What Works for Hemorrhoids?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Hemorrhoids are common cause of bright red bleeding from the rectum and something you will often be managing from home. Know that some experts recommend colonoscopy for all patients older than 40 years who have hemorrhoidal symptoms and rectal bleeding, but if that’s been done or your doctor is sure it’s just hemorrhoids, what works?

1.  Fiber supplementation. Using Psyllium or unprocessed bran has been shown in studies to decrease bleeding, pain, prolapse and itching from hemorrhoids. This is because fiber helps you have soft bulky stools that can be passed without straining. Do this, no matter what.

2.  Over the counter topical hemorrhoid medications come as nonprescription topical preparations you know well, like preparation H. Some contain steroids (Anusol HC), anesthetics, and astringents (witch hazel) and are recommended for hemorrhoidal disease. It may surprise you to know that no randomized studies support their use. Steroid-containing creams should not be used for prolonged periods because of their effects on skin.

3.  Sitz baths. A sitz bath is a warm, shallow bath (you can put medications in it if you want) that you sit in and the water covers only your hips and buttock. Sitz baths are commonly recommended for hemorrhoids but guess what, a review of studies found no benefit for hemorrhoids so maybe don’t waste your time.

3.  Nifedipine ointment (a prescription, made by a compounding pharmacy) and lidocaine cream work for hemorrhoids that are thrombosed, meaning a clot has formed inside the hemorrhoid. These are exquisitely painful and nifedipine ointment plus Xylocaine (lidocaine) is more effective for pain relief than either alone.

4.  Surgery. The most common surgical treatments are rubber band ligation and excisional hemorrhoidectomy (cutting it out). A review comparing excisional hemorrhoidectomy to rubber band ligation showed that ligation resulted in less postoperative pain and allowed patients to return to work and to their previous level of functioning faster. For patients with severe hemorrhoids though, excisional hemorrhoidectomy has less chance of recurrence.

Dr O.

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