Hemorrhoids

Alternative Names

Treatment

Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other steps for anal itching include:

• Wear cotton undergarments.
• Avoid toilet tissue with perfumes or colors.
• Try not to scratch the area.

Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.

For cases that don't respond to home treatments, a surgeon or gastroenterologist can apply heat treatment, called infrared coagulation, to shrink internal hemorrhoids. This may help avoid surgery. Surgery that may be done to treat hemorrhoids includes rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.

Outlook (Prognosis)

Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.

Possible Complications

The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.

Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.

When to Contact a Medical Professional

Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment. You should also be seen if you have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding, especially if you have never bled from hemorrhoids before.

Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.

References

American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterology. 2004 May;126(5):1461-2.

Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th ed. Philadelphia, Pa: Saunders; 2002.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Rakel P.Textbook of Family Practice. 6th ed. Philadelphia, Pa: Saunders; 2002.