Hemorrhoids Treatment & Prevention Options

Conditions & Diseases: Digestive Diseases

Hemorrhoids

Treatment Options

Hemorrhoids can be treated by following methods described below:

Medications
Non-operative procedures for internal hemorrhoids
Surgical procedures

I. Medications:

Local Anesthetics: Usage of local anesthetics helps relieve pain, burning, and itching sensation by numbing the nerve endings temporarily, but must be limited to the perianal area and lower anal canal to avoid allergic reactions such as internal burning and itching. Some of the local anesthetics include:

Benzocaine 5% to 20% (Americaine Hemorrhoidal, Lanacane Maximum Strength, Medicone)
Benzyl alcohol 5% to 20%
Dibucaine 0.25% to 1.0% (Nupercainal)
Dyclonine 0.5% to 1.0%
Lidocaine 2% to 5%
Pramoxine 1.0% (Fleet Pain-Relief, Procto Foam Non-steroid, Tronothane Hydrochloride)
Tetracaine 0.5% to 5.0%

Vasoconstrictors: As the name indicates, these chemicals constrict the blood vessels and reduce swelling. These chemicals also help in reducing pain and itching due to their mild anesthetic affect. Some of the vasoconstrictors include:

Ephedrine sulfate 0.1% to 1.25%
Epinephrine 0.005% to 0.01%
Phenylephrine 0.25% (Medicone Suppository, Preparation H, Rectacaine).

Protectants: These are used to prevent irritation, itching, pain and burning of the perianal area by forming a physical barrier on the skin. Some of the protectants are:

Aluminum hydroxide gel
Cocoa butter
Glycerin
Kaolin
Lanolin
Mineral oil (Balneol)
White petrolatum
Starch
Zinc oxide or calamine (which contains zinc oxide) in concentrations of up to 25%
Cod liver oil or shark liver oil if the amount of vitamin A is 10,000 USP units/day.

Astringents: These cause coagulation or clumping of proteins in the cells pertaining to perianal skin of the anal canal leading to dryness of the skin resulting in relief from burning, itching and pain. Some of the astringents include:

Calamine 5% to 25%
Zinc oxide 5% to 25% (Calmol 4, Nupercainal, Tronolane)
Witch hazel 10% to 50% (Fleet Medicated, Tucks, Witch Hazel Hemorrhoidal Pads)

Antiseptics: Antiseptics actively curb the growth of bacteria and other organisms. Antiseptics include:

Boric acid
Hydrastis
Phenol
Benzalkonium chloride
Cetylpyridinium chloride
Benzethonium chloride
Resorcinol

Keratolytics: Keratolytics are chemicals that lead to disintegration of outer layers of skin or other tissues allowing medications to penetrate deeper into tissues. The two approved keratolytics are:

Aluminum chlorhydroxy allantoinate (alcloxa) 0.2% to 2.0%
Resorcinol 1% to 3%

Analgesics: Analgesics relieve pain, itching and burning sensation on nerves. Some of the examples of analgesics are as follows:

Menthol 0.1% to 1.0% (greater than 1.0% is not recommended)
Camphor 0.1% to 3% (greater than 3% is not recommended)
Juniper tar 1% to 5%

Corticosteroids: Only weak corticosteroids should be used to relieve itching and reduce inflammation since their chronic use results in permanent damage to the skin.

II. Non-operative procedures for internal hemorrhoids

Various non-operative procedures are used to treat internal hemorrhoids causing inflammation in hemorrhoidal cushions producing scarring and leading to shrinkage of cushions attached to underlying muscle of the anal canal. It is important to note that these procedures do not cause pain and thus do not require anesthesia.

Sclerotherapy: In this procedure, phenol or quinine urea is injected into the base of the hemorrhoid leading to inflammation and finally scarring. The patient experiences some pain after the procedure, which subsides the following day.

Rubber band ligation: In this procedure, the base of hemorrhoidal anal cushion is tightly encircled with rubber bands leading to death of tissue causing ulcers that heal with scarring. This procedure can be used to treat first-, second- and third- degree hemorrhoids. Some of the complications include bacterial infection in the tissues surrounding anal canal (cellulites) which could spread to the tissues within pelvis ultimately leading to abscess and entry of infection into bloodstream (sepsis). Bleeding after one or two weeks after the ligation procedure could become severe.

Heat Coagulation: In this procedure, hemorrhoidal tissues are killed with heat leading to inflammation and scarring. Procedures such as bipolar diathermy, direct-current electrotherapy and infrared photocoagulation are conveniently used to treat first, second, and third-degree hemorrhoids (2).

Infrared Photocoagulation: In this procedure, an infrared light is used to coagulate the dilated veins of the hemorrhoid causing the hemorrhoids to shrink.

Laser Coagulation: This procedure involves application of electric current emitted by an electrode probe to the hemorrhoids triggering a chemical reaction leading to cessation of blood supply to the hemorrhoids and shrinking of the inflamed tissue (6)

III. Surgical Procedures

There are various surgical procedures to treat hemorrhoids:

Dilation: Forceful dilation of anal sphincter by stretching the anal canal leads to weakening of the anal sphincter, since it is assumed that increased sphincter pressure is responsible for hemorrhoids. Frequent dilation damages the sphincter and may lead to incontinence of stools.

Doppler Ligation: This surgery involves ligation (tying off) of the individual artery supplying blood to the hemorrhoidal vessels with the help of a special illuminated anoscope and a Doppler probe that measures blood flow leading to shrinking of the hemorrhoid.

Sphincterotomy: In this surgical procedure, the internal portion of the anal sphincter is partially cut off to reduce the pressure of the sphincter within the anal canal.

Hemorrhoidectomy: In this procedure, internal and external hemorrhoids are cut off and the wounds left may be sutured (stitched) or left open. Hemorrhoidectomy is generally performed on patients suffering from third- or fourth- degree hemorrhoids (2).

Prevention Methods

Some of the preventive methods for hemmorhoids include:

High Fiber Foods: Consumption of high fiber diet such as whole-grain breads, cereals, raw vegetables, raw and dried fruits, and beans softens the stool and increases its bulk lessening the strain that can cause hemorrhoids. Low or no fiber foods such as ice cream, soft drinks, cheese, white bread and red meat must be avoided.

Liquids consumption: Fruit juices and 8-10 glasses of water must be consumed daily. Liquids containing caffeine such as coffee and tea or alcohol must be avoided, since they cause dehydration leading to constipation.

Stool softeners: Sprinkling of bran or psyllium on foods or stirring it into fruit juices can be helpful as stool softeners. Laxatives must be avoided since they may cause diarrhea.

Fiber supplements: Products such as Metamucil and Citrucel and about eight glasses of water help keep stools soft and regular.

Exercise: Regular exercise with high fiber diet helps loose excess weight and promotes smooth, regular bowel movements. Standing and sitting for long periods can increase the pressure on the anal veins.

Urge: A person must immediately go to the toilet as soon as there is an urge, since waiting could lead to passage of the bowel movement and urge. This could lead to drying and hardening of the stool.

Avoid Straining: Straining to pass the stools must be avoided and things should happen naturally (9) & (10).

Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com

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