Hemorrhoids: Which Treatment Should I Use?

• 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. Be safe with medicines. Read and follow all instructions on the label.

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.
  • Rubber band ligation helps about 8 out of 10 people who have it done. That means it doesn't help about 2 out of 10.^{footnote 1}
  • Infrared photocoagulation has about the same success rate as rubber band ligation. But improvements may not last as long.^{footnote 2}
• 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.^{footnote 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).
• Infection.

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.