Hemorrhoid Treatments and Medications

Hemorrhoids are common in both men and women and up to 50% of all people. For those experiencing hemorrhoids, there are plenty of at-home treatments and medications available to help reduce the pain and get rid of the irritation they can cause. Let’s take a look at the causes and what can be done to treat the problem.

What are hemorrhoids?

Hemorrhoids are a gastrointestinal disease generally suffered by adults aged 45 to 65. However, younger people can still get them, especially if they experience bouts of diarrhea or constipation.

Hemorrhoids are caused by increased pressure on the veins in and around the anus and lower rectum. This can result from prolonged straining, sitting, coughing, constipation, or pregnancy.

There are two kinds of hemorrhoids - internal hemorrhoids and external hemorrhoids.

• Internal hemorrhoids: Internal hemorrhoids form inside the rectum. These are typically less painful, even when they produce bleeding. However, internal hemorrhoids may also start to extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can produce small amounts of mucus or cause leakage. This can lead to irritation and itchiness. Wiping constantly to try to relieve the itching can worsen the problem.

• External hemorrhoids: External hemorrhoids form under the skin around the anus. These are considered more uncomfortable because the overlying skin around the anus contains many pain-sensing nerves. If a blood clot forms inside an external hemorrhoid, you can have sudden and severe pain. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin that can itch and become irritated.

When hemorrhoids cause pain, it can be quite debilitating. So when it reaches that point where they become bothersome, medical intervention is recommended. 

Diagnosing hemorrhoids

Often, hemorrhoids develop for no apparent reason, but often, they are associated with chronic (long-term) constipation or diarrhea, straining during bowel movements, and prolonged sitting.

As uncomfortable as it may be to speak about, it’s important to talk to a healthcare provider and be open about your symptoms. If you suspect you have hemorrhoids, a good place to start is with your primary care provider. They can conduct an examination and refer you to a specialist if necessary. Generally, a specialist such as a gastroenterologist or a proctologist will only be recommended if there is concern about complications. 

A physical examination of the anus usually confirms a diagnosis of external hemorrhoids as they are easily visualized. This physical will likely include a digital exam of the lower rectum, which can confirm the structure of muscles and often locate any polyps or tumors.

An anoscopy is another type of physical examination. It employs an endoscopic device with a light to examine the interior wall of the anal canal and the very lowest part of the rectum. In other words, a small, rigid instrument called an anoscope or anal speculum is inserted a few inches into the anus. Intimidating as it may sound, an anoscopy is considered painless, although you may feel some pressure. 

In some cases, a more complete examination of the large intestine may be suggested, in which case a colonoscopy or flexible sigmoidoscopy can be utilized.

Barium enemas, which employ a contrast solution instilled into the rectum for X-ray imaging, may also be an option after the initial consultation. 

Some questions your healthcare provider may ask during your appointment include:

• When did your symptoms start? 

• Have you experienced this before?

• Does anything seem to trigger your discomfort?

• Are you taking any medication? 

You may also want to ask your healthcare provider some questions, such as:

• Do I have hemorrhoids?

• What are my treatment options?

• Do you need to run any tests?

• Will there be a physical examination? 

• How long will it take to heal?

• What caused the hemorrhoids? 

We understand that many people feel uncomfortable discussing this topic, but we encourage you to find a healthcare provider you trust and can speak openly with. They’re professionals, and the more information you give, the better they’ll be able to help and evaluate the right treatment option for you. 

Hemorrhoid treatment options

If you’ve been diagnosed with hemorrhoids, the good news is that there are plenty of treatment options available. These include home treatments, like over-the-counter medications, sitz baths, and dietary changes, but can also extend to prescription medication or even surgery in some circumstances. 

Remember, hemorrhoids are treatable, and there are ways to prevent the uncomfortable condition from flaring up again. Some ways to prevent hemorrhoids are to avoid straining during bowel movements, eat a high-fiber diet—plenty of fruit, vegetables, and whole grains—and stay well hydrated. Regular exercise, going to the bathroom as soon as you feel the urge, and not sitting for extended periods can also help prevent another flare-up. 

