For elderly patients with rectal bleeding, the physical examination should be supplemented with either proctosigmoidoscopy plus a barium enema or total colonoscopy. Heavy lifting and straining at stool should be avoided. Sitz baths and suppositories or ointments containing benzocaine or another local anesthetic can relieve symptoms. For mildly prolapsed or bleeding internal hemorrhoids, rubber bands can be applied snugly around the base of each major hemorrhoid during one or more office visits. The bands should be positioned above the anal canal, or great pain results.
Posttreatment discomfort is moderate, and long-term results are good.
Hemorrhoidectomy of secondary hemorrhoids is more difficult. Cryosurgery and laser therapy are less popular alternatives because the amount of tissue removed is small, thus healing and symptom relief are delayed. For combined hemorrhoids or internal hemorrhoids with major prolapse, hemorrhoidectomy is the most effective treatment. It can relieve symptoms immediately and has excellent long-term results. For a thrombosed external hemorrhoid, subcutaneous injection of a local anesthetic and evacuation provide immediate relief.