treatment
There are three main principles for the treatment of hemorrhoids:
No medication or surgery is necessary for asymptomatic hemorrhoids, and improvement of living habits is the main focus
Symptomatic hemorrhoids are alleviating and eliminating symptoms, not necessarily a radical cure;
The treatment of hemorrhoids is mainly non-surgical treatment, and necrosis of strangulated hemorrhoids, incarcerated hemorrhoids, internal hemorrhoids of degree Ⅱ and mixed hemorrhoids can be considered for surgical treatment.
Acute treatment
Strangulated hemorrhoids or incarcerated hemorrhoids will cause severe pain if they are not reset in time. After the emergency, doctors will push the hemorrhoids back into the anus to reset, and then use gauze pads to prevent re-emergence. If necrosis has occurred, emergency surgery needs to be considered.
General treatment
Changes in lifestyle, eating habits and bowel habits are very important for patients with hemorrhoids.
In the acute stage of hemorrhoids, you can choose to take a warm water bath, 2 to 3 times a day, which can reduce inflammation and edema, and relieve perianal discomfort and itching. The water temperature should not be too hot to avoid scalding.
When hemorrhoids or hemorrhoids protrude out of the anus, manual reduction is required. It is best to perform hemorrhoids reduction before going to bed, and the hemorrhoids can be obviously improved after a rest overnight. If the hemorrhoids come out during defecation, they should be washed and reset by themselves, and the anal opening should be blocked with fingers or gauze to prevent them from coming out again, which can get a noticeable improvement.
medical treatement
Due to large individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected under the guidance of a doctor in full consideration of personal circumstances.
Topical medication
Ointments containing local anesthetics such as lidocaine may improve pain;
Ointments containing glucocorticoids such as hydrocortisone may improve itching;
Antispasmodic drugs such as nitroglycerin ointment can improve bleeding, pain, itching, irritation and difficulty in defecation. Other similar drugs include isosorbide dinitrate ointment, topical nifedipine preparations, etc.;
Chinese patent medicine hemorrhoid ointment or suppository can be used empirically under the guidance of a doctor, such as Mayinglong hemorrhoid ointment (suppository) 1 to 2 times a day.
Note: Ointments containing local anesthetics or glucocorticoids may cause contact dermatitis or thinning and atrophy of skin and mucous membranes, and long-term use should be avoided.
Oral drugs
Oral drugs such as acetaminophen and ibuprofen can relieve related pain;
When secondary hemorrhoids are infected, attention should be paid to the application of anti-infective drugs to control the infection.
Some Chinese patent medicines can be taken orally to promote hemorrhoid venous reflux, reduce hemorrhoid bleeding, make hemorrhoid edema subsided, and help recovery.
Note: Avoid taking drugs that can cause constipation or diarrhea as much as possible.
Injection sclerotherapy
This method is to inject sclerosing agent to produce aseptic inflammatory reaction around hemorrhoids and hemorrhoids, and fibrosis of submucosal tissues, so as to achieve hemorrhoids atrophy, and it is effective for the treatment of hemorrhagic internal hemorrhoids of degree I and II.
After perianal local anesthesia, insert an anoscope to observe the position of the hemorrhoids, and then inject 2~3ml of sclerosing agent into the submucosa of the hemorrhoids. If the effect of one injection is not satisfactory, the injection can be repeated once a month later; if there are many hemorrhoids, the injection can also be divided into 2 to 3 injections.
Apron band ligation
In this method, a special rubber ring is used to ligate the root of the internal hemorrhoids, and the elasticity of the rubber ring is used to block the blood supply of the hemorrhoids, so that the hemorrhoids are ischemic and necrotic, and then fall off and heal. It can be used for Ⅰ, Ⅱ, and Ⅲ degree internal hemorrhoids.
The apron band ligation method is more effective than sclerotherapy or infrared coagulation method, with high safety and fewer treatments. External hemorrhoids are not suitable for the use of rubber band ligation therapy, because this method will cause severe pain in external hemorrhoids.
Infrared coagulation therapy
Similar to the principle of injection sclerotherapy, it uses infrared light to make internal hemorrhoids harden or shrink. The effect of treating I and II internal hemorrhoids is better, and the recurrence rate of III and IV internal hemorrhoids is higher.
Ultrasound guided hemorrhoid artery ligation
A special proctoscope with a Doppler ultrasound probe is used. When the artery above the hemorrhoids is detected, it is sutured and ligated accurately. It relieves the symptoms by blocking the blood supply of the hemorrhoids. It is mainly used for internal hemorrhoids of degree II to IV. .
Surgical treatment
For people with poor conservative treatment, it is recommended to choose outpatient minimally invasive surgery such as apron band ligation, injection sclerotherapy, or ultrasound-guided hemorrhoid artery ligation. Usually, surgery is considered only when the outpatient treatment is not effective or has special circumstances.
Hemorrhoidectomy
It is the most effective method for the treatment of severe hemorrhoids, mainly used for internal hemorrhoids and mixed hemorrhoids of degree II and III.
Circumcision of prolapse and hemorrhoids
It is mainly used for Ⅲ and Ⅳ degree internal hemorrhoids, second degree internal hemorrhoids and circular hemorrhoids that have failed non-surgical treatment. Compared with traditional surgery, it has the advantages of mild pain, short operation time and quick recovery of patients.
Thrombus external hemorrhoid dissection
Used to treat thrombotic external hemorrhoids.
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