How Are Hemorrhoids (Piles) Treated?

Hemorrhoids, also called piles, are swollen veins in the anus and rectum. They typically develop when there's increased pressure on that area, such as when you are constipated or pregnant. While hemorrhoids are common and often go away on their own without treatment, they can be painful and itchy.

Fortunately. there are a variety of treatments available to ease symptoms—and to help prevent hemorrhoids from occurring again in the future. Treatment may include lifestyle changes or medication for mild cases. More severe cases of hemorrhoids might require a medical procedure.

Lifestyle

Hemorrhoids can often be treated at home, largely by making lifestyle modifications. The changes made to treat hemorrhoids are also changes that can be made to prevent the hemorrhoids from coming back.

One way to help ease hemorrhoid symptoms is to make changes to your bowel movements and the stool itself. Doing so can make it easier for you to make a bowel movement, meaning you put less pressure on the hemorrhoids.

One way to have easier bowel movements is to make sure you are getting enough fiber. You can eat high-fiber food like fruits and vegetables or take a fiber supplement such as Metamucil (psyllium) or Citrucel (methylcellulose). The fiber will keep stools soft and reduce the likelihood that the hemorrhoids will make you bleed.

Staying hydrated will also encourage regular bowel movements and prevent constipation.

As what you are doing while making the bowel movement, try not to strain. Straining will put extra pressure on the hemorrhoids. You'll also want to avoid sitting on the toilet for more than a minute or two at a time.

A sitz bath can also help in the treatment of hemorrhoids. A sitz bath is a warm bath in a shallow tub that can help keep your muscles loose and your blood flow moving—both of which are important in the hemorrhoid healing process. Sitting in the water for 10 to 15 minutes a few times a day can help relieve pain.

You'll also want to be as active as possible. Moving around can take the pressure off the veins that are affected by hemorrhoids.

An ice pack may temporarily soothe the affected area, as would witch hazel wipes.

Medications

Hemorrhoids frequently clear up within a week or so, but they can still be quite uncomfortable. To help manage your symptoms as the hemorrhoids clear, a healthcare provider may recommend you use medications. Medication options will depend on factors like the severity of your individual case and the type of hemorrhoids you have: internal (inside of the anus) or external (outside of the anus).

Over-The-Counter

Oftentimes, hemorrhoids can be treated using over-the-counter (OTC) medications. For these milder cases, there are several topical and oral options available.

For topical treatments, hemorrhoids are often treated with creams or ointments. These products can temporarily relieve symptoms and are often available OTC.

Some topical products work to dry or protect the skin around the anus. These include astringents like witch hazel and zinc oxide topical paste like Desitin. Other products work to shrink the hemorrhoid. This includes a phenylephrine ointment like Preparation H.

Corticosteroids, like cortisone, is a cream that can help reduce swelling and pain. One example is Preparation H hydrocortisone.

Topical anesthetics like Nupercainal (dibucaine) or RectiCare (lidocaine) can temporarily numb the pain.

Often, hemorrhoid products will include a combination of these ingredients. For instance, some hemorrhoid creams might also contain lidocaine.

There are also suppositories that can be inserted into the rectum to provide symptom relief.

Check with a healthcare provider if you find yourself still needing to use any hemorrhoid treatments for more than a week. This could be a sign you might need a stronger treatment option. Even though topical remedies for hemorrhoids are recommended by medical experts to provide temporary relief from pain on a short-term basis—they haven't been studied for long-term use.

You'll also want to check in with a healthcare provider if the product is causing you to get dry skin around your anus or causing a rash.

Oral medication can help bring hemorrhoid relief, too. Oral stool softeners (known as emollient laxatives) can help reduce constipation or straining while going to the bathroom. Meanwhile, pain relievers such as Tylenol (acetaminophen) or Advil (ibuprofen) can help with pain and discomfort.

Prescription

There are some prescription medication options for treating more moderate to severe hemorrhoid symptoms. Topical nifedipine might control pain.

If an external hemorrhoid becomes thrombosed, meaning it has developed a blood clot, a topical nitroglycerin ointment can help manage the rectal pain.

Procedures and Surgeries

If your hemorrhoids are very painful, keep coming back, or aren't improving with home remedies or medication, you might need an outpatient procedure at a medical office to get rid of your hemorrhoids.

The most common minimally invasive procedure is rubber band ligation. With this procedure, a small, surgical rubber band is tied around the bottom portion of an internal hemorrhoid to cut off the blood supply to the tissue. Within a week, the hemorrhoid and band will fall off.

Other minimally invasive treatments for internal hemorrhoids include:

• Sclerotherapy injection: This procedure involves injecting the hemorrhoid with a solution that'll cause scar tissue to form. The scar tissue will cut off the hemorrhoid’s blood supply, with a goal of shrinking the hemorrhoid.
• Infrared photocoagulation: A tool with an infrared light at the end is aimed at the hemorrhoid to cause scar tissue. The heat from the light helps cut off the blood supply and shrink the hemorrhoid.
• Electrocoagulation: During the procedure, a tool with an electric current is beamed toward the hemorrhoid. The current causes scar tissue to form, cutting off the blood supply and shrinking the hemorrhoid. 

An external hemorrhoid that has formed a blood clot can be painful. A botulinum toxin injected into your anal sphincter may help manage the pain.

If outpatient procedures aren't successful for internal or external hemorrhoids, you may need to undergo surgery with anesthesia.

A hemorrhoidectomy is the removal of a larger hemorrhoid. The surgery involves completely removing the hemorrhoid and any extra tissue that's causing bleeding or the vein to protrude. This can be done for internal or external hemorrhoids.

Hemorrhoid stapling and suturing can work for internal hemorrhoids. In this surgery, a stapling tool is used to remove surrounding tissue of the hemorrhoid. The surgery can also help place a protruding hemorrhoid back into the appropriate spot.

Living With and Managing Hemorrhoids

Hemorrhoids are common and usually not a cause for alarm. They typically go away on their own, especially after simple lifestyle modifications or the use of OTC medication. A procedure or surgery is typically only needed for hemorrhoids that are causing severe bleeding or that have prolapsed (the tissue is bulging outside our anus) and have not responded to any other treatment.

As you wait for your hemorrhoids to resolve, you can take steps to reduce their itching. You can wear cotton underwear. You can also use fragrance- and color-free toilet paper. In fact, you can even use baby wipes instead of toilet paper for a less abrasive wiping experience. And while it might be difficult, try not to scratch the itch.

While it's a good idea to take some preventive measures for future hemorrhoids episodes, try not to worry about whether or not they'll return. Hemorrhoids aren't always preventable, particularly in people who are pregnant or routinely lift a lot of weight. Other factors may also determine whether or not hemorrhoids develop again, like the type and severity of the initial hemorrhoid and the treatment you've used. People who receive surgery for hemorrhoids typically have the lowest chances of recurrence.

A Quick Review

Hemorrhoids are enlarged veins in the anus and rectum that can cause uncomfortable symptoms like itching, pain, and sometimes bleeding. Many cases of hemorrhoids go away on their own, but there are several treatments that might be recommended to help with the discomfort in the meantime. These include lifestyle changes like taking in more fiber and sitting in a sitz bath. Many of these lifestyle changes can also prevent new hemorrhoids from forming in the future. You can also use over-the-counter medications like creams and ointments. If lifestyle changes or OTC medication don't work, you might need to try a prescription medication. If none of these initial treatments work or the hemorrhoid is causing much pain, a medical procedure or surgery to shrink or remove the hemorrhoid might be necessary.