Hemorrhoids are among the most common digestive complaints, yet they remain one of the most misunderstood.
A new review in JAMA highlights how widespread the condition is and what the best treatments are.
More than 10 million Americans deal with hemorrhoids, which occur when veins in the rectum or anus become swollen and irritated.
They are typically divided into three types:
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• Internal
• External
• Mixed
Internal hemorrhoids form inside the rectum, external hemorrhoids under the skin around the anus, and mixed hemorrhoids involve both areas.
Symptoms range from bleeding and itching to pain and prolapse, where tissue bulges outside the anus.
The good news is that most hemorrhoids improve with simple lifestyle changes.
The review notes that increasing dietary fiber and fluids is the first step.
Avoiding straining on the toilet also helps.
Some patients benefit from phlebotonics—plant-based compounds that strengthen vein walls.
These noninvasive approaches are often enough for early-stage hemorrhoids.
When symptoms persist, office-based procedures come next.
Rubber band ligation, where a small band cuts off blood supply to the hemorrhoid, is the most effective of these methods, with an average success rate close to 90%.
Other options include sclerotherapy (injection therapy) and infrared coagulation, both of which shrink hemorrhoids by damaging the vessels that feed them.
For more severe cases—particularly large, prolapsing hemorrhoids (grade III or IV) or mixed disease—surgery may be required.
Hemorrhoidectomy remains the standard surgical approach.
External hemorrhoids, on the other hand, are usually treated medically unless they become suddenly thrombosed, in which case urgent surgical removal may be considered.
This shows that lifestyle changes should always be your first step. And they work even if you need to do a little more than eating fiber and take it easy with the pushing.
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