Editing Hemorrhoid (section)

===Conservative===
Conservative treatment typically consists of foods rich in [[dietary fiber]], intake of oral fluids to maintain hydration, [[nonsteroidal anti-inflammatory drug]]s, [[sitz bath]]s, and rest.<ref name=Review09 /> Increased fiber intake has been shown to improve outcomes<ref name=Alon2005>{{cite journal |last1 = Alonso-Coello |first1 = P. |last2 = Guyatt |first2 = G. H. |last3 = Heels-Ansdell |first3 = D. |last4 = Johanson |first4 = J. F. |last5 = Lopez-Yarto |first5 = M. |last6 = Mills |first6 = E. |last7 = Zhuo |first7 = Q. |last8 = Alonso-Coello |first8 = Pablo |title = Laxatives for the treatment of hemorrhoids |journal = Cochrane Database Syst Rev |issue = 4 |pages = CD004649 |year = 2005 |volume = 2010 |pmid = 16235372 |doi = 10.1002/14651858.CD004649.pub2 |pmc = 9036624 |editor1-last = Alonso-Coello |editor1-first = Pablo }}</ref> and may be achieved by dietary alterations or the consumption of [[fibre supplements|fiber supplements]].<ref name=Review09 /><ref name=Alon2005 /> Evidence for benefits from sitz baths during any point in treatment, however, is lacking.<ref>{{cite journal |last = Lang |first = DS |author2 = Tho, PC |author3 = Ang, EN |title = Effectiveness of the Sitz bath in managing adult patients with anorectal disorders |journal = Japan Journal of Nursing Science |date = December 2011 |volume = 8 |issue = 2 |pages = 115–28 |pmid = 22117576 |doi = 10.1111/j.1742-7924.2011.00175.x }}</ref> If they are used, they should be limited to 15 minutes at a time.<ref name=Beck2011 />{{rp|182}} Decreasing time spent on the toilet and not straining is also recommended.<ref name=Dav2018>{{cite journal|last1=Davis|first1=BR|last2=Lee-Kong|first2=SA|last3=Migaly|first3=J|last4=Feingold|first4=DL|last5=Steele|first5=SR|title=The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids.|journal=Diseases of the Colon and Rectum|date=March 2018|volume=61|issue=3|pages=284–92|doi=10.1097/DCR.0000000000001030|pmid=29420423|s2cid=4198610}}</ref>

While many [[topical agent]]s and [[suppositories]] are available for the treatment of hemorrhoids, little evidence supports their use.<ref name=Review09 /> As such, they are not recommended by the [[American Society of Colon and Rectal Surgeons]].<ref name="ASCRS2018" /> [[Steroid]]-containing agents should not be used for more than 14 days, as they may cause thinning of the skin.<ref name=Review09 /> Most agents include a combination of active ingredients.<ref name=Beck2011 /> These may include a barrier cream such as [[petroleum jelly]] or [[zinc oxide]], an analgesic agent such as [[lidocaine]], and a [[vasoconstrictor]] such as [[epinephrine]].<ref name=Beck2011 /> Some contain [[Balsam of Peru]] to which certain people may be allergic.<ref name="dermnetnz1">{{cite web |url = http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |title = Balsam of Peru contact allergy |publisher = Dermnetnz.org |date = December 28, 2013 |access-date = March 5, 2014 |url-status = live |archive-url = https://web.archive.org/web/20140305094411/http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |archive-date = March 5, 2014 }}</ref><ref>{{cite book |title = The ASCRS Textbook of Colon and Rectal Surgery: Second Edition |year = 2011 |isbn = 978-1-4419-1581-8 |url = https://books.google.com/books?id=DhQ1A35E8jwC&pg=PA280 |url-status = live |archive-url = https://web.archive.org/web/20140704121836/http://books.google.com/books?id=DhQ1A35E8jwC&pg=PA280 |archive-date = 2014-07-04 |last1 = Beck |first1 = David E. |last2 = Roberts |first2 = Patricia L. |last3 = Saclarides |first3 = Theodore J. |last4 = Senagore |first4 = Anthony J. |last5 = Stamos |first5 = Michael J. |last6 = Nasseri |first6 = Yosef |publisher = Springer }}</ref>

[[Flavonoids]] are of questionable benefit, with potential side effects.<ref name=Beck2011 /><ref>{{cite journal |vauthors = Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, etal |title = Meta-analysis of flavonoids for the treatment of haemorrhoids |journal = Br J Surg |volume = 93 |issue = 8 |pages = 909–20 |date = August 2006 |pmid = 16736537 |doi = 10.1002/bjs.5378 |s2cid = 45532404 |doi-access = free }}</ref> Symptoms usually resolve following pregnancy; thus active treatment is often delayed until after delivery.<ref>{{cite journal |last = Quijano |first = CE |author2 = Abalos, E |title = Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium |journal = Cochrane Database of Systematic Reviews |date = Jul 20, 2005 |volume = 2012 |issue = 3 |pages = CD004077 |pmid = 16034920 |doi = 10.1002/14651858.CD004077.pub2 |pmc = 8763308 }}</ref> Evidence does not support the use of [[Traditional Chinese medicine|traditional Chinese herbal treatment]].<ref>{{Cite journal|issue = 10|pages = CD006791|last1=Gan|first1=Tao|last2=Liu|first2=Yue-dong|last3=Wang|first3=Yiping|last4=Yang|first4=Jinlin|date=2010-10-06|language=en|doi=10.1002/14651858.cd006791.pub2|pmid = 20927750|title = Traditional Chinese Medicine herbs for stopping bleeding from haemorrhoids|journal = Cochrane Database of Systematic Reviews}}</ref>

