Hemorrhoids (piles) are a common condition involving swollen, enlarged veins that form either inside the lower rectum or underneath the skin around the anus. These vascular cushions are a normal part of the anatomy, but they become problematic when they swell, leading to symptoms like pain, itching, bleeding, and discomfort. The development of hemorrhoids is often linked to increased pressure in the lower rectum. Interventions range from simple self-care measures and in-office procedures to definitive surgical solutions, depending on the severity of the condition.
Immediate Relief Through Self-Care
Immediate relief from the burning, itching, and swelling of a flare-up often begins with accessible home treatments. A warm sitz bath involves soaking the anal area in warm, shallow water for 10 to 20 minutes, two or three times a day. This practice helps relax the anal sphincter muscles, relieve discomfort, and improve blood flow. Taking a sitz bath immediately following a bowel movement is beneficial to gently cleanse the area.
Over-the-counter topical products can also provide targeted symptom control. Creams and ointments may contain various active ingredients to address specific discomforts. Hydrocortisone is a mild steroid used to reduce inflammation and itching, while phenylephrine acts as a vasoconstrictor to temporarily shrink swollen blood vessels.
Astringent pads containing witch hazel can be applied externally to soothe and protect the irritated skin. Local anesthetic agents, such as lidocaine, are also available in topical formulations to numb the area and relieve acute pain. Promoting soft, easy-to-pass stool is vital to prevent further irritation. Staying well-hydrated helps the digestive system process waste smoothly, which reduces the need to strain during a bowel movement.
Minimally Invasive Office Procedures
If self-care measures do not resolve symptoms, a doctor may recommend an outpatient treatment. These minimally invasive procedures are typically used for internal hemorrhoids that are bleeding or prolapsing but do not require general anesthesia. Rubber band ligation, often the first-line treatment for Grade I to Grade III internal hemorrhoids, involves placing a small elastic band around the base of the hemorrhoid.
This band works by cutting off the blood supply to the hemorrhoidal tissue. Deprived of blood, the hemorrhoid withers and eventually falls off, usually within about a week. Sclerotherapy is another technique, which involves injecting a chemical solution, or sclerosant, into the tissue near the internal hemorrhoid. This solution causes the vein walls to collapse, leading to scarring and shrinking of the hemorrhoid mass over several weeks.
Infrared coagulation (IRC) offers a heat-based approach to treating small- to medium-sized internal hemorrhoids. During this procedure, a probe delivers a focused burst of infrared light to the base of the hemorrhoid. The heat creates a small area of scar tissue, which stops the blood flow to the hemorrhoid, causing it to shrink. These non-surgical options have minimal recovery time and allow most patients to return to their normal activities quickly.
Surgical Options for Advanced Hemorrhoids
For severe cases, such as large, persistent Grade III or Grade IV hemorrhoids that are resistant to office-based treatments, surgical intervention may be necessary. The most definitive procedure is a conventional hemorrhoidectomy, which involves the surgical removal of the swollen tissue. This approach is considered the gold standard for long-term effectiveness and provides the lowest recurrence rate for advanced disease.
An alternative surgical method is stapled hemorrhoidopexy, sometimes called a procedure for prolapse and hemorrhoids (PPH). This technique does not remove the hemorrhoid itself but instead uses a circular stapling device to excise a ring of tissue above the hemorrhoid. The process repositions the prolapsed hemorrhoidal tissue back into its normal anatomical location and disrupts the blood flow. While it is associated with less postoperative pain and a quicker return to work than a traditional hemorrhoidectomy, it may carry a higher long-term risk of recurrence.
Preventing Recurrence
Sustained relief requires long-term adjustments to lifestyle habits that address the underlying causes of hemorrhoids. A primary focus is on maintaining soft, bulky stools to prevent straining during bowel movements. Adults should aim for a daily dietary fiber intake of 20 to 35 grams, achieved through a diet rich in fruits, vegetables, whole grains, and legumes.
Fiber absorbs water, which adds volume to the stool and makes it easier to pass, requiring less pushing. Ingesting adequate fluids is equally important, as fiber without sufficient water can actually lead to constipation. Drink plenty of water to ensure the fiber works effectively to soften your stools.
Optimizing toilet habits helps to reduce pressure on the veins in the lower rectum. Avoid sitting on the toilet for more than five minutes at a time, especially with a phone or book, as this puts unnecessary stress on the anal blood vessels. Never delay a bowel movement when the urge is felt, and avoid straining or forcing the stool out. Incorporating regular moderate physical activity, such as walking, can also improve gut motility and prevent the constipation that contributes to flare-ups.