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What If At-Home Hemorrhoid Treatments Don't Work?

How Can I treat My Hemorrhoids? Part 2:
What If At-Home Treatment Doesn't Work?

By Benjamin Krevsky, MD, MPH | August 6, 2015

Hemorrhoids are swollen veins in the anal canal. Of course, everyone has veins in this area, but when they become enlarged they can bleed, itch, and cause pain. Hemorrhoids can be located internally, externally, or sometimes both. While rarely a serious condition, hemorrhoids certainly cause a lot of discomfort and concern. I previously discussed treatments you can do at home to get relief. These treatments included hydration, fiber, sitz baths, moist wipes, ointments, creams, suppositories, and more. But what do you do when this does not solve the problem?

When should I see my doctor?

Again, before assuming that your condition is hemorrhoids, it is a good idea to see your doctor for an examination. After all, it is difficult to take a look for yourself. If there is any bleeding, severe pain occurs, or there is fecal incontinence (loss of bowel control) you should definitely see the doctor. A large amount of bleeding or the sudden onset of severe pain means you should see the doctor immediately.

What does the doctor have to offer?

A gastroenterologist that treats hemorrhoids or a proctologist (surgeon) has a lot to offer in the treatment of internal hemorrhoids. This can range from prescription medications to minor surgery to major surgery.

Prescription ointments, creams, and suppositories

These usually contain an emollient (medication to soften and soothe the skin). In addition, there may be an anesthetic (for example, pramoxine) and/or steroid (hydrocortisone). Prescription strength medications often work better than their over-the-counter cousins. But sometimes not so much. An oral tablet called Vasculera comes with some prescription treatment kits (Analpram advanced kit) and also helps reduce the size of hemorrhoids.

Rubber band ligation

In this common treatment, the doctor applies miniature rubber bands to the internal hemorrhoids. This causes them to shrink up, stop bleeding, and pull back inside. There are several different techniques for performing the procedure. In one form, (CRH O’Regan) single bands are applied once a week for several weeks. This is done as an outpatient in the doctor’s office. Multiple bands can also be placed right after a colonoscopy or other endoscopic procedure while you are still sedated. This would be done in an outpatient surgery center or hospital procedure room. Bands can also be placed without another procedure. Depending on the doctor and your individual situation, it could be with or without sedation. While rubber band ligation works for most patients, it doesn’t work all the time. Also, there are some potential complications – bleeding, pain, and infection. Recovery can range from a day or two to six weeks.

Infrared coagulation

In this procedure, hot light is applied to the base of the hemorrhoid to seal it off. This is usually done in a surgery center, but can be done in the office. The advantages include a high success rate in small or medium hemorrhoids, very rapid recovery, and very low risk of any complications. Usually, your recovery is complete as soon as the procedure is finished. There may be a second treatment required if the first treatment does not work.

Laser treatment

Actually, this is not done any more. It was similar in principle to Infrared coagulation, but the equipment is much more complicated and expensive.

Bipolar therapy

This uses electrical energy to cauterize the hemorrhoids. While it is effective, it can be a painful treatment.

Radiofrequency hemorrhoid ligation

This method uses a probe to grasp the hemorrhoid and then cauterize it using high frequency electricity (HETTM) . Experience with this technique is limited.

Doppler ligation

In the operating room, a surgeon uses a special ultrasound probe in the rectum to find the arteries supplying the hemorrhoids. Then a suture is placed around each artery to cut off the blood flow. This is performed in the operating room and requires special equipment not commonly available. Recovery is quick and painless for most people.

Surgical hemorrhoidectomy

This involves cutting out the hemorrhoids with a scalpel or cutting through the wall of the rectum and stapling the area shut again. This is true surgery and has a recovery period of several weeks. It can be very painful post-operatively and infection is often a problem. However, this treatment works for the worst hemorrhoids, works when the other treatments fail, and has the longest period before the hemorrhoids come back.

Did you just say that hemorrhoids come back?

Yes! Sometimes it takes a year or two, sometimes longer, but they can come back again after any treatment. They can even come back after surgery, but usually not for a long time.

How do I decide which therapy is the best for me?

Everybody's situation is different. Discuss the options with your gastroenterologist or surgeon. If they only offer one kind of treatment, they may not be selecting the best one for your hemorrhoids.

In the meantime, if you have more questions or feel your condition is urgent, contact your Temple physician or healthcare provider.

About the Author
Benjamin Krevsky, MD, MPH,
is a Professor of Medicine at Temple University School of Medicine. Dr. Krevsky is regularly listed as one of the Best Doctors in America and has been selected as a Top Doctor in Philadelphia Magazine. He is an active clinician and educator, having published over 200 papers, audiotapes and books. His clinical interests include colon cancer screening and treatment, anorectal disorders, motility disorders, and endoscopic treatment of gastrointestinal diseases. He has been honored with selection as a Fellow of the American College of Physicians, American Society for Gastrointestinal Endoscopy, American Gastroenterological Association, and American College of Gastroenterology.

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