What is included in the conservative management of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Medical management is the initial treatment of choice for grade I internal and nonthrombosed external hemorrhoids. It consists of warm baths (twice or thrice daily [bid/tid]); a high-fiber diet [27] ; adequate fluid intake; stool softeners; topical and systemic analgesics; proper anal hygiene; and in some cases, a short course of topical steroid cream. A 2012 review indicates a potential benefit of phlebotonics in treating hemorrhoids. [28]

Retraining the patient's toilet habit is also a consideration. Decreasing straining and constipation shrinks internal hemorrhoids and decreases their symptoms; therefore, first-line treatment of all first- and second-degree (and many third- and fourth-degree) internal hemorrhoids should include measures to decrease straining and constipation.

Many patients see improvement or complete resolution of their symptoms with conservative measures. Aggressive therapy is reserved for patients who have persistent symptoms after 1 month of conservative therapy. Treatment is directed solely at symptoms and not at the appearance of the hemorrhoids.

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