Which treatment for hemorrhoids is right for me?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Consider the following when making your decision:

• Home treatment is usually the first step in treating hemorrhoids. Home treatment includes adjusting your diet to avoid constipation, drinking more fluids, using a stool softener, and using ointments to relieve symptoms.
• Fixative procedures, which cut off the blood flow to the hemorrhoids using rubber bands, lasers, heat, or chemical injections, are an option if you have internal hemorrhoids that bulge from the anus during bowel movements.
• 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.

Medical Information

What types of hemorrhoids are there?

Hemorrhoids may occur either near the opening of the anus (external hemorrhoids) or inside the anal canal (internal hemorrhoids).

• External hemorrhoids may be painful but usually do not need medical treatment unless a clot develops.
• Internal hemorrhoids usually do not cause pain. However, they can itch, cause a pressure sensation, and make it difficult to clean the anal area. They may also bleed or stick out from the anus. Internal hemorrhoids are assessed and treated according to how bad they are.
  • First-degree hemorrhoids do not bulge from the anus.
  • Second-degree hemorrhoids bulge from the anus during bowel movements but go back into the anus afterward on their own.
  • Third-degree hemorrhoids bulge from the anus during bowel movements, but they can be pushed back into the anus.
  • Fourth-degree hemorrhoids bulge outside the anus all the time.

What are the methods of treatment for hemorrhoids?

Hemorrhoids are treated with home treatment, fixative (nonsurgical) procedures, and/or surgery.

Home treatment

Home treatment methods for hemorrhoids mainly involve having healthier bowel habits.

You can avoid making hemorrhoids worse by blotting the anus gently after bowel movements with white toilet paper moistened with water or a cleansing agent such as Balneol or with moistened, medicated pads such as Tucks. Also, avoid rubbing the anal area, and avoid soaps with perfumes or dyes. To relieve symptoms, apply ice several times a day. Also, try applying moist heat, such as warm, damp towels, several times daily, or sitting in warm water (sitz bath).

Other measures you can take at home include increasing the amount of fiber and water in your diet and taking stool softeners. This will help prevent constipation and make stools easier to pass. Changing some of your habits so that you do not strain while having bowel movements will often relieve symptoms caused by both types of hemorrhoids. This also may keep hemorrhoids from becoming bigger. However, although hemorrhoids may shrink, they will not go away.

Fixative procedures

The goal of fixative procedures is to reduce the blood supply to the hemorrhoid, causing the hemorrhoid to shrink or go away. These nonsurgical treatments cure most smaller and some larger internal hemorrhoids. Fixative procedures include tying off hemorrhoids with rubber bands (rubber band ligation); scarring the tissue around the hemorrhoids (coagulation therapy) with devices that use heat, a laser, or an electrical current; and injecting hemorrhoids with chemicals that cause them to shrink (injection sclerotherapy). These are called fixative procedures because the scar that results keeps nearby veins from bulging into the anal canal.

Hemorrhoidectomy

Surgical removal of hemorrhoids (hemorrhoidectomy) is the most successful way to treat large internal hemorrhoids. Small internal hemorrhoids are sometimes treated surgically when several hemorrhoids are present, bleeding cannot be controlled with other treatments, or both internal and external hemorrhoids are present.

How effective are the different hemorrhoid treatments?

Most internal hemorrhoids become smaller and cause less pain with either home treatment or fixative procedures, which cut off blood flow to the hemorrhoids.

• Hemorrhoid surgery may give better long-term results than fixative procedures.
• Compared with fixative procedures, surgery costs more, is more risky, and has a longer recovery period.
• Fixative procedures are less risky and less painful than surgery and require less time off from work and other activities.
• Of the fixative procedures, rubber band ligation seems to give the best results but also appears to have a higher risk of complications, especially pain.

Fixative procedures, especially rubber band ligation, may successfully treat hemorrhoid symptoms.

Rubber band ligation is used to treat small and medium-sized hemorrhoids that are too large to be treated by injection sclerotherapy and infrared photocoagulation. It is the most successful fixative procedure and the one most commonly used. More than 86% of the time, hemorrhoid symptoms do not return. If they do return, they can be treated again with rubber band ligation or other treatments.¹

Infrared photocoagulation is also used to treat small hemorrhoids. It has fewer risks than injection sclerotherapy and a similar success rate. It is generally more expensive than injection sclerotherapy.¹

Injection sclerotherapy is rarely performed; its success depends on the skill of the doctor, and it works well only for small hemorrhoids. About 77% to 86% of the time, the hemorrhoids do not return.¹

Improvements in symptoms after rubber band ligation appear to last longer than after other types of fixative procedures, but people reportedly have more pain after the procedure than after injection sclerotherapy or infrared photocoagulation.

Surgery usually cures a hemorrhoid, but the long-term success of hemorrhoid surgery depends largely on how well you are able to change your daily bowel habits to avoid constipation and straining.

What are the risks of the different treatments for hemorrhoids?

Most fixative procedures, such as rubber band ligation and infrared photocoagulation, usually 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 difficulty urinating because of pain. If the person is completely unable to urinate, treatment will be needed.
• Infection or abscess. In rare cases, rubber band ligation may cause a bad infection that can be life-threatening and requires hospitalization for treatment.

Rubber band ligation appears to cause more pain than other types of fixative procedures. Infrared photocoagulation usually causes fewer side effects and does not have the rare, life-threatening complications.¹

Surgery (hemorrhoidectomy) is more likely than fixative procedures to cause side effects. These 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.
• Inability to urinate or pass stools. Inability to pass stools may cause stools to become stuck in the anal canal (fecal impaction).
• Infection.

In rare cases, a more serious problem may develop.

What are the risks of not treating hemorrhoids?

If you do not treat hemorrhoids, you may continue to have discomfort, pain, or bleeding. If bleeding is severe, it may cause anemia. You may have difficulty keeping the anal area clean.

If you change your daily habits so that your stools are soft and easy to pass, your hemorrhoids will probably get smaller, cause less pain, and may not cause any symptoms. If you have fixative procedures or surgery, you will still need to get enough fluid and fiber to keep your stools soft.

If you need more information, see the topic Hemorrhoids.

Your Information

Your choices are:

• Use home treatments to control hemorrhoid symptoms.
• Have a fixative procedure that cuts off the blood flow to the hemorrhoids. Rubber band ligation and infrared photocoagulation are the most commonly performed fixative procedures.
• Have surgery to remove the hemorrhoid (hemorrhoidectomy).

The decision about what treatment to use for hemorrhoids takes into account your personal feelings and the medical facts. The method you choose will depend on:

• The location of the hemorrhoids, whether they are internal or external.
• The size of the hemorrhoids and how bad they are.
• The amount of pain or discomfort the hemorrhoids cause.
• The amount of bleeding from the hemorrhoids.
• Other conditions that may affect your choice.

People who have certain health conditions may not be able to have some fixative or surgical procedures. These conditions include:

• Bleeding disorders or taking medicine to prevent blood clots (blood thinners or anticoagulants).
• Human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS).
• Rectal prolapse.
• Anal tumors or narrowing (strictures) at the opening of the anal canal.
• A large tear in the lining 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.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about the different methods of treating hemorrhoids. Discuss the worksheet with your health professional.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use a certain treatment for hemorrhoids.

Check the boxes below that represent your overall impression about your decision.

Return to the topic Hemorrhoids.