Over-the-counter (OTC) medicines

Most mild cases of hemorrhoids can be treated with topical creams, gels, ointments, suppositories, and wipes available OTC at your local pharmacy. The most popular OTC medications tend to contain a vasoconstrictor, which tightens blood vessels and shrinks skin tissue. This helps reduce the size of the hemorrhoid, thus alleviating pressure and pain. 

These medications also tend to include skin protectants and sometimes even numbing agents, such as lidocaine. Some OTC hemorrhoid medications contain hydrocortisone, a steroid that helps reduce inflammation, thus reducing pressure and pain. 

Prescription medications

If the condition is more severe or isn’t relieved by OTC medications, your healthcare provider may prescribe a prescription medication. These usually include suppositories and topical preparations.

Surgery

For large internal hemorrhoids or extremely uncomfortable external hemorrhoids, your healthcare provider may refer you for a surgical procedure. Depending on your condition, a surgeon may recommend a hemorrhoidectomy, which removes the extra tissue causing bleeding, or hemorrhoid stapling, which blocks blood flow to the hemorrhoid. Medical treatments are effective, but unless you make diet and lifestyle changes, hemorrhoids may come back.

Nonsurgical options

When internal hemorrhoids continue to cause symptoms despite home treatment, your healthcare provider may recommend an office-based nonsurgical procedure. Here are the most common options:

• Rubber band ligation: This is the most widely used medical procedure for treating internal hemorrhoids. A small elastic band is inserted into the anal canal and then placed around the base of a hemorrhoid. The band cuts off the hemorrhoid's circulation, which causes the hemorrhoid to wither and fall off within a couple of weeks. The rubber band eventually falls off unnoticed. The procedure requires no anesthesia, although a numbing agent is sometimes used if you feel discomfort.

• Sclerotherapy: Sclerotherapy is a treatment that involves the injection of a chemical solution into blood vessels. This solution causes a local reaction that interferes with blood flow inside the hemorrhoid, causing it to shrink. 

• Coagulation therapy: This treatment uses infrared light or heat, laser, or electric current to cut off the hemorrhoid's blood supply. Once the hemorrhoid shrinks and dies, scar tissue forms on the anal canal wall to hold nearby veins in place so they don't bulge into the anal canal. One hemorrhoid is treated at a time, with a 10- to 14-day period between treatments.

Hemorrhoid medications

Let’s look more closely at the medicinal options available to treat hemorrhoids.

After visiting your healthcare provider, they may suggest you try an OTC medicine or prescribe something to help. The majority of medications available to treat hemorrhoids are creams, ointments, or suppositories. These medicines are largely designed to reduce the itch that comes with hemorrhoids and shrink the enlarged tissue. 

Over-the-counter

These topical creams, ointments, pads, and suppositories are used for mild cases, temporarily relieving pain and anal itching. They usually contain ingredients such as witch hazel, phenylephrine, lidocaine, or hydrocortisone. Brand names include T.N. Dickinson's Witch Hazel Cleansing Pads, Tucks Pads, and Preparation H. 

Do not use OTC hydrocortisone creams for more than a week, as they can cause tissue thinning. 

You may also try pain relievers such as oral acetaminophen and ibuprofen to ease the discomfort while the hemorrhoid heals. 

Prescription medications

Although smaller hemorrhoids often go away on their own, sometimes your doctor will need to prescribe something stronger. They may recommend treatments that contain hydrocortisone, pramoxine, or nitroglycerin.

Hydrocortisone is a steroid that helps to reduce the size and swelling of a hemorrhoid, while pramoxine is a numbing agent. Brand names include Analpram, Pramasone, and Mezparox, with generic options also available. 

Choosing the best medication

With so many medications available to treat hemorrhoids, you may be wondering which option is the best, which can only be determined by your healthcare provider on a case-by-case basis. The best choice will depend on your medical history, the severity of your hemorrhoids, and if you’re taking any other medications that may negatively interact with hemorrhoid medication. 

To make things easier to understand, we’ve broken down some of the different prescription medications available to treat hemorrhoids.

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Best medications for hemorrhoids