According to the Merck Manual, hemorrhoids are swollen, twisted veins located in the anorectal area. Hemorrhoids may occur inside the anus (internal) or under the skin around the anus (external). Hemorrhoids are classified according to location, severity and the amount of pain they cause. A 2004 review published in "Gastroenterology" examined the most effective hemorrhoid cures.
Types of Hemorrhoids
External hemorrhoids occur under the skin around the anus below the anorectal line. The anorectal line is where the skin lining changes to mucous membrane in the anal canal. Internal hemorrhoids occur inside the anus above the anorectal line. Prolapsed hemorrhoids occur when an external or internal hemorrhoid protrudes outside the anus. Hemorrhoids are classified by a grading system. First degree hemorrhoids bleed but do not prolapse (protrude). Second degree hemorrhoids prolapse with bowel movements, but spontaneously return inside the anus. Third degree hemorrhoids prolapse and require manual reduction. Fourth degree hemorrhoids prolapse and can't be reduced.
The Study
The study, " American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids," examined the most effective hemorrhoid medical, nonoperative and surgical treatments. The researchers found that most first degree hemorrhoids can be treated with home remedies. Second degree and some third degree hemorrhoids can be treated with nonoperative procedures. Surgery is only performed on large third degree or fourth degree hemorrhoids that are extensive and painful.
Medical Treatment
Most hemorrhoidal symptoms can be relieved by simple home remedies, including increased dietary fiber, nonprescription drugs and herbal supplements. Adding high-fiber foods (fruits, vegetables and whole grains) to the diet and natural plant fibers (psyllium or Metamucil) can help treat and prevent constipation and hemorrhoids. Nonprescription medications, such as topical corticosteroids, local anesthetics, skin protectants, phenylphrine HCL and witch hazel, can help relieve pain, itching and swelling. Taking botanicals (horse chestnut, butchers broom, gotu kola and witch hazel) and bioflavonoids (MPFF and Troxerutin) can help treat and prevent hemorrhoids.
Nonoperative Treatment
Nonsurgical procedures, called fixative procedures, reduce the blood supply to the hemorrhoid. This shrinks the hemorrhoid and prevents the development of more hemorrhoids. Fixative procedures include rubber band ligation (the hemorrhoid is tied of with a rubber band), sclerotherapy (the hemorrhoid is injected with a chemical solution) and infrared coagulation (a heat, laser, or electric current device creates scar tissue).
Surgery
Surgical removal of hemorrhoids, known as hemorrhoidectomy, may be necessary for severe, extensive hemorrhoids. Although hemorrhoidectomy can provide better long-term results than fixative procedures, it is used less frequently. Hemorrhoidectomy can require longer recovery times, has a greater risk of complications and is a more expensive treatment option.
