Management

The best management is prevention, with factors such as increasing fibre and fluid intake, avoiding excess caffeine and alcohol, and treating constipation if present. (1)

The active treatment of haemorrhoids includes:

• conservative treatment. Examples are good perianal hygiene, avoiding straining at stool, simple analgesia (avoid codeine) and topical treatments.
• treatments such as rubber band ligation, injection sclerotherapy and bipolar diathermy
• surgical treatments - such as haemorrhoidectomy - are reserved for large or symptomatic haemorrhoids that do not respond to other treatments.

1. Wald A, Bharucha AE, Limketkai B, et al. ACG clinical guidelines: management of benign anorectal disorders. Am J Gastroenterol. 2021 Oct 1;116(10):1987-2008.