TREATMENT OVERVIEW
Hemorrhoid treatment starts at home. Since hemorrhoids are made worse by straining to pass stools, changing some of your daily bowel habits so you can have regular, soft bowel movements may help relieve symptoms and keep hemorrhoids from getting worse. (For more information, see the Home Treatment section in this topic.)
EXTERNAL HEMORRHOIDS
External hemorrhoids usually do not need medical treatment unless a hemorrhoid bursts. This may cause blood to pool under the skin, forming a hard, extremely painful lump at the anus. This is called a clotted hemorrhoid.
- If you see a doctor during the first 24 to 48 hours after the lump forms, he or she may remove the lump to lessen the pain and speed recovery. This procedure is called excision. (See the section Other Treatment in this topic for more information.)
- If the lump is not removed within 24 to 48 hours, the pain will gradually lessen over the next few days, even though the lump is still present. The skin covering the lump may break open on its own, causing bleeding. With home treatment, pain and bleeding stop in about a week (although the lump may remain for several weeks).
External hemorrhoids are not usually removed by surgery (hemorrhoidectomy). However, external hemorrhoids may be treated with surgery if:
- The hemorrhoids are so large that they are tender and make cleaning the anal area painful.
- The person is having surgery on the anal area for other reasons, such as internal hemorrhoids or a tear (anal fissure) in the lining of the end portion of the large intestine (anal canal).
INTERNAL HEMORRHOIDS
Most people who have internal hemorrhoids have bothersome symptoms that may be relieved with home treatment. A doctor may need to treat internal hemorrhoids if they continue to bleed after trying home treatment, or if they become so large that they bulge out of the anus.
The goal of most nonsurgical procedures is to reduce the blood supply to the hemorrhoid, causing the hemorrhoid to shrink or wither away. A scar then forms where the hemorrhoid was located. The thickened scar tissue gives added support to the anal canal tissue, because it is firm and does not allow surrounding tissues to stretch.
Nonsurgical treatments cure most smaller and some larger internal hemorrhoids. These are called fixative procedures because the scar that results from the procedure keeps nearby veins from bulging into the anal canal.
FIXATIVE PROCEDURES INCLUDE:
- Tying off hemorrhoids with rubber bands (rubber band ligation). Rubber band ligation is used most often and is more likely than other fixative procedures to make symptoms go away and stop hemorrhoids from recurring in the future.
- Burning the tissue around the hemorrhoids (coagulation therapy) with devices that use heat, a laser, or an electrical current.
- Injecting hemorrhoids with chemicals (injection sclerotherapy) that cause them to shrink.
For information about these procedures, see the Other Treatment section in this topic.
When compared with surgery, fixative procedures (especially rubber band ligation and coagulation therapy) are less risky and less painful and result in less time away from work and other activities. However, some people need to return for three to four procedures before all of their hemorrhoids are treated. Not all doctors have the experience or the equipment to perform all types of fixative procedures.
Surgical removal of hemorrhoids (hemorrhoidectomy) is the most successful way to treat larger internal hemorrhoids. In rare cases when a large hemorrhoid bulges out of the anus and the blood supply is cut off (strangulated hemorrhoid), an emergency surgical removal of the strangulated hemorrhoid (hemorrhoidectomy) is done.
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.
Sometimes a combination of treatments (for example, a fixative procedure and a hemorrhoidectomy) is the best way to get rid of hemorrhoids.
