How to Treat Hemorrhoids

Soak in warm water or a sitz bath. To alleviate irritation and pain, while also shrinking the veins, it is recommended to soak hemorrhoids in warm water (not too hot) for 15 to 20 minutes at a time, three times a day. If you prefer not to take a full-body bath, try using a sitz bath, a plastic basin placed on the toilet seat. This tool allows you to soak your bottom and hips while sitting. After soaking, discomfort, itching, and rectal spasms will be reduced.

• You can also add ¼ cup of sea salt to the sitz bath and soak for 30 minutes per session. Salt is an excellent antibacterial agent that helps heal wounds and treat infections.
• Adding witch hazel extract, known for its soothing and cooling properties, can also help relieve hemorrhoids. This treatment should be performed at least once a day, for 15 to 20 minutes.

Apply an ice pack to the hemorrhoids. Place the ice pack in the freezer until fully frozen. Be sure not to apply the ice directly to the hemorrhoids. Instead, wrap the ice pack in a towel or clean cloth before gently pressing it against the hemorrhoidal area. Do not apply the ice for an extended period as this could damage the surrounding skin. It’s best to apply it for a few minutes, then pause and wait for the skin to return to room temperature before reapplying.

• Cold compresses help reduce inflammation, which in turn alleviates pain and swelling. Additionally, the blood vessels shrink, stopping the bleeding.

Apply topical creams. You may try using a cream containing phenylephrine to shrink blood vessels and reduce bleeding. You can also apply soothing creams to relieve pain, irritation, and itching (which may be the cause of the bleeding). However, topical creams will not stop the bleeding. Soothing cream ingredients include hydrocortisone, aloe vera, witch hazel extract, and vitamin E.

• If you use hydrocortisone, apply it in the morning and evening, and avoid using it for more than a week. Overuse of hydrocortisone can lead to hormone imbalances from the hypothalamus and pituitary gland or cause thinning of the skin in the affected area.

Use soft toilet paper and avoid scratching. Rough toilet paper can cause more irritation and tears in the skin. To soothe pain and reduce irritation, use moist wipes or medicated wipes. Alternatively, you can use medical gauze soaked in witch hazel, hydrocortisone, aloe vera extract, or vitamin E. Do not rub vigorously, as this can cause more irritation or bleeding; instead, gently blot or press the area.

• Scratching only aggravates bleeding and irritation, making the hemorrhoids even more sensitive, and can lead to a more severe infection.

Take supplements to reduce bleeding. Some supplements are not readily available in stores, so you may need to purchase them online or from herbal shops. Always consult your doctor before taking any supplements, especially if you're on other medications. If you are pregnant or breastfeeding, this is even more important, as many supplements have not been tested on pregnant or breastfeeding women. Here are some supplements or traditional medicines to consider:

• Fargelin extra: This Chinese herbal medicine can be taken three to four times a day to strengthen vein walls and reduce bleeding.
• Flavonoid supplements: These help reduce bleeding, relieve pain and itching, and prevent recurrence. They improve the tone of blood vessels, reducing the likelihood of capillary leakage.
• Calcium dobesilate or Doxium pills: Take this medicine for two weeks as directed. It helps reduce bleeding from capillaries, prevents blood clots, and improves blood viscosity. These effects help reduce tissue swelling, which causes hemorrhoids.

Reduce pressure on the hemorrhoids. This method helps prevent or reduce strain on the hemorrhoidal area. You should eat fiber-rich foods to soften stools and prevent constipation. Aim to consume fruits, vegetables, and whole grains, or take fiber supplements (the recommended daily intake is 25 grams for women and 38 grams for men). Drink plenty of water and establish regular bowel habits, and avoid straining during bowel movements. You should also avoid sitting for long periods on the toilet, as this increases pressure on the hemorrhoidal veins and may lead to bleeding. Exercise and walking can help reduce pressure on the hemorrhoids.

• Sitting on a donut-shaped cushion can relieve pressure on the affected area. Sit directly in the center of the cushion, ensuring the anal area is positioned over the hole. However, be aware that this could cause more pressure on the anus, so discontinue use if symptoms worsen, if bleeding continues, or if the condition recurs after improvement.

Surgical Removal of Hemorrhoids for External or Internal Hemorrhoids. This is a common method for treating external hemorrhoids, particularly when they are large or cannot be treated with less invasive procedures. The surgeon removes the hemorrhoid using various tools such as scissors, a scalpel, or an electro-cautery device (which uses electricity to seal blood vessels on the hemorrhoid). Local anesthesia, combined with pain relief medications, spinal anesthesia, or general anesthesia, will be administered.

• Surgical removal of hemorrhoids is the most effective and ideal solution for severe or recurrent hemorrhoids. Although painful, the doctor will prescribe pain medication or recommend sitz baths and/or topical ointments post-surgery for relief.
• Compared to hemorrhoid removal surgery, the hemorrhoid banding method has a higher risk of recurrence and can lead to rectal prolapse, which is when a portion of the rectum protrudes from the anus.

