Outpatient management of hemorrhoids

Hemorrhoids are a common anorectal condition characterized by bleeding, thrombosis, and prolapse. Initial treatment is usually focused on nonoperative interventions. Behavior modifications including sitz baths, regular exercise, consuming a low-fat diet, avoidance of excessive time on the toilet, and minimizing constipating medications may provide symptomatic relief. Oral fiber supplementation is safe and highly effective. A variety of nonsurgical ablative treatments exist, including rubber band ligation, injection sclerotherapy, and infrared photocoagulation; each of which offers unique advantages. Patients presenting with thrombosed external hemorrhoids and 48-72 h of symptoms usually benefit from excision of the hemorrhoid. More invasive options aimed at ablation of hemorrhoids are reserved for patients with persistent symptoms or higher grade hemorrhoids.