Conservative treatment of hemorrhoids

Conservative treatment for hemorrhoids

Humans have sought a cure for hemorrhoids since the dawn of civilization, but there isn’t a single easy answer. There are numerous treatment options available, including diet modifications, over-the-counter medications, laxatives and in some cases – operative procedures to remove the hemorrhoids.

A cure for hemorrhoids

Piles are normal structures of the anorectum and it is not always advisable to remove the hemorrhoidal tissue. The presence of symptomatic hemorrhoids should be well evaluated. As a general rule, the initial treatment of symptomatic hemorrhoids is directed at easing the bowel movements by modifying the stool. The most common causes of hemorrhoids are constipation and straining while having a bowel movement. To fight constipation, physicians usually recommend increasing fiber and fluid intake. Recommended fiber intake of 25-30 g per day is rarely achievable. That’s why bulk-forming fiber supplements (such as psyllium) are becoming increasingly popular.

The goal is to make the stool soft, moist and easy to pass. But organic fiber and fiber supplements only work in combination with fluids (pure water is recommended). You should try to drink at least 64-70 oz of water (or more depending on weight). To deal with fecal impaction or persisting constipation problems, physicians usually recommend stool softeners (methylcellulose, lactulose, docusate) or stimulate laxatives (senna). Careful dosage is needed and you shouldn’t mix stool softeners (or laxatives) with bulk-forming agents (psyllium). Some stool softeners should be used only temporarily as long-term (or excessive) usage could lead to addiction and the lazy bowel syndrome. Since symptomatic hemorrhoids are a recurring problem, it’s advised to stick with the high-fiber diet, even when there are no symptoms or the conservative treatment isn’t giving immediate results.

Home treatment of hemorrhoids

To treat hemorrhoids many patients are looking for other solutions, such as different home remedies, bathing in warm water or sitz baths. Warm water (but not too hot) does provide symptomatic relief of pain, itching and general discomfort in the perianal area. Symptomatic hemorrhoids also require strict toilet routine. You should use the bathroom when the urge comes. Delaying it could cause the stool to back up in the rectum. With the time passing, the stool dries up and becomes harder to discharge.

Other conservative measures that should be taken are related to the bathroom behavior. Some contributing factors to the hemorrhoidal disease are thought to be – excessive straining, pushing, prolonged sitting on the toilet, general lack of movement. You should spend on the toilet 5 min. at most. If it doesn’t happen, leave it for later. Straining while having a bowel movement is only going to make things worse. Reading on the toilet or browsing your smartphone isn’t advisable. In addition, it is important to improve the perianal hygiene. A good idea is to clean the anus with water after each bowel movement. If this is impractical, then baby wipes or moistened pads could be used. Dry toilet paper could cause excessive wiping and aggravate the symptoms, especially if external hemorrhoids are presented. The anus should be carefully dried afterward.

Another option for relieving the symptoms of the hemorrhoidal disease is squatting. Advocates of squatting point out that it’s the natural position for humans. Squatting allows the anorectal angle to straighten, so there is less effort applied in the process of defecation. However, there is no scientific evidence that squatting can prevent the appearance of symptomatic hemorrhoids. Squatting is also problematic for a lot of people who lack the flexibility or have different health issues. It should be discouraged in elder patients.

Medical treatment for hemorrhoids

There is a very large number of topical agents (creams, gels, ointments) and suppositories available on the market. Physicians aren’t always familiar with each of them. Bleeding internal hemorrhoids can benefit from topical agents, containing hydrocortisone. Most products include a combination of agents, such as local anesthetics, which could provide temporary relief of pain and itching. Corticosteroids could be useful as anti-inflammatory drugs. However, there is not enough scientific evidence that these over-the-counter products can benefit the patient. Excessive usage of some of these products can actually lead to side effects, such as dermatitis.  You should discuss the application of certain topical agents with your physician.

Some doctors will prescribe you the so called phlebotonics. These products are a collection of plant extracts (mostly flavonoids) with synthetic compounds (i.e. calcium dobesilate). They are usually used to treat venous insufficiency or lymphoedema. The positive effect on venous blood flow and overall venous tone suggests that they might be useful for the treatment of symptomatic piles. There have been numerous trials assessing the effects of phlebotonics, but the mechanism of work remains unknown. Nevertheless, many patients are reporting significant symptomatic improvement in a matter of days.

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