Review of the 17 best ointments for hemorrhoids: advantages, applications and prices

List of the best ointments for hemorrhoids: top 10 most effective. Reviews and prices

Hemorrhoids are varicose veins located in and around the anus. If irritated and swollen, it can lead to pain and even bleeding. The most common signs of the disease themselves disappear spontaneously after a week or two. However, frequent and painful relapses are possible.

Today's medicine offers many treatment strategies that have enormous potential - from home remedies to instrumental methods.

The assortment of pharmacies offers various proctological drugs, for example, ointments, gels, tablets, suppositories, creams. They fight burning, itching, act as an analgesic, decongestant, and anti-inflammatory agent.

Advantages and disadvantages

Products for external application in the form of ointments have both advantages and disadvantages. The positive side includes accessibility, ease of use, quick effect, elimination of harmful effects on the stomach and liver. Long-term use helps relieve symptoms of hemorrhoids, strengthen the walls of blood vessels, and reduce nodes. Many drugs are approved for use in pregnant women and during lactation. Ointments rarely cause addiction or withdrawal symptoms.

Disadvantages include greasy marks on clothing and bedding after using ointments, and the need to combine ointments with oral medications, since they are not always effective as independent therapy.

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This article has been verified by a current qualified physician, Victoria Druzhikina, and can be considered a reliable source of information for site users.

Bibliography

1. https://www.gastroscan.ru/literature/authors/9497
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How to choose the right ointment?

To treat hemorrhoids, the following therapeutic regimens are used depending on the type and severity of the disease:

1. To relieve pain, the following pain-relieving ointments for hemorrhoids, containing lidocaine and anesthesin, will be effective: Procto-Glivenol, Relief Advance, Proctazan, Emla, Irobin and others;
2. You can overcome the relatively mild initial degree of hemorrhoids with the help of heparin ointments, as well as rectal suppositories containing benzocaine and heparin, for example, Nigepan;
3. If the inflammatory process from hemorrhoids has spread to nearby tissues, antimicrobial and antibacterial agents are prescribed, such as Vishnevsky Ointment, Levomikol, Ichthyol (ichthyol ointment), Mafenide acetate;
4. When the disease progresses rapidly, doctors typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs for short), such as Diclofenac, Piroxecam, and Ibuprofen;
5. For rectal bleeding, combined medications (hemostatics) are used, which contain both anti-inflammatory and vasoconstrictor components, as well as anesthetic and venotonic substances, for example, Adroxon in the form of a solution, as well as Procto-Glivenol and Relief.

Below we will move on to a more detailed consideration of inexpensive and effective ointments for hemorrhoids.

Which antihemorrhoidal drugs are better: ointments, gels, suppositories or tablets

Every patient wants the fastest remedy for hemorrhoid symptoms. But only the doctor determines which option is best for a particular patient. There is no universal algorithm here. Tablets affect the body from the inside.

They are necessary in order to:

• relieve inflammation;
• reduce pain syndrome;
• stop the bleeding.

Tablets for severe pain symptoms of hemorrhoids are usually prescribed in the following order:

• painkillers;
• hemostatic;
• phlebotics or venotics.

Suppositories, gels and ointments for hemorrhoids are prescribed to relieve local symptoms. Rectal suppositories are very effective in such cases. Their components quickly penetrate into tissues and:

• neutralize pain, burning and itching in the rectum;
• relieve inflammation;
• heal microcracks;
• help reduce cones and blood clots.

Ointments and gels help against the manifestations of external hemorrhoids. Based on their operating principle, they are divided into several categories. They are often prescribed as an addition to tablets.

How to use it correctly?

Features of the use of ointments in the treatment of hemorrhoids:

1. Before using the product, you need to wash the area around the anus without soap and pat the skin dry with a napkin;
2. Apply the product around the anus and inside the anus, using special nozzles and applicators;
3. The usual frequency of use is 2-3 times a day and after each bowel movement; in the remission stage, a single application is possible;
4. Ointments and gels with hormonal components are used with extreme caution, in minimal portions, and, if possible, for a short period, their withdrawal occurs gradually;
5. The course of treatment with ointments takes on average from 5 to 7 days, therapy with heparin ointment can last up to 2 weeks.

