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4 Levels of Hemorrhoid Care

4 Levels of Hemorrhoid Care

Not all hemorrhoid problems are the same. Symptomatic hemorrhoid treatment depends on the severity of the symptoms. Sometimes symptoms are mild and respond to simple lifestyle modification and creams or ointments. In other cases the symptoms might require more invasive treatment or even surgical intervention.

There are four levels of hemorrhoid care:

Hemorrhoid Treatment Level One: Diet and Lifestyle modification

Hemorrhoid Treatment Level Two: Topical Medications

Hemorrhoid Treatment Level Three: Relatively Painless In-office Procedures

Hemorrhoid Treatment Level Four: Surgery


Hemorrhoid Treatment Level One: Diet and Lifestyle modification

Treatment Level One is for hemorrhoids that show up as painless bleeding or with bulging out of the anus when you strain. At this level we recommend basic diet and lifestyle modifications.

First of all it is important to get plenty of water in your diet. Many times hemorrhoid problems come from constipation. One way to avoid constipation is to drink at least 64 ounces of water each day.

Plenty of fiber in the diet is also a great way to prevent and treat mild hemorrhoid symptoms. A diet rich in fruits and vegetables will give you plenty of fiber. However, it is often difficult to get the recommended amounts of fiber from food alone. There are many diet supplements that can help you get the fiber you need including our H-Releve Anorectal Dietary Health Supplement capsules.

Exercise is also a key component in this first Hemorrhoid Treatment Level. Exercise aids in proper digestion with better blood flow to your intestines, and it also helps prevent constipation.

When you realize that increased pressure on hemorrhoids causes them to become problematic, you can understand the reasoning behind avoiding prolonged time sitting on the commode. First of all, don’t read on the toilet. If you don’t move your bowels within five minutes, get up and try again later.

Another useful aid for mild hemorrhoid symptoms is sitz baths. All you do is fill up your bath tub with a few inches of warm water. Then soak your buttocks and anal area for about 10-15 minutes. Avoid scrubbing and then gently pat yourself dry. You can do this after each bowel movement or up to 2-3 times a day.

Finally, when constipation does not respond to the above measures, you can try lubricants, laxatives or stool softeners. Some options are:

  • Docusate (stool softener)
  • Mineral Oil (lubricant)
  • Plyethylene Glycol, magnesium citrate, senna and bisacodyl (laxatives)

Hemorrhoid Treatment Level Two: Topical Medications

When hemorrhoid symptoms do not respond to Level One treatments you can try topical medications. These are especially useful to treat symptoms such as itching, pain and burning. There are many different options out there to choose from including ointments, creams, suppositories, foams and medicated wipes.

Moisturizing creams can help relieve your symptoms while healing takes place. There are also astringent medications that help dry up and firm swollen and inflamed hemorrhoids. Some creams contain a fast acting anesthetic agent such as lidocaine. Finally, corticosteroid containing medications help reduce inflammation, itching and swelling.

Some excellent examples of these medications are available here from The H Company. These are:

  • H-Releve Moisturizing Cream
  • H-Releve Anti-Itch Cream
  • H-Releve Hemorrhoidal Cream

Hemorrhoid Treatment Level Three: Relatively Painless In-office Procedures

When hemorrhoid symptoms do not improve with Level One or Level Two recommendations, it is often necessary for your doctor to remove your hemorrhoids with a simple in-office procedure. Thankfully, these procedures can be performed quickly and relatively painlessly in your surgeon’s office.

The most common procedure used is called rubber band ligation. Here, your doctor uses a special device that places constrictive elastic bands around the hemorrhoid. This cuts off the blood supply to the problematic tissue, and it eventually dies and falls off on its own after about a week.

Complications to rubber band therapy are rare but can include bleeding, thrombosis, pain and difficulty urinating.

Some other procedures used in this treatment level are:

  • Sclerotherapy: Hemorrhoid tips are injected by a liquid that causes hemorrhoid tissue to shrink and die.
  • Infrared Photocoagulation: Heat is used to get rid of hemorrhoid tissue.
  • Electrocoagulation: Electricity is used to kill hemorrhoid tissue.
  • Cryotherapy: Extreme cold is applied to the hemorrhoid causing it to shrink and die.

Hemorrhoid Treatment Level Four: Surgery

In the most complicated situations hemorrhoids might require surgical removal. This treatment is reserved for hemorrhoid problems that do not respond to any other treatment or procedure. Very large external hemorrhoids may also be treated with surgery.

These operations require general anesthesia and must be performed in a hospital setting. Since this is a more invasive treatment, the risk of side effects also increases.

For example, for hemorrhoids that are large and that permanently bulge out of the anus, surgical resection is required. While the patient is under anesthesia, the surgeon cuts out the problematic hemorrhoid tissue with a scalpel.

There is also a surgical procedure called the stapled hemorrhoidectomy where the hemorrhoids are literally stapled with a special device. This returns the hemorrhoid tissue back to its proper place in the anal canal, and it also causes redundant tissue to die and fall off.

In transanal hemorrhoidal dearterialization a special device called a Doppler probe locates the blood supply to the problematic hemorrhoid. Your surgeon then ties a suture around the blood vessel cutting off the blood supply to the hemorrhoid causing it to die and fall off.

Finally, for external hemorrhoid thrombosis, your surgeon might have to drain or cut out the hemorrhoid under general anesthesia. This is reserved for situations where there is a significant amount of pain.