Silent No More: Get Help for Your Hemorrhoids
It's a problem lots of people deal with but no one talks about. How do you cope with hemorrhoids? Or, even better, how can you avoid getting them in the first place?
At-Home Hemorrhoid Treatments
Treating hemorrhoids with medication won't make them go away, but most of
the time it alleviates symptoms. "Basic medical treatments are a variation
of witch hazel, such as Preparation H or Tucks pads," says Raymond.
"Witch hazel dehydrates and shrinks them but doesn't make them go away. My
preference is Tucks pads, which have a lot of witch hazel. You tuck them in the
Raymond tells WebMD that "when hemorrhoids are painful, don't use dry
toilet paper. It's like using sandpaper." She advises using hypo-allergenic
baby wipes or flushable Cottonelle. "If itching is a problem, diaper
ointment can provide relief."
Good hygiene is also very important since fecal matter or mucus drainage
irritates the skin and hemorrhoid area. Too much wiping can worsen discomfort,
so the American Gastroenterological Association suggests that a bath or shower
can be used as an alternative to wiping after a bowel movement.
Ointments containing lidocaine, hydrocortisone creams and suppositories, and
warm sitz baths can also provide hemorrhoid relief.
When Home Remedies Don't Help
Various nonsurgical treatments are available to remove internal hemorrhoids.
Luca Stocchi, MD, of the Cleveland Clinic, explains that hemorrhoids are graded
according to severity from I to IV. Surgery is used on grade IV hemorrhoids and
sometimes on grade III. Nonsurgical procedures are typically performed in a
doctor's office without anesthesia and can be used to treat hemorrhoids from
grades I to III. They include:
Injection sclerotherapy: This treatment is sometimes used for smaller
bleeding hemorrhoids. The doctor injects a special solution to shrink the
hemorrhoidal tissue. Success rates vary.
Rubber band ligation: Several sessions may be required for rubber
band ligation, which is used for larger internal hemorrhoids or those that fail
to respond to injection sclerotherapy. A rubber band is put round the
hemorrhoid to choke off its blood supply. The hemorrhoid eventually falls off
on its own. Recurrence may be as high as 68% after four or five years, but
symptoms usually respond to repeat procedures. Pain following the procedure is
generally minor and can be relieved with sitz baths and pain medications.
"Complications are minimal, and patients can return to normal activities
the same day," says Stocchi, a colorectal surgeon.
Infrared photocoagulation: Some doctors use infrared photocoagulation
to treat small internal hemorrhoids, hemorrhoids that cannot be treated with
rubber band ligation because of pain sensitivity, or hemorrhoids that are not
cured with rubber band ligation. A probe focuses infrared radiation on the
hemorrhoid, burning it. The procedure requires multiple treatments, and the
recurrence rate can be high.
Do You Need Surgery?
Surgical hemorrhoidectomy is performed when more conservative treatments
fail. "Tissue that includes blood vessels is excised, so there is
bleeding," says Stocchi. Most patients can go home the same day, but the
need for catheterization may require an overnight stay.
Stapled hemorrhoidectomy was introduced in 1998 as an alternative to
traditional surgical hemorrhoidectomy. A stapling device is used to attach the
hemorrhoid to rectal muscle. "It's advocated as a less painful alternative
for grades I through III, and when appropriately done it's as effective as
hemorrhoidectomy," says Stocchi. "But the long-term outcomes regarding
recurrence are unknown."
Patients can expect pain that makes it difficult to sit after surgery, says
Stocchi. But they can resume normal activities in a few days, and some do so
immediately. "One patient resumed her marathon training a week after
Complications can include impacted stool, especially in elderly patients, or
infection. "It's important for patients to use a stool softener, or it
could require another trip to surgery," Stocchi tells WebMD.
While surgery is generally reserved for internal hemorrhoids, Stocchi says
that thrombosed external hemorrhoids may require prompt attention.
Raymond advises patients to try to avoid surgery by making lifestyle changes
and using over-the-counter remedies to soothe hemorrhoids.