List of ointments for the treatment of hemorrhoids

Currently, there are many medications that will help solve such a delicate problem as hemorrhoids. You just need to make the right choice in favor of the most appropriate comprehensive treatment for this disease. To do this, it is best to seek help from a proctologist, who will conduct a full examination and prescribe a therapy that is suitable for you.

According to reviews, the top 10 most common ointments for the treatment of hemorrhoids are presented below:

• Proctosan - 290 rubles
• Aurobin - 270 rubles
• Levomekol - 100 rubles
• Proctosedyl - 320 rubles
• Relief - 330 rubles
• Gepatrombin G - 220 rubles
• Posterizan - 340 rubles
• Heparin ointment - from 40 rubles.
• Troxevasin - 180 rubles.
• Fleming's ointment - 290 rubles

In addition to the ointments listed above (the best drugs according to reviews), other medications are also used in the treatment of hemorrhoids, for example, Glinkor Fort or Proctonis capsules, Venarus tablets, Adroxon hemostatic suppositories or Dexpanthenol healing ointment. The active compounds included in the drug Glinkor Fort strengthen blood vessels and thus relieve swelling of hemorrhoids and adjacent tissues.

Modern technologies in the treatment of chronic hemorrhoids

Goncharov D.Yu. Ph.D. Hemorrhoids are one of the widespread diseases of the adult population of industrialized countries. It has been established that in people over 40 years of age, symptoms of hemorrhoids are found in 60-70% of cases. Hemorrhoids account for about 40% of the structure of coloproctological diseases.

In recent years, minimally invasive methods of treating hemorrhoids have become firmly established in the daily practice of coloproctologists. The advantages of these methods over surgical interventions are the possibility of their use on an outpatient basis, without loss of ability to work; high efficiency in the initial stages of the disease; a small number of complications.

The most commonly used minimally invasive methods are:

• hardware ligation of hemorrhoids with latex rings,
• sclerotherapy,
• infrared photocoagulation of hemorrhoids,
• suture ligation of hemorrhoidal arteries under Doppler control,
• electrocoagulation of hemorrhoids.

The indication for minimally invasive surgical interventions is uncomplicated internal hemorrhoids of stages I - III.

When choosing a method of treating patients with hemorrhoids, it is advisable to use a classification that subdivides chronic hemorrhoids into stage IV.

• I Art. Discharge of scarlet blood from the anus without prolapse of hemorrhoids.
• II Art. Prolapse of hemorrhoids with self-reduction into the anal canal (with or without bleeding).
• III Art. Periodic prolapse of hemorrhoids and the need for their manual reduction into the anal canal (with or without bleeding).
• IV Art. Constant prolapse of hemorrhoids along with the rectal mucosa, inability to reduce them into the anal canal using a manual aid (with or without bleeding).

Contraindications include: a combination of hemorrhoids with an anal fissure, rectal fistula, inflammatory diseases of the anal canal and perineum, acute hemorrhoids.

Ligation of hemorrhoids with latex rings is the most commonly used technique (32-82%), and sclerotherapy, due to the frequent development of complications (11-47%), is used less and less. Other minimally invasive treatment methods are used in less than 5% of cases.

Ligation of hemorrhoids with latex rings

Blaisdell first developed and used a tool for applying a circular latex ligature to the pedicle of a hemorrhoid in 1954. Subsequently, other, more advanced models of ligators were developed.

The use of this method is indicated for internal hemorrhoids II, sometimes III degree. Contraindications for performing ligation of hemorrhoids are: a combination of internal hemorrhoids with an anal fissure and rectal fistula; acute hemorrhoids; inflammatory diseases of the anal canal; treatment with anticoagulants.

Direct ligation (clamping) of hemorrhoids occurs using a latex ring with an internal diameter of 1 mm, which has good elasticity and provides uniform, constant compression of the tissue. Rejection of the hemorrhoid along with the ligature occurs 5 to 9 days after manipulation. During this period, as a rule, there is a slight discharge of scarlet blood from the anal canal, which does not require the prescription of medications, since it stops on its own. A connective tissue scar forms at the site of the rejected hemorrhoid.

