Hemorrhoids

Treatment

Hemorrhoids may be treated with simple self-care steps or surgery, depending on the severity of the condition.

Self-Care Procedures

For milder hemorrhoids, doctors may recommend:

• Daily warm baths
• Consumption of additional liquids and fiber to soften the stool and reduce constipation
• Hand washing the area with soap and water (rather than a washcloth)
• Avoiding prolonged periods of standing or sitting

Rubber Band Ligation

Rubber band ligation is the most effective nonoperative (without incision or excision) treatment for internal hemorrhoids that don't respond to self-care. Sometimes referred to as "banding," rubber band ligation is a relatively simple procedure in which the doctor attaches tiny rubber bands to the base of internal hemorrhoids. With their circulation cut off, they painlessly fall away after seven to 10 days and are expelled with stool. Usually only one or more hemorrhoids are treated at a time, so a patient may need to have additional hemorrhoids treated after four to six weeks.

An analgesic is usually prescribed after the surgery. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS) and anticoagulants should not be taken for two weeks afterwards, as they could increase bleeding. Warm baths can help relieve pain from anal sphincter spasms, which some people may experience after the procedure.

If a patient has severe pain immediately or pain which gets progressively worse, it's possible that the rubber band was placed too low near the anal opening and will need to be removed.

Rarely, a serious infection can develop after rubber band ligation. Patients should seek immediate treatment if they experience persistent anal pain, inability to urinate or fever. Because of the chance for infection, rubber band ligation is not a good option for people with immunodeficiencies such as AIDS, transplant patients and patients on chemotherapy.

Operative Surgery

Surgery is an option when hemorrhoids are severely prolapsed, don't improve with rubber band ligation or are complicated by another disorder. The surgery is usually an outpatient procedure, but sometimes requires an overnight stay. It's usually performed under general or local anesthesia. Surgery is usually a closed hemorrhoidectomy or a circular stapled hemorrhoidopexy.

In a closed hemorrhoidectomy, a special anal speculum exposes the hemorrhoidal tissue so that the surgeon can cut out the hemorrhoids and close the resulting wound with an absorbable suture. This procedure is usually performed to correct severe situations such as strangulated hemorrhoids.

Illustration of a circular stapled hemorrhoidopexy

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In a circular stapled hemorrhoidopexy, excess mucosal tissue above the hemorrhoids (around the entire circumference of the anal canal) is removed, pulling the hemorrhoids back up into position. The tissue above and below the excised ring is stapled together. This procedure is less painful than a closed hemorrhoidectomy and has a quicker recovery period.

The other surgical procedure sometimes performed on hemorrhoids is removing a thrombus (blood clot) from an external hemorrhoid to relieve pain. (Because the blood clots usually shrink and dissolve on their own, if the pain is not worsening, a doctor might prescribe an analgesic along with self-care procedures and monitor the hemorrhoid instead.) After the hemorrhoid is incised and the blood clot(s) removed, the wound may be either stitched closed or left open. The surgery is usually performed as an office procedure using local anesthetic.