Management of internal haemorrhoids

Clinical Practice Committee, 2004Davis, 2018Internal haemorrhoids may respond to the following lifestyle measures:

• ensuring adequate intake of fibre and noncaffeinated fluids to avoid constipation
• avoiding straining during defecation
• responding to the urge to defecate, and not trying to initiate defecation without this.

Over-the-counter treatments for internal haemorrhoids include ointments and suppositories containing emollients and a mild astringent, local anaesthetic or corticosteroid. Although they may help to relieve itch or discomfort, there is little evidence that they promote sustained improvement in internal haemorrhoids. Short-term use of topical corticosteroids may provide symptomatic relief but can exacerbate candidiasis and other local infections. Prolonged use of preparations containing a local anaesthetic should be avoided because they can cause adverse effects such as local skin sensitisation or dermatitis.

Refer patients who do not respond to lifestyle measures and over-the-counter treatments to a gastroenterologist or a surgeon with expertise in managing haemorrhoids. Specialist interventions for persistent bleeding include rubber-band ligation, injection sclerotherapy or infrared coagulation. Rubber-band ligation is less likely to require repeat treatment than other local therapiesMacRae, 1995. Surgery may be appropriate if the internal haemorrhoid cannot be reduced or is associated with a skin tag.

Internal haemorrhoids that develop during pregnancy should be managed using lifestyle measures and over-the-counter treatments because they usually resolve after delivery.