Hemorrhoids medical therapy

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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, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), 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 improving digestion and preventing 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.

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.

Topical anti-inflammatory

• Topical anti inflammatory agents mixed with cortisone may be used to relieve inflammation and shrink the size of the hemorrhoids.
• 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, improves the venous and lymphatic flow and thus improves the symptoms and decreases the incidence of bleeding.

Antispasmodics

• Local nitroglycerin can be used to alleviate the spasm associated with the pain