Rectum
Hemorrhoid Management
search
Hemorrhoid Management
See also
Hemorrhoid
Internal Hemorrhoid
External Hemorrhoid
External
Thrombosed Hemorrhoid
Prevention
Avoid
Constipation
(mainstay of therapy)
Goal is soft bulky stool that is easily passed without straining
High bulk diet (soluble
Dietary Fiber
) 30 grams per day or fiber supplement (e.g.
Citrucel
or
Metamucil
)
Decreases overall symptoms as well as decreases
Hemorrhoid
al bleeding by 50%
Alonso-Coello (2005) Cochrane Database Syst Rev (4):CD004649 [PubMed]
Increased volume of fluids 64 ounces non-caffeinated fluid per day
Stool Softener
(e.g.
Colace
)
Avoid
Irritant Laxative
s
Prevention
Avoid increased anorectal pressure
Do not strain at stool
Do not sit on toilet for prolonged periods
Do not read on toilet
Prevention
Minimize anorectal local inflammation
Practice good hygiene
Baby wipes without
Alcohol
Avoid topical irritant or allergens
Use only hypoallergenic soaps
Use only white toilet tissue
Preparations
Topical agents (typically found in combination agents)
Decrease bleeding and swelling
Witch hazel Tucks (astringent)
Phenylephrine
(
Decongestant
)
Skin protectants
Zinc Oxide
Antiinflammatory
Topical Corticosteroid
s
Topical Anesthetic
s
Topical
Lidocaine
or other agents
Preparations
Topical Agents in Pregnancy
Topical external medications considered safe in pregnancy
Witch Hazel (Tucks)
Petrolatum (topical protectant)
Pramoxine (
Topical Anesthetic
)
Hydrocortisone
1%
Precautions
Avoid internal use or regular use of topical agents
Avoid
Phenylephrine
containing products (e.g. preparation H)
May decrease uterine perfusion
References
(2019) Presc Lett 26(8):45
Management
Gene
ral
See individual preparations listed above
Most topical
Hemorrhoid
al agents are combinations of these preparations
No evidence for prescription topicals (anusol-HC) over OTC Medications (Preparation-H)
Pain (
External Hemorrhoid
s, esp.
Thrombosed Hemorrhoid
s)
Manage
Thrombosed Hemorrhoid
if present
Topical astringent wipes (e.g. Witch Hazel Tucks)
Sooths burning pain and clean the area
Hydrocortisone
(no proven benefit if no inflammation; avoid prolonged use)
Preparation-H (contains
Phenylephrine
)
Anusol HC
ProctoFoam HC
Analgesic
s
Topical Anesthetic
s (e.g.
Lidocaine
ointment)
Shortterm use externally only
Cold pack applied to anal area
Hot sitz bath in tub for 20-30 minutes twice daily
No evidence of benefit, but without risk
Other measures
Oral Bioflavinoid supplements or Phlebotonics (e.g. Hidrosmin, hesperidin)
Some studies suggest decreased bleeding,
Pruritus
or fecal leakage
Not FDA approved
Perera (2012) Cochrane Database Syst Rev (8):CD004322 +PMID: 22895941 [PubMed]
References
Pickard in Dornbrand (1992) Ambulatory Care, p. 225-6
Goroll (2000) Primary Care, p. 430-1
Schrock in Feldman (1998) Sleisenger GI, p. 1964-7
Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97 [PubMed]
Hussain (1999) Prim Care 26(1):35-51 [PubMed]
Mott (2018) Am Fam Physician 97(3): 172-9 [PubMed]
Type your search phrase here