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Hemorrhoids: Which Treatment Should I Use?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Hemorrhoids: Which Treatment Should I Use?
Get the facts
- Use home treatments to control hemorrhoid symptoms.
- Have a nonsurgical procedure that cuts off the blood flow to hemorrhoids. This works only for internal hemorrhoids.
- Have surgery to remove the hemorrhoid. This works for both internal and external hemorrhoids.
Key points to remember
- Home treatments for hemorrhoids work for most people: Eat more fiber, drink more fluids, use a stool softener, and use ointments to help your symptoms.
- When home treatments don't work on internal hemorrhoids, fixative procedures may help. These are treatments that involve cutting off the blood flow to the hemorrhoids using rubber bands, lasers, heat, or electrical currents. These procedures are usually less painful than surgery.
- You might consider surgery to remove hemorrhoids (hemorrhoidectomy) for internal hemorrhoids that bulge from the anus or external hemorrhoids that are causing symptoms and have not improved with home treatment.
- External hemorrhoids are near the opening of the anus. They may be painful, but home treatments usually work to control them.
- Internal hemorrhoids are inside the anal canal. They usually don't cause pain. But they can itch, cause a feeling of pressure, and make it hard to clean around the anus. They may also bleed or leak mucus. Sometimes they stick out of the anus.
You can try the following home treatments:
- Blot the anus gently after bowel movements with white toilet paper moistened with water or a cleansing agent, such as Balneol. You can also use moistened baby wipes or medicated pads, such as Tucks.
- Avoid rubbing the anal area. And avoid soaps with perfumes or dyes.
- Use hemorrhoid ointments, such as Preparation H.
- Don't strain while you are having a bowel movement.
- Apply ice several times a day. Also try applying moist heat (such as warm, damp towels) several times a day, or sit in warm water (sitz bath).
- Eat more fiber, and drink more water.
- Take stool softeners.
You can also take nonprescription pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) and naproxen (Aleve), can help with pain and swelling.
These treatments cure most small and some large internal hemorrhoids. They aren't used for external hemorrhoids. They work by cutting off the blood supply to the hemorrhoid, which makes the hemorrhoid shrink or go away.
There are different ways to do this:
- Rubber band ligation. This is the most successful nonsurgical procedure. It is the one most often used for small and medium hemorrhoids. It involves tying off hemorrhoids with rubber bands.
- Coagulation. This procedure involves using heat, a laser, or an electrical current to create scar tissue around the hemorrhoids. Infrared photocoagulation uses infrared light to do this.
Surgery for hemorrhoids is called hemorrhoidectomy. It is the most successful way to treat large internal hemorrhoids.
Surgery is used for small internal hemorrhoids when:
- Several hemorrhoids are present.
- Bleeding cannot be controlled with other treatments.
- Both internal and external hemorrhoids are present.
Surgery may be a good choice for internal hemorrhoids that bulge from the anus. It is the only choice for external hemorrhoids that are causing symptoms and haven't improved with home treatment.
- Home treatment works for most people.
- Nonsurgical procedures are less risky and less painful than surgery. They require less time off from work and other activities.
- Of the nonsurgical procedures, rubber band ligation seems to work best. But it also appears to have a higher risk of complications, especially pain.
- Surgery usually cures a hemorrhoid. But the long-term success of hemorrhoid surgery depends a lot on how well you are able to change your daily bowel habits to avoid constipation and straining.
- Compared with nonsurgical procedures, surgery costs more, is more risky, and has a longer recovery period.
Most nonsurgical treatments have few risks. Possible problems may include:
- Pain or discomfort. For some people, the pain may be so bad that they will not be able to do their normal activities for a day or so.
- Bleeding, which may require another doctor visit to treat.
- Temporary trouble urinating because of pain. If you are completely unable to urinate, you'll need treatment.
- Infection or abscess.
Rubber band ligation appears to cause more pain than other types of nonsurgical procedures. Infrared photocoagulation usually causes fewer side effects.2
Risks of surgery
Surgery is more likely to cause side effects than nonsurgical treatments. These side effects may include:
- Pain, which may last for weeks. Passing bowel movements, even if they are soft, can be quite painful.
- Bleeding, which may last for a few days. If the bleeding is severe, you may need treatment.
- Being unable to urinate or pass stools. This may cause stools to become stuck in the anal canal (fecal impaction).
In rare cases, a more serious problem may develop.
People who have certain health conditions may not be able to have surgery or procedures for hemorrhoids. These conditions include:
- Bleeding disorders or taking blood thinners.
- HIV infection or AIDS.
- Rectal prolapse.
- Anal tumors or narrowing at the opening of the anal canal.
- Anal fissure or infection around the anus.
- Crohn's disease or ulcerative colitis.
- Cirrhosis of the liver.
- Irritable bowel syndrome or other conditions that cause a person to have frequent diarrhea, severe constipation, or both.
- Heart failure.
- Portal hypertension.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- Blot the anus gently with white toilet paper moistened with water or a cleanser, or use moistened baby wipes or medicated pads.
