External hemorrhoids affect 75% of the population during their lifetime. They can be caused by pregnancy, a low-fiber diet, constipation and other conditions.

There are several solutions to relieve external hemorrhoids: creams , supplements & oral medications , surgical interventions and lifestyle changes.

Note: The information presented in this article is provided for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always consult a physician or qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

Topical creams & solutions

Topical treatments (creams, ointments, suppositories) are the first line of defense for rapid relief. Most are generally available without a prescription (except those containing corticosteroids).

There are several approaches to the local treatment of hemorrhoids, and many creams use a combination of these approaches:

• Anesthetic effect: People with hemorrhoids often seek quick relief from their pain/itching. Many creams therefore contain anesthetics such as lidocaine .
• Veinotonics : These promote blood circulation, thus helping to reduce pressure around hemorrhoidal veins. They can be found in natural formulas, for example, using butcher's broom or horse chestnut.
• Local corticosteroids : they help reduce edema and inflammation linked to hemorrhoids
  
• Lubricating agents: Often administered in the form of suppositories, they facilitate defecation and thus reduce pressure on the anal wall, which can help relieve hemorrhoids.

Topical creams can provide welcome relief during a hemorrhoidal flare-up. However, they have not been shown to prevent long-term recurrences , and prolonged use is not recommended.

In particular, cortisone creams should not be used for more than a few days without medical advice, as prolonged use can cause irritation or thinning of the skin. Similarly, local anesthetics carry a (rare) risk of local allergy.

If you are looking for a 100% natural soothing cream, you can of course discover Butt Butter cream.

Supplements and oral medications

Dietary supplements and oral medications can be very effective in treating external hemorrhoids. Although they may take several days to work, they treat the underlying problem by addressing the underlying causes.

There are several types of dietary supplements and medications available to treat external hemorrhoids:

• Transit supplements: Dietary supplements that promote transit (for example, psyllium or certain probiotics ) can be extremely effective in treating hemorrhoidal disease. A meta-analysis of 378 patients showed that dietary fiber supplementation reduced bleeding by 50% and the risk of recurrence by 47%.
• Vein tonics: By promoting good blood circulation, vein tonics can reduce anal pressure and help heal hemorrhoidal flare-ups. Vein tonics can exist in artificial or natural forms (horse chestnut, butcher's broom). Numerous publications indicate the effectiveness of horse chestnut in relieving hemorrhoidal flare-ups.
• Flavonoids: They may also have venotonic properties, as well as anti-inflammatory properties that may promote healing. A meta-analysis of 14 controlled trials (involving 1,514 patients ) showed that flavonoids significantly reduced the risk of persistent symptoms or no improvement compared to placebo (58% relative reduction), as well as the frequency of bleeding, pain, and pruritus during the attack. Flavonoids are found in many foods such as black tea, chocolate, and parsley.

Traditionally, it has been believed that certain foods that improve liver circulation (unblocking the portal vein) could help soothe hemorrhoidal disease. However, the latest published research seems to suggest that the presence of hemorrhoids is not directly related to liver circulation.

If you are looking for a dietary supplement that combines benefits for circulation and transit, try Butt Butter.

Surgical interventions

In the most severe and persistent cases (5% to 10% of cases), medical intervention may become necessary. These methods are generally considered very effective, but they can be cumbersome and require convalescence.

Surgery is also more common in the case of internal hemorrhoids.

There are several surgical methods to treat hemorrhoids:

• Rubber band ligation : the principle is to place a small elastic ring at the base of the internal hemorrhoidal bundle to cut off the blood flow. The ligated segment necrotizes and falls off within a few days, then a scar forms within 2 to 3 weeks, which fixes the mucosa and reduces the volume of the hemorrhoids. Studies report a success rate of 70 to 90% of absence of symptoms at 3 years after ligation. Consult a doctor
• Excision of an external thrombosis: When the external hemorrhoid forms a painful blood clot (thrombosis), a quick surgical solution is clot excision. Performed under local anesthesia on an outpatient basis, the procedure involves cutting the skin and removing the clot and the surrounding distended venous sac. This procedure provides immediate pain relief and allows for faster healing, especially if performed within the first 72 hours of the onset of thrombosis.
• Surgical hemorrhoidectomy: This is the most radical procedure, reserved for severe forms (irreducible prolapsed hemorrhoids, chronic bleeding leading to anemia, or failure of other treatments). Hemorrhoidectomy involves removing the hemorrhoidal patches in their entirety. It is performed in the operating room, under local or general anesthesia, most often on an outpatient basis (discharge the same day). This surgery offers the highest long-term cure rate, at the cost of a more painful convalescence (pain during defecation lasting 1 to 2 weeks). 

Preventing recurrences: practical everyday advice

After overcoming a hemorrhoidal crisis, the goal is to prevent another flare-up. Here are some tips that may help prevent a relapse:

• High-fiber diet: Eat a diet rich in dietary fiber (fruits, vegetables, whole grains) to soften stools and make them easier to pass. An intake of at least 25–30 g of fiber per day is recommended for adults. You can read our detailed article on fiber sources.
• Adequate hydration: Drink enough water throughout the day (at least 1.5 L, or even 2 L per day). Good hydration, coupled with fiber, helps soften stools and prevent constipation. Also limit excessive alcohol and caffeinated beverages, which can promote dehydration or digestive irritation.
• Careful local hygiene: After each use of the toilet, gently clean the anal area with warm water or a damp, non-irritating toilet paper. We also recommend patting yourself dry rather than rubbing.
• Have regular bowel movements without straining: Don't delay going to the bathroom, which can harden stools. When using the bathroom, adopt good habits: avoid sitting for too long or straining too hard. A commonly suggested tip is to slightly elevate your feet (for example, with a small stool—this is the squatty-potty method) to adopt a squatting position, which can help with bowel movements without excessive strain.
• Physical activity: Some studies suggest that exercising the Kegel muscles (of the pelvic floor) can help reduce anal fissures and hemorrhoids. However, avoid repetitive lifting of very heavy loads which increases abdominal pressure, as well as prolonged sedentary lifestyle (do not remain seated for hours without a break).

The most important thing: consult a doctor

Regardless of your approach, if you suffer from hemorrhoids, consult a doctor or pharmacist. They will be best placed to provide you with a prescription and a personalized treatment plan tailored to your symptoms.

Consulting a medical professional when suffering from hemorrhoids may seem embarrassing, but this fear is unfounded: doctors and pharmacists are used to dealing with these cases on a daily basis, as they are extremely common.

Sources:

Higuero, T. (2014). Recommendations for clinical practice in the treatment of hemorrhoidal disease Short text. Colon & Rectum, 8(2), 105-109.

Alonso-Coello, P., Mills, E. D., Heels-Ansdell, D., López-Yarto, M., Zhou, Q. I., Johanson, J. F., & Guyatt, G. (2006). Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG, 101(1), 181-188.

Hippocastanum, HHTA (2018). Aesculus hippocastanum (Aescin, horse chestnut) in the management of hemorrhoidal disease. Turk J Colorectal Dis, 28, 54-57.

Alonso-Coello, P., Zhou, Q., Martinez-Zapata, M.J., Mills, E., Heels-Ansdell, D., Johanson, J.F., & Guyatt, G. (2006). Meta-analysis of flavonoids for the treatment of haemorrhoids. Journal of British Surgery, 93(8), 909-920.

Mayo Foundation for Medical Education and Research. (2023, August 25). Hemorrhoids . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280