Rubber Band Ligation for Internal Hemorrhoids. The doctor inserts an endoscope into the anus (a plastic device used to view the rectum). They then tie a rubber band around the base of the hemorrhoid, cutting off the blood flow, which causes it to shrink and eventually fall off, leaving a scar in place.

• You may experience discomfort after the procedure, but you can alleviate it by using a sitz bath, soaking in warm water, and/or applying topical medication.

Injection Sclerotherapy for Internal Hemorrhoids (Sclerosing Agent Therapy). The doctor uses a plastic device to view the rectum and then injects a chemical solution, such as 5% phenol in oil, vegetable oil, quinine, urea hydrochloride, or hypertonic saline, into the base of the hemorrhoid. These chemicals cause the veins to constrict.

• Sclerotherapy is less effective than rubber band ligation.

Treating Internal Hemorrhoids with Laser or Radiofrequency (Infrared Coagulation Therapy). The doctor may use an infrared laser or radiofrequency waves to coagulate the veins near the hemorrhoid. In the case of infrared lasers, the doctor will insert a probe close to the base of the hemorrhoid. When using radiofrequency waves, they attach a spherical electrode to a frequency generator, which is placed on the hemorrhoidal tissue, causing the cells to coagulate and dry up.

• Infrared therapy has a higher recurrence rate compared to rubber band ligation.

Cryotherapy for internal hemorrhoids. The doctor uses a probe that generates extremely cold temperatures, targeting the base of the hemorrhoid. The extreme cold destroys the tissue. However, this method is not commonly used due to the frequent recurrence of hemorrhoids.

Hemorrhoid stapling. The surgeon uses a device to clamp the protruding hemorrhoid, preventing it from bulging outside the anus. Once clamped, blood flow to the hemorrhoid is cut off, causing the tissue to die and stop bleeding.

• Recovery time is usually quicker and less painful compared to hemorrhoidectomy.

Learn the causes of hemorrhoids. Chronic constipation, excessive straining, and prolonged sitting on the toilet are common contributors to hemorrhoids. Constipation and prolonged sitting put excessive pressure on the veins, causing them to become congested and reducing blood circulation. Pregnancy also puts significant pressure on rectal veins, especially during childbirth, which can lead to hemorrhoids.

• The likelihood of developing hemorrhoids increases with age and is more common among obese individuals.
• There are two types of hemorrhoids: internal (inside the rectum) and external (around the anus). Unlike external hemorrhoids, internal ones are not painful, but both types can bleed if ruptured.

Recognizing the symptoms of hemorrhoids. It can be difficult to detect symptoms of internal hemorrhoids until they bleed, and they are usually not painful. However, if you have external hemorrhoids, the following symptoms may occur:

• Bleeding without pain during bowel movements. The bleeding is usually minimal and bright red.
• Itching or irritation around the anus.
• Pain or discomfort.
• Swelling around the anus.
• A tender or painful lump near the anus.
• Leaking stool.

How to check for hemorrhoids. Stand in front of a mirror and examine whether there is any protrusion around the anus. The color can range from normal skin tone to dark red, and may be painful if pressed. If you notice this, it suggests you have external hemorrhoids. After using the bathroom, check for blood on the toilet paper. Hemorrhoid blood is usually bright red, not dark red (dark red blood indicates it originates from deeper in the digestive system).

• It is difficult to see internal hemorrhoids at home without specialized equipment. Therefore, it is best to visit a doctor and provide your full medical history to help them rule out other causes of bleeding such as colon cancer or polyps, both of which can cause bleeding.

When to seek medical help. If symptoms persist or you continue to experience pain after a week of self-treatment, you should consult a doctor. Bleeding during bowel movements can be concerning, especially if you're at risk for other conditions like ulcerative colitis or colon cancer. You should also visit a doctor if the blood is dark red or your stool appears dark/black like tar. This could indicate bleeding from deeper in the intestines, possibly from a tumor.

• Try to estimate the amount of blood lost. If you feel fatigued, restless, pale, with cold hands or feet, a fast heartbeat, or dizziness along with blood loss, you should seek immediate medical attention. It's also essential to see a doctor if the bleeding increases over time.

What to expect during a medical examination. The doctor will confirm the presence of hemorrhoids by inspecting the outside of the anus and performing a rectal exam with their finger. They will lubricate their index finger and insert it into the anus, feeling the rectal walls for lumps, masses, or signs of bleeding. If internal hemorrhoids are suspected, the doctor may insert a colonoscope (a plastic tube) through the anus into the rectum. The scope uses light to help the doctor identify swollen, engorged, or bleeding blood vessels.

• Additionally, a stool test may be conducted, where you will place a small sample of stool on a testing card. This test detects tiny blood cells in the stool, which could be a sign of conditions like hemorrhoids, cancer, or colon polyps.
• If you're scheduled for a stool blood test, avoid eating red meat, radishes, horseradish, watermelon, or raw broccoli for three days prior, as these foods may lead to false positive results.