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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 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==
*There is no medicine that will cure hemorrhoids, but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or [[Topical anesthetic|topical analgesic]] (such as Nupercainal), can provide temporary relief.  
===High-fiber diet===
*Consistent use of medicated creams during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation.  
* Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.
*However, creams containing [[steroid]] preparations weaken the skin and may contribute to further flare-ups. <ref>http://www.netdoctor.co.uk/medicines/100002157.html</ref><ref>http://www.medbroadcast.com/drug_info_details.asp?brand_name_id=946</ref>  
* 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>


===Natural treatments===
===Topical analgesics===
* Reducing regional pressure in such ways as improving posture and muscle tone, or in severe cases, undergoing a profound psychophysical reeducation, by a method such as the Alexander Technique.
*[[Lidocaine (ointment)|Lidocaine ointment]] 5% is used to relieve pain associated with complicated hemorrhoids.
* Taking herbs and dietary supplements that strengthen vein walls, such as butcher's broom, horse chestnut, bromelain, and Japanese pagoda tree extracts. Drinking 99% pure aloe juice can also relieve itching and swelling.
*[[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 application of natural [[astringent]]s and soothing agents, such as [[Witch hazel (astringent)]], cranesbill, [[Aloe|aloe vera]], and honey
* Drinking chamomile tea several times a day
* Eating fiber-rich bulking agents such as plantain and [[Psyllium seed husks]] to help create soft stool that is easy to pass to lessen the irritation of existing hemorrhoids.
* Using the squatting position for bowel movements.<ref>{{cite journal | author=Christine Dimmer, Brian Martin, Noeline Reeves and Frances Sullivan | title=Squatting for the Prevention of Hemorrhoids | journal=Townsend Letter for Doctors & Patients | issue=159 | year=1996 | month=October | pages=66-70 | url=http://www.uow.edu.au/arts/sts/bmartin/pubs/96tldp.html}}</ref>


The combination of internal and external remedies is particularly recommended, e.g. witch-hazel suppositories combined with frequent cups of strong chamomile tea.<ref>K. Kraft and C. Hobbs, ''Pocket Guide to Herbal Medicine''. New York: Thieme.</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]].


Oral dietary supplementation can help to treat and prevent many complications of hemorrhoids, and natural botanicals such as Butchers Broom, Horse Chestnut, and bioflavonoids can be an effective addition to hemorrhoid treatment.<ref>{{cite journal |author=MacKay D |title=Hemorrhoids and varicose veins: a review of treatment options |journal=Altern Med Rev |volume=6 |issue=2 |pages=126–40 |year=2001 |pmid=11302778 |doi= |url=http://www.thorne.com/altmedrev/.fulltext/6/2/126.pdf |format=PDF}}</ref>
===Sitz baths===
*Sitz baths can be helpful in alleviating [[pruritus]].


===Butcher's Broom===
===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>


===Antispasmodics===
*Local [[nitroglycerin]] can be used to alleviate the [[spasm]] associated with pain.


{| style="float: right; width: 350px;"
| [[Image:Butcher's Broom (Ruscus aculeatus) (15720526217).jpg|right|400px|Ruscus aculeatus - By Bernard DUPONT from FRANCE - Butcher's Broom (Ruscus aculeatus), CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=40725696]]
|}
* Butcher’s broom extract, or Ruscus aculeatus, contains ruscogenins that have [[anti-inflammatory]] and [[vasoconstrictor]] effects.
* Supplementation with Butcher’s Broom helps tighten and strengthen veins. Butcher’s broom has traditionally been used to treat venous problems including hemorrhoids and [[varicose veins]].<!--
--><ref name="two">{{cite book | editor=Pizzorno JE and Murray MT, eds. | title=Encyclopedia of Natural Medicine | edition=revised 2nd edition | location=CA | publisher=Prima Publishing | year=1998 | pages=829}}</ref><!--
--><ref>{{cite journal |author=Rudofsky G |title=[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress] |language=German |journal=Fortschr. Med. |volume=107 |issue=19 |pages=52, 55–8 |year=1989 |pmid=2668140 |doi=}}</ref><!--
--><ref>{{cite journal |author=Cappelli R, Nicora M, Di Perri T |title=Use of extract of Ruscus aculeatus in venous disease in the lower limbs |journal=Drugs Exp Clin Res |volume=14 |issue=4 |pages=277–83 |year=1988 |pmid=3048951 |doi=}}</ref><ref name="pmid15486746">{{cite journal |vauthors=Greenspon J, Williams SB, Young HA, Orkin BA |title=Thrombosed external hemorrhoids: outcome after conservative or surgical management |journal=Dis. Colon Rectum |volume=47 |issue=9 |pages=1493–8 |year=2004 |pmid=15486746 |doi=10.1007/s10350-004-0607-y |url=}}</ref>
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===Horse Chestnut===
* Horse chestnut extract, or Aesculus hippocastanum, contains a saponin known as aescin, that has [[anti-inflammatory]], anti-edema, and venotonic actions.
* Aescin improves tone in vein walls, thereby strengthening the support structure of the vein.
* Double blind studies have shown that supplementation with horse chestnut helps relieve the pain and swelling associated with chronic venous insufficiency.<!--
--><ref>{{cite journal |author=Pittler MH, Ernst E |title=Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review |journal=Arch Dermatol |volume=134 |issue=11 |pages=1356–60 |year=1998 |pmid=9828868 |doi=}}</ref><!--
--><ref>{{cite journal |author=Diehm C, Trampisch HJ, Lange S, Schmidt C |title=Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency |journal=Lancet |volume=347 |issue=8997 |pages=292–4 |year=1996 |pmid=8569363 |doi=}}</ref>
[[Image:Graine de Marron.jpg|400|By Roger prat - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18440994]]
===Bilberry Bioflavonoid===
* Bilberry extract, or Vaccinium myrtillus, is an anthocyanoside bioflavonoid.
* Supplementation with this potent flavonoid protects and maintains venous strength and function.<!--
--><ref name="two" /><ref><!--
-->{{cite book | author=Murray MT. | title=Encyclopedia of Nutritional Supplements | location= NY | publisher=Three Rivers Press | year=1996 | pages=326}}</ref>
===Enema===
* This Practice is used to clean the rectum. 
* While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor.
* In an enema, water is injected into the rectum and then flushed out, cleaning the area.
===At-home Treatment===
==== High fiber diet ====
* Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.
* The human body cannot digest fiber, but fiber helps improve digestion and prevent constipation.
* 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.3
* Bulk stool softener or a fiber supplement such as [[psyllium]] (Metamucil) or [[methylcellulose]] (Citrucel) may be useful in the management.
==== 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
===Outpatient Treatment===
If at-home treatments do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctor’s office or a hospital. Outpatient treatments for internal hemorrhoids include the following:
==== Rubber band ligation ====
*The doctor places a special rubber band around the base of the hemorrhoid.
*The band cuts off circulation, causing the hemorrhoid to shrink.
==== Sclerotherapy. ====
*The doctor injects a chemical solution into the blood vessel to shrink the hemorrhoid.
==== Infrared coagulation ====
*The doctor uses heat to shrink the hemorrhoid tissue.
==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.
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