What types of hemorrhoids are there?
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
- Internal hemorrhoids usually do not cause pain. But 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
- Third-degree hemorrhoids bulge from the anus during bowel
movements, but they can be pushed back into the anus.
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 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. But although
hemorrhoids may shrink, they will not go away.
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) and scarring the tissue
around the hemorrhoids (coagulation therapy) with devices that use heat, a
laser, or an electrical current. These are called fixative procedures because
the scar that results keeps nearby veins from bulging into the anal
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
- 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
- Fixative procedures are less risky and less painful than
surgery and require less time off from work and other
- 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. It is
the most successful fixative procedure and the one most commonly used. Symptoms
get better in more than 8 out of 10 people who have rubber band ligation. Some
people may have hemorrhoids come back. But if hemorrhoids 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 about
the same success rate as rubber band ligation.2
Improvements in symptoms after rubber band ligation appear to last longer
than after infrared photocoagulation, but people reportedly have more pain
after rubber band ligation than after infrared photocoagulation.2
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
- Temporary difficulty urinating because of pain. If the
person is completely unable to urinate, treatment will be
- 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
(hemorrhoidectomy) is more likely to cause side effects than fixative
procedures. These side effects may include:
- Pain, which may last for weeks. Passing bowel
movements, even if they are soft, can be quite painful.
which may last for a few days. If the bleeding is severe, you may need
- Inability to urinate or pass stools. Inability to pass
stools may cause stools to become stuck in the anal canal (fecal
In rare cases, a more serious problem may develop.
What are the risks of not treating hemorrhoids?
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
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
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