Hemorrhoids and Treatments

Among these techniques, the most widely used in the United States is rubber band ligation. Rubber band ligation is the treatment of choice for first and second degree hemorrhoids. Although rubber band ligation is a widely favored technique, its post-procedural complications include pain, local swelling, urinary symptoms and fecal urgency.17 These symptoms are more prevalent in procedures where multiple bandings are applied; the incidence of pain after banding has been found to be approximately 91 percent

Most patients are familiar with the painful and sometimes prolonged recovery after traditional excisional hemorrhoidectomy. Post-operative pain is the main reason that patients have been reluctant to seek treatment for their hemorrhoids.

Stapled hemorrhoidectomy is a new technique in which insertion of cirmcumferential purse-string sutures and the subsequent firing of a circular stapler remove hemorrhoids. It is a significantly less painful surgical method for third degree hemorrhoids, but it is still too early to assess the long-term symptomatic and functional outcomes of this procedure19.

Non-surgical approaches to Hemorrhoidal Pain Reduction

Table 1
Preparation H Anusol -HC suppositories Lidocaine Ointment
Anal pram HC cream 1% Topical Nifedipine Analpram HC 2.5
Anusol HC Cream 1% Donut Cushion Warm Sitzbaths

All of these medications or treatments are short-acting. In addition, prolonged use of some ointments could be potentially harmful, and do not improve the patient's functional ability or reduce pain immediately during acute hemorrhoid episode.

Over-the-counter medications such as Preparation H were proven ineffective in one study, which compared healing rates of rectal mucosal ulceration in patients using proprietary hemorrhoid cream vs placebo. 20

Anusol HC contains hydrocortisone, a topical steroid. It is thought that the use of hydrocortisone (1 or 2%) may benefit patients suffering from pruritis. However, long-term use of corticosteroids is to be avoided because it will cause thinning and atrophy of the perianal skin. Analpram contains hydrocortisone as well as pramoxine, a topical anesthetic.

Topical nifedipine is a dihydropyridine, calcium antagonistic. One study found that total remission of symptoms during a 14-day treatment period occurred in 92% of the nifedipine patients, vs 45.8% of control patients.4% of the treated group had local hyperemia, which disappeared when treatment was discontinued.21

Local anesthetics like lidocaine are not to be taken by pregnant women, nursing mothers, elderly people, subjects with heart failure and liver insufficiency. In addition, topical creams with cortisteroids are considered teratogenic, thus should not be used by pregnant women or nursing mothers. Topically applied, these types of medications can be absorbed in sufficient amounts to produce systemic effects. Other side effects include itching, burning and stinging.