There are two main methods for ligating hemorrhoids. The first is based on drawing cavernous tissue into the sleeve of a mechanical ligator using a special soft clamp, after which one or two ligatures are dropped from the instrument onto the stem of the hemorrhoid. The ring should only compress the pedicle of the node, without capturing tissue located below the anorectal line.

The essence of the second method is to use a vacuum ligator, which is connected to a suction device. The working part of the instrument should be pressed tightly against the hemorrhoid. After turning on the suction, negative pressure is created in the device cylinder, and the assembly is gradually drawn into the ligator coupling. When the pressure reaches 0.7 - 0.8 atmospheres, two latex rings are dropped from the instrument onto the stem of the hemorrhoid.

During the first session, ligation of one or two hemorrhoids is performed. The next stage of treatment is prescribed no earlier than 15 days later.

If the technique is followed correctly, the patient should not experience severe pain. After the manipulation, slight pain, a feeling of pressure, a feeling of a foreign body in the rectum, and tenesmus may appear, which may persist for 1 to 2 days. These sensations can be relieved by taking non-narcotic analgesics.

Complications of ligation of hemorrhoids are: pain (noted if the manipulation is performed incorrectly), thrombosis of external hemorrhoids (occurs in 2-3% of patients), bleeding (observed in 1% of patients). The effectiveness of the technique is more than 80%.

Sclerotherapy

For the first time, sclerotherapy as a method of treating hemorrhoids was used by I.I. Karpinsky (Russia) in 1870, using iron persulfate and phenol for these purposes. However, frequently developing complications after such sclerotherapy have led to the limitation of the use of this method. With the advent of new sclerosing drugs, anoscopes, and special needles, interest in this technique has increased again.

In the Russian Federation, preparations from the detergent group are approved for use. These include: polidocanol-ethoxysclerol, thrombovar, fibrowein, sodium morruate, sodium tetradecyl sulfate. Detergents are the most effective and safe phlebosclerosing chemicals. The mechanism of action of this group of drugs is based on the ability to cause coagulation of endothelial proteins and desquamation of the epithelium. Detergents have a local effect on vascular tissue and do not lead to systemic thrombus formation.

The indication for sclerotherapy is internal hemorrhoids of stages I-II; continued bleeding from hemorrhoids.

Contraindications to this method include: external hemorrhoids, paraproctitis, thrombosis of hemorrhoids, ulceration of the mucous membrane, anal fissure.

The essence of the sclerotherapy technique is to introduce the drug into the thickness of the hemorrhoidal node, using a specially curved needle with a limiter. Depending on the size of the hemorrhoid, from 0.5 to 2.0 ml of detergent is administered.

On the first day after the procedure, a tissue reaction to chemical coagulation occurs and pain may develop. A pronounced pain reaction may be associated with the introduction of the drug not into the thickness of the hemorrhoid, but into the muscular layer of the intestine, as well as with the introduction of a concentrated sclerosing drug in a larger volume. In this case, thrombosis and necrosis of the mucous membrane of the hemorrhoidal node may occur.

In order to prevent the development of pain and inflammation, it is advisable to perform sclerosis of no more than two hemorrhoids in one session. The second stage of treatment is prescribed no earlier than after 2 weeks. During a follow-up examination on days 12-14 after the procedure, a flat, round, painless, sclerotic area of ​​cavernous tissue with unchanged mucosa is determined in the anal canal.

Sclerotherapy for hemorrhoids is most effective for stage I hemorrhoids. As the stage of the disease increases, the number of good results decreases and the number of relapses increases. Sclerosing therapy does not allow achieving a radical cure of patients from the manifestations of hemorrhoidal disease, and good long-term treatment results are observed in only 20% of patients.

Infrared photocoagulation

With the beginning of the use of ultraviolet and infrared radiation in medicine, A. Neiger in 1978 proposed a technique for infrared photocoagulation of hemorrhoids. The method is distinguished by its simplicity and short exposure time. It is used in the initial stages of internal hemorrhoids, as well as to stop hemorrhoidal bleeding. Contraindications are external hemorrhoids, thrombosis of internal hemorrhoids, combination with paraproctitis and anal fissure.

