Hemorrhoids (piles) are swollen/inflamed blood vessels that can form in the anus or lower rectum. Hemorrhoids can develop as a result of chronic constipation, diarrhea, or consistently trying to force a bowel movement to occur. Other potential causes include aging, genetics, pregnancy, overuse of laxatives, spending long periods of time on the toilet, and so on.
Common symptoms of hemorrhoids include itching, burning, rectal bleeding with bright red blood, and developing sensitive lumps in the anal or rectal area.
DISCLAIMER: Prior to trying any courses of hemorrhoid self-treatment, it is important to consider having a colorectal specialist analyze symptoms to determine if self-treatment is safe and appropriate.
A preliminary, baseline non-pharmacological treatment option to try is increasing dietary fiber intake. Up to 25-35 grams of fiber per day is recommended by the American Society of Colon & Rectal Surgeons. Increasing dietary fiber intake may help with reducing straining (clenching of the rectum in an attempt to force a bowel movement).
Examples of foods that are high in fiber are whole grain wheats, nuts, grains, potatoes, many green vegetables, and so on. In addition, various medicinal products are also high in fiber; psyllium (Metamucil) products are a key and common example. By increasing fiber intake, in addition to helping to decrease straining, it may help a more solid stool form for easier passage.
If increasing dietary fiber intake does not relieve hemorrhoid symptoms to a sufficient degree, over-the-counter (OTC) medications options may then be considered. Medications that contain phenylephrine and/or hydrocortisone typically are first-line treatment options for hemorrhoids.
No matter the medication, it is important to consider the type (formulation) of medicine that may be needed. If hemorrhoids are internal, suppositories may be necessary. Internal hemorrhoids form in the anal lining or lower rectum. If symptoms are more external, topical creams, gels, ointments, or wipes may be considered instead. External hemorrhoids form under the skin around the anus. Need an anatomic visual? This diagram may help.
Preparation H (phenylephrine) can help with making swollen blood vessels reduce in size. In turn, this can help shrink the hemorrhoid(s) and can help reduce burning and itching symptoms. Preparation H is available in many formulations.
While using Preparation H, it is important to know how to apply the various formulations if it. An embedded video, courtesy of GSK, provides a helpful demonstration on how to apply gel, ointment, and cream formulations of Preparation H for external symptoms. Separately, a different embedded video shows how to insert a Preparation H suppository for internal symptoms.
Anusol-HC (hydrocortisone) can also help with reducing itching and inflammation. Anusol-HC comes in a suppository form and also other various topical formulations such as creams, wipes, etc. Anusol-HC topical formulations typically can be used two to four times daily depending on the severity of the condition. Dosing for suppositories can vary. Anusol-HC is applied in a similar fashion to Preparation H.
Aside from phenylephrine and hydrocortisone products, other products with minimal data may also be trialed. Medications such as witch hazel (Tucks pads), mineral oil, zinc oxide, and/or pramoxine have potential use. In addition, Colace (docusate) can be used to help with straining. Many of these products also come in combination with phenylephrine and hydrocortisone.
However, after speaking to a doctor and prior to trying any product, Pharmacist Consult recommends speaking with your personal pharmacist or other healthcare provider to better determine which specific product may be best for you.
If self-treatment options do not relieve symptoms after a number of days, it is recommended to be evaluated by a colorectal specialist. In certain cases of hemorrhoids, surgery may be necessary.
References:
- Hemorrhoids. American Society of Colon & Rectal Surgeons (ASCRS). Accessed 17 November 2020. Accessible via: https://fascrs.org/patients/diseases-and-conditions/a-z/hemorrhoids
- High Fiber Diet. Jackson Siegelbaum Gastroenterology. Accessed 17 November 2020. Accessible via: https://www.gicare.com/gi-health-resources/high-fiber-diet/
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