The treatment goals for hemorrhoids are to relieve symptoms, improve quality of life, and prevent the condition from worsening. Treatment strategies are usually tailored based on the severity of symptoms and the overall health status of the patient, including various approaches such as medication, non-pharmacological therapies, and surgical options. Physicians will combine different treatment methods according to individual case needs to achieve the best results.
Treating hemorrhoids requires addressing the underlying causes, such as improving bowel function, reducing pressure on the anus, and incorporating daily care. Mild symptoms can be managed through lifestyle adjustments and medication, while severe bleeding, thrombosis, or irreducible prolapse may require surgical intervention. Patients should seek early diagnosis and work closely with their healthcare team to develop the most appropriate treatment plan.
Modern hemorrhoid treatment follows the concept of "graded treatment," categorizing symptoms into three levels based on severity: Level 1 targets mild symptoms primarily with medications and lifestyle adjustments; Level 2 addresses moderate symptoms, potentially increasing local treatments or non-invasive surgeries; Level 3 focuses on severe or recurrent cases, which may involve surgical excision or advanced therapies.
Treatment plans often combine multiple methods, such as pairing medication with sitz baths to alleviate pain, or using analgesics post-surgery to promote recovery. Physicians will assess the patient's age, medical history, and symptom characteristics to choose the safest and most effective combination.
Emerging therapies like laser treatment and radiofrequency ablation offer more precise tissue repair but should be selected based on the medical facility's equipment and the physician's experience. These new technologies are typically applicable to specific types of internal or external hemorrhoids.
Topical ointments and suppositories act directly on the affected area, providing rapid relief from inflammation and swelling. Ointments containing local anesthetics (such as lidocaine) can temporarily relieve pain, while steroids or non-steroidal anti-inflammatory drugs (such as hydrocortisone) can reduce tissue swelling. Nitroglycerin suppositories can dilate blood vessels, improving blood flow to promote tissue repair.
Common medication combinations include anti-inflammatory and vasoactive components, such as sodium alginate gel, which can strengthen vascular wall structure and reduce exudate. Caution is advised with long-term steroid use, as it may lead to skin atrophy; it is recommended to follow the physician's instructions regarding the duration of use.
Oral medications are often used to alleviate related complications, such as oral fiber supplements (like methylcellulose) that soften stools and promote smooth bowel movements. Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve acute pain, but long-term use should be monitored for gastrointestinal side effects.
For venous hemorrhoids, microcirculation enhancers like diosmin can enhance venous tone and reduce exudate. These medications are typically used as adjunctive therapy and need to be combined with other care measures for significant improvement.
Daily sitz baths for 15-20 minutes can significantly relieve pain and swelling, recommended 2-3 times a day. The water temperature should be controlled at 38-40 degrees Celsius, and a small amount of salt or herbal tea (such as witch hazel) can be added to enhance anti-inflammatory effects. This method promotes blood circulation and cleanses the affected area to prevent infection.
Sitz baths are particularly suitable during acute flare-ups and can be used during the recovery phase post-surgery. Care should be taken to ensure the water temperature is not too high to avoid burns, and bathing equipment should be used exclusively and regularly disinfected to prevent bacterial infections.
Rubber band ligation is a common outpatient procedure suitable for second to third-degree internal hemorrhoids. The physician places a rubber band around the base of the hemorrhoid, blocking blood flow, leading to natural necrosis and detachment of the tissue, usually requiring 2-3 treatments to achieve effect. This method is minimally invasive with quick recovery but may be accompanied by mild pain or bleeding.
Sclerotherapy involves injecting a solution into the hemorrhoid base, causing tissue fibrosis and contraction, suitable for bleeding internal hemorrhoids. Common sclerosing agents include phenol or sodium tetradecyl sulfate, and patients should avoid strenuous activities post-treatment to prevent tissue sloughing. The effects of this therapy can last approximately 6-12 months, and repeat treatments may be necessary.
Stapled hemorrhoidopexy (PPH) uses specialized instruments to excise and suture prolapsed hemorrhoidal tissue while preserving anal sphincter function, suitable for severe prolapsed hemorrhoids. This surgery has a short hospital stay but requires assessment of the patient's anal structure for suitability.
Laser coagulation and radiofrequency ablation use thermal energy to destroy abnormal blood vessels, suitable for small internal hemorrhoids. These techniques are highly precise with minimal bleeding but may require multiple treatments, and effectiveness varies based on individual tissue response.
