Management of Hemorrhoids

Current Evidence and Recommendations

The World Health Organization and other guideline societies suggest that no recommendation can be made regarding the role of NSAIDs for complicated hemorrhoids based on available literature 1, 2
Conservative management with dietary and lifestyle changes is strongly recommended as first-line therapy for all hemorrhoid grades, according to the European Society of Coloproctology 3, 5
Flavonoids are suggested to relieve hemorrhoidal symptoms with moderate quality evidence supporting their use, as recommended by the American Gastroenterological Association 2, 5, 6

Topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks has shown a 92% resolution rate for thrombosed hemorrhoids, based on evidence from the World Journal of Emergency Surgery 4, 5
Short-term use of topical corticosteroids (no more than 7 days) may help reduce local perianal inflammation, as suggested by the American College of Gastroenterology 4, 5

Do not blindly attribute rectal bleeding to hemorrhoids, as it may indicate other serious conditions requiring further evaluation, according to the World Health Organization 1, 2
Anoscopy and possibly colonoscopy should be considered in cases of rectal bleeding to rule out other pathologies, especially with concerning personal or family history, as recommended by the European Society of Gastrointestinal Endoscopy 2, 3