The use of [[phlebotonics]] has been investigated in the treatment of low-grade hemorrhoids,<ref name="ASCRS2018">{{cite journal |last1=Davis |first1=BR |last2=Lee-Kong |first2=SA |last3=Migaly |first3=J |last4=Feingold |first4=DL |last5=Steele |first5=SR |title=The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. |journal=Diseases of the Colon and Rectum |date=March 2018 |volume=61 |issue=3 |pages=284–292 |doi=10.1097/DCR.0000000000001030 |pmid=29420423 |s2cid=4198610 |type=Professional society guidelines}}</ref><ref name="Perera2012">{{cite journal |last1=Perera |first1=Nirmal |last2=Liolitsa |first2=Danae |last3=Iype |first3=Satheesh |last4=Croxford |first4=Anna |last5=Yassin |first5=Muhammed |last6=Lang |first6=Peter |last7=Ukaegbu |first7=Obioha |last8=van Issum |first8=Christopher |title=Phlebotonics for haemorrhoids |journal=Cochrane Database of Systematic Reviews |issue=8 |pages=CD004322 |date=15 August 2012 |doi=10.1002/14651858.CD004322.pub3 |pmid=22895941|s2cid=28445593 |pmc=11930390 }}</ref><ref>{{cite journal |last1=Higuero |first1=T |last2=Abramowitz |first2=L |last3=Castinel |first3=A |last4=Fathallah |first4=N |last5=Hemery |first5=P |last6=Laclotte Duhoux |first6=C |last7=Pigot |first7=F |last8=Pillant-Le Moult |first8=H |last9=Senéjoux |first9=A |last10=Siproudhis |first10=L |last11=Staumont |first11=G |last12=Suduca |first12=JM |last13=Vinson-Bonnet |first13=B |title=Guidelines for the treatment of hemorrhoids (short report). |journal=Journal of Visceral Surgery |date=June 2016 |volume=153 |issue=3 |pages=213–8 |doi=10.1016/j.jviscsurg.2016.03.004 |pmid=27209079 |type=Professional society guidelines|doi-access= }}</ref><ref>{{cite journal |last1=Trompetto |first1=M. |last2=Clerico |first2=G. |last3=Cocorullo |first3=G. F. |last4=Giordano |first4=P. |last5=Marino |first5=F. |last6=Martellucci |first6=J. |last7=Milito |first7=G. |last8=Mistrangelo |first8=M. |last9=Ratto |first9=C. |title=Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement |journal=Techniques in Coloproctology |date=24 September 2015 |volume=19 |issue=10 |pages=567–575 |doi=10.1007/s10151-015-1371-9|pmid=26403234 |hdl=10447/208054 |s2cid=30827065 |hdl-access=free }}</ref> although these drugs are not approved for such use in the United States or Germany.<ref>{{cite book |last1=Garg |first1=Nitin |last2=Gloviczki |first2=Peter |title=Vascular Medicine: A Companion to Braunwald's Heart Disease |date=2013 |publisher=Elsevier Health Sciences |isbn=9781437729306 |pages=652–666 |chapter-url=https://www.sciencedirect.com/science/article/pii/B9781437729306000550 |chapter=55—Chronic Venous Insufficiency|edition=Second }}</ref><ref name="Stucker2016">{{cite journal |last1=Stücker |first1=M |last2=Debus |first2=ES |last3=Hoffmann |first3=J |last4=Jünger |first4=M |last5=Kröger |first5=K |last6=Mumme |first6=A |last7=Ramelet |first7=AA |last8=Rabe |first8=E |title=Consensus statement on the symptom-based treatment of chronic venous diseases. |journal=Journal of the German Society of Dermatology |date=June 2016 |volume=14 |issue=6 |pages=575–83 |doi=10.1111/ddg.13006 |pmid=27240062 |type=Professional society guidelines|doi-access=free }}</ref> The use of phlebotonics for the treatment of chronic venous diseases is restricted in Spain.<ref>{{cite web |title=Consolidated List of Products—Whose Consumption and/or Sale Have Been Banned, Withdrawn, Severely Restricted or Not Approved by Governments, Twelfth Issue—Pharmaceuticals. United Nations—New York, 2005 |url=http://apps.who.int/medicinedocs/en/m/abstract/Js16780e/ |archive-url=https://web.archive.org/web/20141108234228/http://apps.who.int/medicinedocs/en/m/abstract/Js16780e/ |url-status=dead |archive-date=November 8, 2014 |website=apps.who.int |access-date=7 November 2019 |date=2005}}</ref>