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==Overview==
==Overview==
There is no medical treatment for hemorrhoids. The medical of therapy aims at providing symptomatic relief from constipation. Local treatments such as warm sitz baths, [[Cold compression therapy|cold compress]], or [[Topical anesthetic|topical analgesic]] (such as Nupercainal), can provide temporary relief.
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 compression therapy|cold compress]], or [[Topical anesthetic|topical analgesic]] (such as [[Cinchocaine|nupercainal]]), which can provide temporary relief.


==Medical Therapy==
==Medical Therapy==
===High-fiber diet===
* 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]].<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref>
* 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.<ref name="pmid28460197">{{cite journal |vauthors=Cocorullo G, Tutino R, Falco N, Licari L, Orlando G, Fontana T, Raspanti C, Salamone G, Scerrino G, Gallo G, Trompetto M, Gulotta G |title=The non-surgical management for hemorrhoidal disease. A systematic review |journal=G Chir |volume=38 |issue=1 |pages=5–14 |year=2017 |pmid=28460197 |doi= |url=}}</ref>
===Topical analgesics===
*[[Lidocaine (ointment)|Lidocaine ointment]] 5% is used to relieve pain associated with complicated hemorrhoids.
*[[Lidocaine (ointment)|Lidocaine]] relieves pain through blocking [[sodium channel|Na channels]] in the [[sensory nerve]] endings thus inhibiting the propagation of the pain impulse.<ref name="pmid28460197">{{cite journal |vauthors=Cocorullo G, Tutino R, Falco N, Licari L, Orlando G, Fontana T, Raspanti C, Salamone G, Scerrino G, Gallo G, Trompetto M, Gulotta G |title=The non-surgical management for hemorrhoidal disease. A systematic review |journal=G Chir |volume=38 |issue=1 |pages=5–14 |year=2017 |pmid=28460197 |doi= |url=}}</ref>
===Topical anti-inflammatory===
*Topical [[anti-inflammatory]] agents mixed with [[cortisone]] may be used to relieve [[inflammation]] and shrink the size of the hemorrhoids.<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref>
*[[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===
*Sitz baths can be helpful in alleviating [[pruritus]].
===Hydroxyethylrutoside===
*[[Rutin|Hydroxyethylrutoside]] is a venotonic agent that increases the tone in the rectal [[veins]] and improves the [[venous]] and [[Lymphatic drainage|lymphatic flow]], thus improving symptoms and decreasing the incidence of [[bleeding]].<ref name="pmid22895941">{{cite journal |vauthors=Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C |title=Phlebotonics for haemorrhoids |journal=Cochrane Database Syst Rev |volume= |issue=8 |pages=CD004322 |year=2012 |pmid=22895941 |doi=10.1002/14651858.CD004322.pub3 |url=}}</ref>


==== High fiber diet ====
===Antispasmodics===
* Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.
*Local [[nitroglycerin]] can be used to alleviate the [[spasm]] associated with pain.
* The human body cannot digest fiber, but fiber helps improve digestion and prevent constipation.
* Stool softener or a fiber supplement such as [[psyllium]] (Metamucil) or [[methylcellulose]] (Citrucel) may be useful in the management.
*[[Cold compression therapy|cold compress]], or [[Topical anesthetic|topical analgesic]] (such as Nupercainal), can provide temporary relief.


==== Other changes that may help relieve hemorrhoid symptoms include ====
*Drinking six to eight 8-ounce glasses of water or other nonalcoholic fluids each day
*Sitting in a tub of warm water for 10 minutes several times a day
*Exercising to prevent [[constipation]]
*Not straining during bowel movements
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Primary care]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 14:03, 7 August 2017

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

Overview

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.

Medical Therapy

High-fiber diet

  • 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]

Topical analgesics

Topical anti-inflammatory

  • 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

  • Sitz baths can be helpful in alleviating pruritus.

Hydroxyethylrutoside

Antispasmodics

References

  1. 1.0 1.1 Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. doi:10.1007/s11894-017-0574-9. PMID 28567655.
  2. 2.0 2.1 Cocorullo G, Tutino R, Falco N, Licari L, Orlando G, Fontana T, Raspanti C, Salamone G, Scerrino G, Gallo G, Trompetto M, Gulotta G (2017). "The non-surgical management for hemorrhoidal disease. A systematic review". G Chir. 38 (1): 5–14. PMID 28460197.
  3. Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C (2012). "Phlebotonics for haemorrhoids". Cochrane Database Syst Rev (8): CD004322. doi:10.1002/14651858.CD004322.pub3. PMID 22895941.