A high-fiber diet is key for long-term management, with a daily recommendation of 25-30 grams of fiber from sources including whole grains, vegetables, and pectin-rich foods. Adequate hydration (2-2.5 liters daily) helps keep stools soft and reduces pressure during bowel movements.
Spicy foods and alcohol should be avoided, as they may irritate the anal mucosa and exacerbate inflammation. Some patients may need to limit dairy intake, particularly if lactose intolerance is present, which can worsen gastrointestinal discomfort.
Avoid sitting on the toilet for more than 5 minutes, and use a stool to elevate the legs to adjust the bowel position. Avoid reading or using a mobile phone while in the toilet to reduce the risk of excessive straining.
Regular pelvic floor muscle training can strengthen anal sphincter control; it is recommended to perform contraction-relaxation exercises for 15 minutes daily to improve bowel coordination and reduce hemorrhoidal prolapse.
Research is developing drugs targeting angiogenesis, such as biologics that inhibit VEGF factors, which may reduce abnormal dilation of hemorrhoidal blood vessels. Tissue engineering techniques are also attempting to cultivate artificial perianal tissues but are still in experimental stages.
Artificial intelligence-assisted diagnostic systems are being developed to assess the severity of hemorrhoids through image analysis, and may in the future combine with wearable devices to monitor anal pressure changes in real-time, preventing flare-ups in advance.
Minimally invasive catheter treatment systems are being tested, utilizing catheters to inject sclerosing agents or laser energy to precisely treat lesions, expected to reduce the scope of trauma and recovery time.
Gene therapy and stem cell repair theories are in the basic research stage, and may in the future intervene in mechanisms of angiogenesis and connective tissue fibrosis.
Seek immediate medical attention when experiencing persistent bleeding, irreducible hemorrhoids, severe pain, or suspected thrombosis. Chronic flare-ups leading to anemia, vomiting, or high fever require exclusion of other possible gastrointestinal diseases.
If symptoms do not improve after treatment or if there are recurrent episodes, the treatment plan should be reassessed. Older patients or those with diabetes or cardiovascular diseases should undergo careful surgical risk assessment, preferably in consultation with gastroenterologists or colorectal surgeons.
Internal hemorrhoids are located inside the anus and are usually discovered due to bleeding during bowel movements (bright red), prolapse, or itching, and may be painless initially; external hemorrhoids are located on the skin surface of the anus and often accompany noticeable pain, swelling, or tenderness, especially thrombosed external hemorrhoids that form hard lumps and cause severe pain. Diagnosis requires confirmation of location differences through anoscopy or visual examination.
What types of medications are available for non-surgical treatment of hemorrhoids, and what are their mechanisms of action?Common medications include anti-inflammatory suppositories (such as those containing racemic hyoscyamine) that can constrict blood vessels to reduce bleeding, and oral medications like plant extracts (such as oak bark extract) that can strengthen venous walls. Additionally, steroid ointments can relieve inflammation and swelling but should not be used long-term; it is necessary to follow medical advice to avoid side effects like skin atrophy.
How can dietary and exercise improvements in daily care help with hemorrhoid issues?It is recommended to increase dietary fiber (such as whole grains, fruits, and vegetables) and drink plenty of water to soften stools and reduce friction during bowel movements. Engaging in 30 minutes of aerobic exercise daily (such as brisk walking) promotes blood circulation and avoids prolonged sitting or standing. Moreover, avoiding behaviors that increase abdominal pressure during bowel movements, such as sitting for more than 5 minutes, can help prevent worsening.
What symptoms during the use of hemorrhoid medications or suppositories indicate the need to stop immediately and seek medical attention?If abnormal reactions occur after using medications, such as skin redness, allergic rashes, increased bleeding, or abdominal pain, medication should be stopped immediately, and medical consultation is necessary. Some suppositories may cause gastrointestinal discomfort; if symptoms do not improve after 3 days or worsen, the treatment plan should be reassessed.
What lifestyle precautions should be taken during the recovery period after rubber band ligation?For 7-10 days post-surgery, avoid lifting heavy objects and prolonged sitting, and maintain a low-fiber diet to reduce the frequency of bowel movements. Mild bleeding or discomfort may occur in the first 3 days and is normal; however, if there is a significant amount of bright red blood, high fever, or severe pain, immediate medical evaluation is necessary. During the recovery period, daily sitz baths for 15 minutes are recommended to promote healing.
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