The principle of operation of the photocoagulator is that the infrared light flux is focused and directed through the light guide into the cavernous tissue. The tip of the light guide transmits infrared light, which, penetrating the hemorrhoidal node, is converted into thermal energy. As a result, coagulation of submucosal structures occurs with the development of necrobiotic processes in the vascular endothelium, which leads to a decrease in blood supply to the cavernous tissue. The depth of necrosis depends on the duration of exposure.

The technique is carried out as follows. A photocoagulator tube is inserted into the anal canal through an anoscope. The tip presses the mucous-submucosal layer against the muscle layer and photocoagulation is performed. This effect is carried out at 3-4 points, at the stem of the hemorrhoid, leaving gaps between the coagulation zones. In this case, a defect with a diameter of 4-5 mm is formed on the mucosa with a zone of local coagulation necrosis, the depth of which extends to no more than 5 mm. A week after photocoagulation, a scab forms at the site of exposure, which is gradually replaced by connective tissue to form a scar.

It is advisable to carry out coagulation of no more than two hemorrhoids in one stage. The procedure is repeated after 2 weeks. Repeated courses of photocoagulation are possible.

Observation of patients and analysis of treatment results showed that this method is most appropriate to use in stage I of chronic hemorrhoids, as well as to stop hemorrhoidal bleeding.

Cryosurgical treatment

One of the minimally invasive methods of treating hemorrhoids is cold destruction. Cryotherapy is based on the rapid freezing of hemorrhoids with liquid nitrogen. The disadvantages of this method are: pronounced, uncontrolled swelling of the perianal tissues, a feeling of discomfort in the anal canal, pain, a weeping wound, as well as long recovery times. These manifestations are observed in more than 50% of patients. The limited use of this method is also due to the difficulty of controlling the boundary of the spread of cryotherapy, the danger of deep tissue necrosis, and the possibility of bleeding. In this regard, cryotherapy, as a method of treating hemorrhoids, has practically not been used in recent years.

Suture ligation of hemorrhoidal arteries under ultrasound Doppler control

A relatively new minimally invasive technique, which has not yet become widespread in our service market, is suture ligation of hemorrhoidal arteries under the control of Doppler ultrasound. This method is attractive due to its ease of implementation and targeted impact on the etiological factor in the development of hemorrhoids.

The method is based on the identification of hemorrhoidal arteries using Doppler ultrasound, followed by suturing and ligating them with a regular thread. This method was developed and proposed by the Japanese surgeon Morigana R. (1996)

For diagnostic Doppler testing, an ultrasonic surgical device with a sound transducer and an anoscope with an ultrasound sensor built into it are used. After installing this sensor over the hemorrhoidal artery, a light and sound signal is heard on the device. Through the incisura in the anoscope, above the internal hemorrhoidal node, the distal branch of the hemorrhoidal artery is sutured and ligated with a figure-of-eight suture. The criterion for correct ligation of the artery is the disappearance of sound and light signals. In the same way, hemorrhoidal arteries are ligated around the entire circumference of the rectum. This leads to interruption of excess blood supply to internal hemorrhoids and their fixation in the anal canal. This technique is most effective for stages I-III of hemorrhoids.

Contraindications are external hemorrhoids, thrombosis of hemorrhoids, inflammatory diseases of the anal canal, combination with paraproctitis and anal fissure.

A small number of complications include short-term retention of urination, a feeling of discomfort in the anal canal for 2-3 days after the procedure. However, it should be remembered that if the ligature is excessively tightened, the hemorrhoidal artery may erupt with the development of massive arterial bleeding. To prevent delayed arterial bleeding, it is advisable to stitch no more than 2 hemorrhoidal arteries in one session. Subsequent sessions are carried out 2 weeks after the first procedure. Suture ligation of hemorrhoidal arteries under Doppler ultrasound control may be a promising minimally invasive method for the treatment of hemorrhoids. However, to assess the effectiveness of this method, like other techniques, it is necessary to study the long-term results of treatment.

