolerance (5).
Pycnogenol, a product derived from pine bark, has been studied for its oral and topical use in hemorrhoids. Compared to placebo, use of this produce helped managed acute hemorrhoid attacks based on a signs and symptoms questionnaire (6).
If medications don’t provide relief, more intensive medical procedures are available.
Rubber band ligation is a procedure your doctor performs that involves using a rubber band to cut off circulation to the hemorrhoid. Infrared coagulation and radiofrequency ablation therapy are additional procedure options that work similarly to cut off circulation. Without proper blood flow, the hemorrhoid shrinks and symptoms improve.
Sclerotherapy is another option where your doctor injects a vein-destroying chemical into the hemorrhoid. The chemical damages the blood vessels, which blocks circulation and shrinks the hemorrhoid.
This treatment is typically used for patients who experience bleeding even after trying standard therapy. Also, those using anticoagulants or with cirrhosis or immunosuppression may also be ideal candidates for this treatment (7).
In some cases, doctors combine therapies, but there is poor evidence supporting this approach. Keep in mind that during any medical procedure, complications can result including bleeding, fissures, urinary retention and pain.
When standard therapy and outpatient medical procedures fail, surgical removal of hemorrhoids is a last resort option.
Hemorrhoidectomy with a laser or scalpel is a surgery option that removes the hemorrhoids under general anesthesia.
Alternatively, stapled hemorrhoidectomy uses a staple gun to control bleeding hemorrhoids. This procedure is typically for internal hemorrhoids with prolapse.
After non-surgical treatment, hemorrhoids recur about 50% of the time, whereas surgery produces only a 5% recurrence rate. There is no consensus on which procedure is best (8).
Summary: When hemorrhoids are severe and fail to resolve on their own, more intensive treatments are available including prescription strength medication, medical procedures and surgery.
Prevention is the most effective option to control hemorrhoids.
Consume a diet that supports normal bowel movements.
This typically means eating enough fiber and drinking enough fluids (9).
It’s Important to slowly increase fiber intake by about 5g increments, otherwise you may experience gas, bloating or cramping. Try using a psyllium husk fiber supplement if you have difficulty getting it from food alone. The goal is to consume 25 to 40g of total fiber per day (10).
Drink about half of your body weight (in pounds) in ounces each day. A 150-pound person would drink 75-ounces of fluid daily. You’ll need to drink more if you are losing extra fluid through sweat, diarrhea or vomiting.
Additionally, avoid eating spicy foods and drinking alcohol if you have a history of recurring hemorrhoids (11).
Changes to lifestyle can also prevent hemorrhoids.
Here are some general tips to consider:
- Avoid straining during a bowel movement. It’s okay to give up after 2-minutes.
- Use the restroom as soon as you feel the urge to have a bowel movement.
- Take on the squatting position or using a squatty potty to assist in easier bowel movements.
- Include regular moderate exercise and avoid being too sedentary, which prevents constipation.
- Wear comfortable clothing and undergarments that do not place excess pressure on the body. This also avoids irritation and sweat from provoking hemorrhoids.
- Use good hygiene by cleaning your anus daily.
While you can’t completely sure hemorrhoids, you can manage them so it’s vital to follow these preventative tips.
Summary: Prevention is your best bet against hemorrhoids. Eat a high fiber diet with adequate fluids to support regular bowel movements. Incorporate lifestyle tips like avoiding straining, exercising, and using good hygiene.
How to Get Rid of Hemorrhoids
Tailored hemorrhoid treatment provides the best results.
Most hemorrhoids are not bothersome and/or resolve on their own after a few days. There are also conservative treatment options to help with your symptoms like sitz baths, Myrtus communis essential oil, and stool softeners.
If hemorrhoids persist, more aggressive treatments options are available like prescription medications, rubber band ligation, and surgical removal.
Just remember that in the end hemorrhoids are not life threatening. Patience and appropriate preventative tips are the best way to manage.