Hemorrhoids medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
There is no medical treatment for hemorrhoids. The mainstay of therapy is local treatments such as warm sitz baths, using a bidet, extendable showerhead, [[Cold compression therapy|cold compress]], or [[Topical anesthetic|topical analgesic]] (such as | 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=== | ===High-fiber diet=== | ||
* Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining. | * 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 improving digestion and preventing constipation. | * 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. | * 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. | * 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. | * 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=== | ===Topical analgesics=== | ||
*Lidocaine ointment 5% is used to relieve pain associated with complicated hemorrhoids. | *[[Lidocaine (ointment)|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. | *[[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=== | ||
*Topical anti inflammatory agents mixed with cortisone may be used to relieve inflammation and shrink the size of the hemorrhoids. | *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. | *[[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=== | ||
*Sitz baths can be helpful in alleviating pruritus. | *Sitz baths can be helpful in alleviating [[pruritus]]. | ||
===Hydroxyethylrutoside=== | ===Hydroxyethylrutoside=== | ||
*[[Rutin|Hydroxyethylrutoside]] is a venotonic agent that increases the tone in the rectal veins | *[[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> | ||
===Antispasmodics=== | ===Antispasmodics=== | ||
*Local [[nitroglycerin]] can be used to alleviate the [[spasm]] associated with | *Local [[nitroglycerin]] can be used to alleviate the [[spasm]] associated with pain. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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
- 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
- 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
- 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]
Antispasmodics
- Local nitroglycerin can be used to alleviate the spasm associated with pain.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.