Treatments and remedies for haemorrhoids

Treatments for haemorrhoids can be divided into three broad categories:

• preventive and conservative therapies
• outpatient based treatments
• surgical based treatments

The choice of the most suitable solution to address symptoms and causes of haemorrhoids depends on the characteristics and the severity of the disease.

Haemorrhoid prevention and conservative therapy

Diet and lifestyle

Simple changes in lifestyle, hygiene and eating habits can help to prevent haemorrhoids. These can also be successful during the initial stages of the disease.

Please find below some useful tips to relieve the symptoms of haemorrhoids in the mildest cases or to prevent their development altogether:

• regularise intestinal function and keep stools soft and hydrated: this helps reduce the effort during defecation and limit the evacuation time. To do this, it is important to consume a lot of dietary fibres contained in fruit, vegetables, legumes, and cereals or dietary supplements. You should also drink enough quantities of water during the day (at least 1.5 liters).
• perform regular physical exercise to help the intestine function and prevent constipation.
• maintain hygiene in intimate areas with the use of specific products to reduce the risk of local infections.

Medical therapy: topical / systemic

With the presence of mild symptoms, topical preparations such as creams, ointments, and lotions can help reduce the discomfort and pain associated with early stage haemorrhoids.

There are many creams, ointments and lotions available to reduce the symptoms of haemorrhoid disease including:

• emollient and soothing creams, and ointments.
• topical pharmaceutical preparations containing anesthetics (lidocaine) – the use of these are to relieve pain and is usually indicated for short periods because it can cause local hyper-sensitivity.
• topical pharmaceutical preparations containing cortisone – the use of these preparations is to reduce inflammation, burning and local itching, using them for short periods of time.
• Bioflavonoid-based supplements such as diosmin, troxerutin, and hesperidin can help improve venous microcirculation and reduce local swelling and inflammation.

Outpatient treatments

Outpatient treatments are the favoured option in the early stages of the disease when symptoms are more evident.

These treatments act on the haemorrhoidal cushion and aim to reduce excessive blood flow which is causing congestion. However, these treatments often need to be repeated.

The most common outpatient procedures are:

• rubber band ligation: Rubber band ligation is one of the most common outpatient procedures used. It involves cutting off the blood supply to the symptomatic bit of haemorrhoids (using a small elastic rubber ring at the base of the haemorrhoidal cushion), causing it to necrotize and fall off after a few days. Possible complications* include mild discomfort in the treated area that tends to resolve spontaneously, pain after ligation in the case of incorrect positioning of the rubber band, bleeding and haemorrhoid thrombosis.
• sclerotherapy: Sclerotherapy reduces blood flow and volume of the haemorrhoidal cushions by injecting a chemical substance that cause tissue to necrotize and fall. Possible complications* may include temporary soreness in the anorectal area and mild bleeding in the days following treatment.
• cryotherapy: Cryotherapy is one of the least used outpatient treatments. It involves the use of low temperatures to destroy the congested tissue, helping to reduce haemorrhoidal cushions. Possible complications* are edema, bleeding, and infections after treatment.

There are also other lesser-used outpatient procedures that use different technologies, but which share similar complications and a high rate of recurrence of the disease*:

• infrared photocoagulation: Infrared photocoagulation involves the use of infrared rays to overheat the haemorrhoidal cushions, triggering a coagulation process that reduces excessive blood flow. Also, in this case, the hemorrhoid cushion necrotizes and a scar forms at its base. It is usually an expensive procedure and among the possible complications are severe pain and bleeding. Besides, clinical studies on the effectiveness of the treatment are very scarce and only with short-term follow-up.
• laser coagulation: with the guidance of a Doppler probe to identify arteries, laser coagulation involves the use of laser beams to stop excessive blood blow to haemorrhoids. Possible complications* are pain and bleeding. There is limited clinical evidence of treatment effectiveness and short-term follow-up.
• radiofrequency coagulation: radiofrequency coagulation stops the blood flow to the haemorrhoidal cushions, causing necrosis. Possible complications* are pain and bleeding. Clinical studies for this procedure are limited.
• electrocoagulation: electrocoagulation consists of causing thrombosis of the vessels that carry blood to the haemorrhoidal cushions to reduce their volume. This procedure can be painful and cause bleeding*.

* as reported in published literature

Haemorrhoid surgery

When outpatient procedures are not deemed effective or fail, the clinician may direct the patient towards surgical solutions.

Haemorrhoidectomy: Milligan-Morgan and Ferguson techniques

Traditional haemorrhoid surgery, called haemorrhoidectomy, consists of removing haemorrhoidal cushions. Common traditional surgical treatments are the Milligan-Morgan and Ferguson techniques.

With the Milligan-Morgan technique, the wounds are left open by the surgeon who leaves them to heal spontaneously. The surgeon will use a continuous suture to close wounds for the Ferguson method.

These methods, if well executed, are often effective. Complications are rare, but can be serious and include faecal incontinence, severe bleeding, and anal stenosis*.

Moreover, haemorrhoidectomy can cause severe pain causing patients to opt out of surgery. The pain is caused by the wounds, particularly during passing of stools.

Stapled Haemorrhoidopexy

Stapled haemorrhoidopexy has been the first surgical method to solve the problem of haemorrhoidal prolapse without the removal of haemorrhoids.

It involves the use of a circular suturing device (staple) to cut a part of the rectum and reposition haemorrhoids into their original place.

This technique does not involve haemorrhoid removal, but serious complications may arise in a significant percentage of cases. More common complications are post-operative hemorrhage, urgent defecation, strong and persistent rectal-anal pain, and in some cases perforation of the rectum*.

* as reported in published literature

THD^® Doppler Method: minimally invasive surgery for haemorrhoids

The THD^® Doppler procedure is a minimally invasive, non-excisional, surgical technique for haemorrhoid treatment.

This procedure does not involve removing the haemorrhoids, it is simply the application of internal stitches in areas that are not sensitive to pain. These sutures reduce the excessive blood flow to the haemorrhoids and reposition them in their natural place.

The surgeon performs the procedure by means of a special anoscope and a Doppler probe. Thanks to the Doppler signal, the surgeon is able to locate the haemorrhoids arterial vessels and ligate them. In the case of prolapse, after ligation, the surgeon performs a mucopexy, i.e. the repositioning of the mucosa in the original position.

For more information on this treatment, visit the THD^® Doppler Method page.