Treating Hemorrhoids : OTC Remedies, Surgical Options

by Food and Drug Administration (FDA)

(Page 2 of 2)

OTC Remedies

If necessary, there are several nonprescription drugs available that can help relieve certain symptoms of hemorrhoids. FDA's review of those drugs, published in August 1990, found 33 active ingredients safe and effective for protecting the skin, reducing swelling, or relieving discomfort, itching and inflammation. At the same time, however, FDA banned more than 30 other ingredients that have not been proven safe and effective.

Most of the approved ingredients are for external use on the skin, but some may also be used on mucous membranes just inside the rectum. The best drug depends on the particular individual's symptoms, and it may be advisable to consult a doctor or pharmacist about which one to buy, says William E. Gilbertson, director of FDA's division of over-the-counter drug evaluation.

No ingredients to relieve pain, soreness and burning were approved for internal use because there are no nerve endings inside the rectum.

Internal hemorrhoids "don't hurt and they don't itch," says Smith. "Pain means a fissure [break in the skin] or a thrombosed [blood-clot-filled] external hemorrhoid, but it doesn't mean internal hemorrhoid problems."

Manufacturers had until August 1991, when the FDA regulations went into effect, to reformulate products that contained ingredients for pain, soreness and burning or relabel with the statement "for external use only" and a warning not to put the product into the rectum.

In addition, nonprescription hemorrhoid remedy labels must include the statement "If condition worsens or does not improve within seven days, consult a doctor." Two other warnings — "Do not exceed the recommended daily dosage unless directed by a doctor" and "In case of bleeding, consult a doctor promptly" — must also be on the label.

Surgical Options

Occasionally, some form of surgery may be necessary to remove or destroy the hemorrhoid.

One of the most common surgical methods is rubber band ligation. A tiny rubber band — diameter 1 millimeter (about one-twenty-fifth of an inch) — is fitted onto a special gun-like device. When the trigger is pulled, the rubber band is forced onto the base of the hemorrhoid. Because there are no nerve endings in the rectum, no anesthesia is necessary.

It takes about a week for the strangled tissue to slough off and a scar to form. Rubber band ligation works best on first- and second-degree hemorrhoids. (See illustration.)

Other surgical techniques for these less severe hemorrhoids include:

• infrared photocoagulation — A specially designed device uses infrared light to create a small tissue-destroying burn around the base of the hemorrhoid.

• laser coagulation — The laser causes a minor burn, which seals off the blood vessels. This results in the hemorrhoid being retained in a non-prolapsed position.

• sclerotherapy — A solution (either quinine urea, sodium morrhuate, or phenol in oil) is injected into the hemorrhoid, which causes inflammation and eventual scarring that eliminates hemorrhoidal symptoms.

Third- and fourth-degree hemorrhoids may have to be surgically removed, either with traditional scalpels or with lasers.

Complications such as infection and incontinence are possible with all of these techniques.

External Hemorrhoids

Blood clots in external hemorrhoids are "like a black eye," says Smith. "Even if the patient does nothing, the clots will eventually disappear." Treating the pain and irritation with sitz baths, bulk stool softeners, and pain medication may be all that's necessary, he says.

Sometimes, however, the clots are so painful the patient can't bear to wait, and traditional surgery to cut out the clots is necessary.

But even surgery is only a temporary solution. If a person's diet isn't improved, the hemorrhoid may return. And even in the best of cases, in the end, "hemorrhoids don't go away, they just get better," says Smith. n

Dori Stehlin is a staff writer for FDA Consumer. Preventing Constipation

A fiber-rich diet can help prevent constipation, which is important because the strain caused by constipation is how many hemorrhoid problems begin. Good sources of fiber include:

• potatoes
• beans — kidney, navy, lima, pinto
• whole-grain breads
• bran
• fresh fruits
• vegetables, especially asparagus, brussels sprouts, cabbage, carrots, cauliflower, corn, peas, kale, and parsnips.

It will also help to limit these low- or no-fiber foods: ice cream, soft drinks, cheese, white bread, and meat.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.