Therapies and remedies to treat hemorrhoids

Treatments for hemorrhoids can be divided into three broad categories:

• preventive and conservative therapies
• outpatient treatments
• surgical treatments

The choice of the most suitable treatment to address symptoms and causes of hemorrhoids depends on the characteristics and the severity of the disease.

Hemorrhoids prevention and conservative therapies

Diet and lifestyle

During the initial stages of the disease or to prevent it, simple changes in lifestyle, hygiene and eating habits can help.

Here are some useful tips to relieve the symptoms of hemorrhoids in the mildest cases or to prevent their development:

• regularize intestinal function and keep stools soft and hydrated: this helps reduce the effort during defecation and limit the evacuation time. To do this, it is important to consume a lot of dietary fibers contained in fruit, vegetables, legumes, and cereals or dietary supplements. It is likewise necessary to drink enough quantities of liquid during the day (at least 1.5 liters)
• perform regular physical activity to help the intestine function properly and prevent constipation
• carefully attend to hygiene in the intimate areas with specific products to reduce the risk of local infections

Medical therapy: topical / systemic

With the presence of mild symptoms, topical preparations such as creams, ointments, and lotions can help reduce the discomforts associated with hemorrhoids.

There are many preparations available to reduce the symptoms of hemorrhoid disease including:

• emollient and soothing creams, and ointments
• topical pharmaceutical preparations containing anesthetics (lidocaine) – the use of these preparations is to relieve pain and is usually indicated for short periods because it can cause local hyper-sensitivity.
• topical pharmaceutical preparations containing cortisone – the use of these preparations is to reduce inflammation, burning and local itching, for short periods of time
• Bioflavonoid-based supplements such as diosmin, troxerutin, and hesperidin can help improve venous microcirculation and reduce local swelling and inflammation.

Outpatient treatments

Outpatient treatments are utilized in the early stages of the disease when symptoms are more evident.

These treatments act on the hemorrhoidal cushion, reducing excessive blood flow that causes congestion, but often must be repeated.

The most common outpatient procedures are:

• Rubber band ligation: Rubber band ligation is one of the most common office procedures used. It involves cutting off the blood supply to the symptomatic bit of hemorrhoids (using a small elastic rubber ring at the base of the hemorrhoidal cushion) causing it to necrotize and fall off after a few days. Possible complications^* include mild discomfort in the treated area that tends to resolve spontaneously, pain after ligation in the case of incorrect positioning of the rubber band, bleeding and hemorrhoid thrombosis.
• Sclerotherapy: Sclerotherapy reduces blood flow and volume of hemorrhoidal cushions by injecting a chemical substance that cause tissue to necrotize and fall off. Possible complications^* may include temporary soreness in the anorectal area and mild bleeding in the days following treatment.
• Cryotherapy: Cryotherapy is one of the least used office treatments. It involves the use of low temperatures to destroy the congested tissue, helping to reduce hemorrhoidal cushions. Possible complications^* are edema, bleeding, and infections after treatment.

There are also other lesser-used outpatient procedures that use different technologies, but which share similar complications and a high rate of recurrence of the disease^*:

• Infrared photocoagulation: Infrared photocoagulation involves the use of infrared rays to overheat the hemorrhoidal cushions, triggering a coagulation process that reduces excessive blood flow. The hemorrhoid cushion dies and a scar forms at its base. It is usually an expensive procedure and among the possible complications are severe pain and bleeding. However, clinical studies on the effectiveness of the treatment are very scarce and only include short-term follow-up.
• Laser coagulation: with the guidance of a Doppler probe to identify arteries, laser coagulation involves the use of laser beams to stop excessive blood flow to hemorrhoids. Possible complications^* are pain and bleeding. There is limited clinical evidence of treatment effectiveness and short-term follow-up.
• Radiofrequency coagulation: radiofrequency coagulation stops the blood flow to the hemorrhoidal cushions, causing necrosis. Possible complications^* are pain and bleeding. Clinical studies for this method of treatment are limited.
• Electrocoagulation: electrocoagulation consists of obstructing the blood flow to vessels that carry blood to the hemorrhoidal cushions to reduce their volume. This treatment can be painful and cause significant bleeding^*.

^* as reported in published literature

Hemorrhoids surgery

Whenever outpatient procedures are not deemed effective, the specialist may direct the patient towards surgical treatments.

Hemorrhoidectomy: Milligan-Morgan and Ferguson techniques

Traditional surgery, called hemorrhoidectomy, consists of removing hemorrhoidal cushions. Common traditional surgical treatments are the Milligan-Morgan and Ferguson techniques.

With the Milligan-Morgan technique, the wounds are left open by the surgeon, leaving them to heal spontaneously. The surgeon uses a continuous suture to close wounds for the Ferguson method.

These methods, if well executed, are often effective. Complications are rare, but can be serious and include fecal incontinence, severe bleeding, and anal stenosis^*.

Furthermore, hemorrhoidectomy can cause severe pain causing patients to opt out of surgery. The pain is caused by wounds, particularly during passing of stools.

Stapled Hemorrhoidopexy

Stapled hemorrhoidopexy has been the first surgical method to solve the problem of hemorrhoidal prolapse without removing hemorrhoids.

It involves using a circular suturing device (staple) to cut a part of the rectum and reposition hemorrhoids into their original place.

This technique does not involve hemorrhoids removal but serious complications may occur in a significant percentage of cases. More common complications are post-operative hemorrhage, urgent defecation, strong and persistent rectal-anal pain, and in some cases perforation of the rectum^*.

^* as reported in published literature

THD^® Doppler Method: minimally invasive surgery for hemorrhoids

The THD^® Doppler procedure is a minimally invasive non-excisional surgical technique for hemorrhoids treatment.

It does not involve hemorrhoids removal, but only the application of internal stitches in areas insensitive to pain. These sutures allow for the reduction in excessive blood flow to hemorrhoids and reposition them in their natural place.

The surgeon performs the procedure using a special anoscope and a Doppler probe. Thanks to the Doppler signal, the surgeon can locate hemorrhoids arterial vessels and ligate them. In the case of prolapse, after ligation, the surgeon performs a mucopexy, i.e. the repositioning of the mucosa in the original position.

For more information on this treatment, visit the THD^® Doppler Method page.