HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

CONSERVATIVE MANAGEMENT OF HEMORRHOIDAL DISEASE

Ahmet Cihangir Emral

Atılım University, Faculty of Medicine, Department of General Surgery, Ankara, Türkiye

Emral AC. Conservative Management of Hemorrhoidal Disease. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.65-72.

ABSTRACT

Hemorrhoidal disease (HD) is the most common proctological disorder, affecting individuals aged 45 to 65 years. It is characterized by painless rectal bleeding, often occurring during or immediately after defecation, and can be accompanied by pruritus ani, anal discomfort, and prolapse. Recurrent bleeding may lead to complications such as iron deficiency anemia, and in severe cases, massive rectal bleeding that requires hospitalization and blood transfusion. Although pain is uncommon in uncomplicated HD, its presence may suggest the involvement of secondary conditions like thrombosis, anal fissures, anorectal abscess, or neoplasms. Given the overlap in symptoms with other anorectal conditions, accurate differential diagnosis is essential. The primary goal of conservative management is symptom control, focusing on alleviating discomfort and preventing further disease progression. Early-stage internal hemorrhoidal disease typically responds well to conservative treatments, making them the first-line option. Key approaches include dietary and lifestyle modifications, fiber supplementation, stool softeners, warm sitz baths, and topical therapies. Dietary adjustments, such as increased fiber intake and adequate hydration, help improve stool consistency and reduce straining during defecation, which is crucial for symptom management. The “TONE” rule, which advocates for limited defecation time, daily defecation, no straining, and sufficient fiber intake, provides a structured approach to maintaining proper bowel habits. laxatives and osmotic agents are effective in managing constipation and improving HD symptoms. Sitz baths, involving immersion in warm water, relieve pain and discomfort by reducing anal sphincter pressure and promoting relaxation, which is key for symptom relief. Phlebotonics, including flavonoids and calcium dobesilate, play a vital role by reducing inflammation, controlling bleeding, and enhancing vascular tone. These therapies are well tolerated and can significantly decrease recurrence rates. Topical treatments, such as anesthetics and corticosteroids, offer temporary relief but lack long-term efficacy. Special populations, such as pregnant women and immunosuppressed patients, require tailored management approaches. For pregnancy-associated hemorrhoidal disease, conservative treatments are preferred, with fiber supplementation, hydration, and sitz baths being essential for symptom control. Immunosuppressed patients and those with coagulopathies face heightened risks of complications, underscoring the necessity of non-invasive treatments. In patients with inflammatory bowel disease (IBD), conservative therapy is recommended as the first-line treatment due to the high risk of postoperative complications. In cases where conservative treatments have failed, surgical interventions are generally recommended.

Keywords: Hemorrhoids; Conservative treatment; Constipation; Diet; life style

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