- Apply ice several times a day.
- Apply moist heat (such as warm, damp towels) several times a day, or sit in a warm bath.
- Eat more fiber. Drink more water.
- Take stool softeners.
- Use a hemorrhoid ointment.
- Take pain medicine.
- Most people get better using home treatment.
- You avoid the risks that come with nonsurgical procedures or surgery.
- If home treatment doesn't work, you may have a lot of pain and discomfort.
- If a hemorrhoid keeps bleeding a lot, you could become anemic.
- If a hemorrhoid sticks out from the anus, you may have trouble keeping the area clean.
- This is done in the doctor's office. You go home the same day.
- You will probably be awake during the procedure.
- If you have many hemorrhoids, you may have treatment in a hospital and be asleep during the procedure.
- Symptoms get better in about 8 out of 10 people who have this treatment.
- All procedures may cause pain, bleeding, temporary trouble urinating, and infection.
- Rubber band ligation appears to cause more pain than the other nonsurgical procedures.
- Infrared photocoagulation usually causes fewer side effects. But improvements may not last as long as with ligation.
- You may need more than one treatment.
- You are asleep or you are numb from the waist down during the operation.
- You will probably go home the same day.
- Most people can return to work or their normal activities after 2 to 3 weeks.
- Surgery almost always works to remove hemorrhoids and end symptoms.
- Recovery from this surgery can be very painful.
- Narrowing of the anus or rectum (anal or rectal stricture).
- Other risks of surgery include infection, bleeding, and being unable to urinate or pass stools.
- Hemorrhoids sometimes come back after surgery.
Personal stories about treating hemorrhoids
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have had hemorrhoids for many years, but they have never bothered me much. Once in a while they hurt or bleed, and I know that it's time to pay more attention to my diet and drink some extra water. My new doctor and I talked about them during my last visit. She asked if I had ever considered having them treated, and we talked about the pros and cons of my options. I decided that since they don't bother me very much, and because I know what to do if they flare up, I will just keep managing them as I have been. I can always have treatment later if they get worse.
John, age 40
Because I sit all day at work, my hemorrhoids can be a big inconvenience. I get plenty of fiber and water in my diet, but they are still bothering me. My doctor and I agreed that it would be reasonable for me to try the rubber band treatment. I will still have to watch what I eat and drink to keep my stools soft, but I hope that the treatment will take care of most of the pain so I can be more comfortable at work.
Genevieve, age 50
I had a rubber band hemorrhoid treatment several years ago. I recall that the treatment was quite painful, but it worked very well for a long time. Unfortunately, now the problem has come back. My doctor and I are talking about what to do next. He says I can do the rubber band treatment again or have surgery. Since the rubber band treatment worked well for me before, I plan to have it done again.
Ricardo, age 38
I have given all the hemorrhoid home treatments a try, and they have helped. But I still feel like I need something more. It concerns me to have rectal bleeding, although my doctor has tested me and we are confident that I don't have anything more serious than hemorrhoids. I'm going to try one of the nonsurgical treatments and see if that will help stop or reduce the bleeding so I can worry a little less. I have heard good things about the infrared photocoagulation treatment.
Barbara, age 47
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
I've tried home treatments for a while, and I'm not happy with the results.
I'd rather live with my symptoms than go through the temporary pain that nonsurgical procedures or surgery might cause.
My hemorrhoids bother me so much that I am willing to try anything, even surgery, to make them go away.
I want to avoid surgery at all costs, but I'm willing to try a nonsurgical procedure.
I'm worried about the possible side effects of nonsurgical procedures and surgery.
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using only home treatments to treat hemorrhoids
Trying something besides home treatments
Having a nonsurgical procedure for hemorrhoids
NOT having a nonsurgical procedure
Having surgery for hemorrhoids
NOT having surgery
What else do you need to make your decision?
Check the facts
If I have hemorrhoids, I should try home treatment first.
- TrueYou're right! Try eating more fiber, drinking more fluids, using a stool softener, and using ointments to help your symptoms.
- FalseSorry, that's the wrong answer. Try home treatment first: Eat more fiber, drink more fluids, use a stool softener, and use ointments to help your symptoms.
- I'm not sureIt may help to go back and read "Key points to remember." Home treatments work for most people: Eat more fiber, drink more fluids, use a stool softener, and use ointments to help your symptoms.
Surgery may be a good choice if my hemorrhoids are causing symptoms that aren't helped by home treatment.
- TrueThat's right. Surgery may help hemorrhoids that bulge from the anus or cause symptoms that don't get better with home treatment.
- FalseSorry, that's not right. Surgery may help hemorrhoids that bulge from the anus or cause symptoms that don't get better with home treatment.
- I'm not sureIt may help to go back and read "Get the Facts." Surgery may help hemorrhoids that bulge from the anus or cause symptoms that don't get better with home treatment.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Kenneth Bark, MD - Surgery, Colon and Rectal|
- American Gastroenterological Association (2004). American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology, 126(5): 1463–1473.
- Reese GE, et al. (2009). Haemorrhoids, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.