Moist, gentle cleaning following a bowel movement is advised to minimize anal irritation.
Advise patients to avoid excessive straining at stool and to avoid sitting on the toilet for long periods of time.[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.
https://journals.lww.com/ajg/Fulltext/2021/10000/ACG_Clinical_Guidelines__Management_of_Benign.13.aspx
http://www.ncbi.nlm.nih.gov/pubmed/34618700?tool=bestpractice.com
[13]Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2024 May 1;67(5):614-23.
https://journals.lww.com/dcrjournal/fulltext/2024/05000/the_american_society_of_colon_and_rectal_surgeons.5.aspx
[14]van Tol RR, Kleijnen J, Watson AJM, et al. European Society of Coloproctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020 Jun;22(6):650-62.
http://www.ncbi.nlm.nih.gov/pubmed/32067353?tool=bestpractice.com
Constipation can be a causative factor in hemorrhoid formation, which can be avoided by adding fiber and fluids to the diet; consuming 25-30 g of fiber daily is recommended, either with high-fiber foods or with commercial fiber supplements.[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.
https://journals.lww.com/ajg/Fulltext/2021/10000/ACG_Clinical_Guidelines__Management_of_Benign.13.aspx
http://www.ncbi.nlm.nih.gov/pubmed/34618700?tool=bestpractice.com
[12]Moesgaard F, Nielsen ML, Hansen JB, et al. High fiber diet reducing bleeding and pain in patients with hemorrhoids: a double-blind trial of Vi-Siblin. Dis Colon Rectum. 1982 Jul-Aug;25(5):454-6.
http://www.ncbi.nlm.nih.gov/pubmed/6284457?tool=bestpractice.com
[13]Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2024 May 1;67(5):614-23.
https://journals.lww.com/dcrjournal/fulltext/2024/05000/the_american_society_of_colon_and_rectal_surgeons.5.aspx
[14]van Tol RR, Kleijnen J, Watson AJM, et al. European Society of Coloproctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020 Jun;22(6):650-62.
http://www.ncbi.nlm.nih.gov/pubmed/32067353?tool=bestpractice.com
Following rubber band ligation, advise patients to manage pain with simple analgesics (such as acetaminophen), to avoid constipation (low-dose laxatives or stool softeners are often prescribed), to eat a high fiber diet, and to keep themselves hydrated.
For the management of pain following surgical hemorrhoidectomy, advise patients to use regular simple analgesics, such as acetaminophen or ibuprofen, and to use stool softeners daily to avoid constipation. Chemical sphincter relaxants (e.g., nitroglycerin) applied to the anus confer some benefit. Metronidazole may also be prescribed.[39]Lyons NJR, Cornille JB, Pathak S, et al. Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief. Colorectal Dis. 2017 Sep;19(9):803-11.
http://www.ncbi.nlm.nih.gov/pubmed/28589634?tool=bestpractice.com