Electrocoagulation of hemorrhoids

One of the modern minimally invasive techniques is electrocoagulation of hemorrhoids. This method of treating patients with hemorrhoids was first proposed by A. Gain in 1939. The literature reports on coagulation of hemorrhoids using various devices such as AKM, Bicap, Ultroid, WD-II. All these devices are based on the principle of diathermic action of electric current, by conducting it through a conductor to the mucous-submucosal structures. Through thermal and chemical effects on cavernous tissue, necrosis occurs, followed by fibrosis and the formation of scar connective tissue.

The manipulation technique is quite simple. Depending on the type of device used, application electrocoagulation of the mucous membrane near the stem of the hemorrhoidal node (Bicap device) is performed, similar to the photocoagulation method. When using the WD-II device, the mucous membrane of the hemorrhoidal pedicle is pierced with the two-point electrode included in the kit to a depth of 0.5 cm, and when the device is activated, electrocoagulation of the cavernous tissue gradually occurs. The current strength is adjusted individually. The disadvantage of this method when using this device is the long exposure time of the electrode in one hemorrhoidal node (10-15 minutes). During this period of treatment, both the patient in the corresponding position and the doctor performing the procedure become tired. Therefore, in one session, it is possible to coagulate only one hemorrhoid.

Indications for this technique are internal hemorrhoids of stages I - II, and contraindications are acute hemorrhoids, paraproctitis, anal fissure.

According to domestic and foreign researchers, treatment of hemorrhoids using electrocoagulation allows one to obtain good results only in patients with stages I - II of hemorrhoids.

In conclusion of this section, it should be said that the accumulated personal experience of using various minimally invasive techniques, observation of patients and analysis of long-term results of treatment of such patients has shown that these techniques are most effective in the initial stages of hemorrhoids. In stages IV and III of the disease, it is advisable to use a surgical treatment method. Minimally invasive techniques in late stages of hemorrhoids can be used to stop hemorrhoidal bleeding, which can be the first stage of further radical treatment of such patients, as well as in elderly, somatically burdened patients with palliative purposes. In our opinion, no more than 10-15% of patients diagnosed with chronic hemorrhoids can be radically cured using minimally invasive methods. However, the combination of various methods makes it possible to expand the indications for their use. Of course, the positive side of minimally invasive techniques is their ease of use, a small number of complications, low trauma, good tolerability of the procedure, and the possibility of using them on an outpatient basis, which is economically beneficial in modern conditions of insurance medicine.

Surgery

Currently in Russia, the most common method of treating hemorrhoids is hemorrhoidectomy. Most coloproctologists and surgeons in our country use a technique aimed at excision of the main collectors of cavernous tissue, proposed by Milligan E. and Morgan G. in 1937. This operation is used in two modifications. Some doctors use closed hemorrhoidectomy, when after excision of the hemorrhoid, suturing and ligation of the vascular pedicle, the mucous membrane is sutured tightly. Other coloproctologists use an open technique, without restoring the integrity of the rectal mucosa, leaving a solid mucocutaneous strip of tissue between the excised hemorrhoids. Each modification has its own advantages and disadvantages. In connection with the development of new technologies and the development of modern devices, they began to be used when performing hemorrhoidectomy, in order to reduce the number of postoperative complications and reduce the recovery time for patients after surgery. The most commonly used are the ultrasonic harmonic scalpel, the LigaSure electrothermal system, and the radio wave scalpel. In recent years, the method of circular resection of a section of the muco-submucosal layer of the distal rectum using a circular stapler (Longo method) has become widespread.

Ultrasonic harmonic scalpel

This method in our country began to be used in the practice of surgical treatment of hemorrhoids relatively recently, but immediately attracted attention. The operating principle of a harmonic scalpel differs from other electrosurgical devices in that it is based on a high frequency of vibration of the working blade in the longitudinal direction. This allows for simultaneous coagulation and dissection of tissue through mechanical cutting, cavitation and temperature effects. The installation allows you to reliably coagulate vessels up to 5 mm in diameter. It is important to note that in this case, a strictly targeted effect on tissue occurs, and the depth of thermal damage to adjacent structures does not exceed 1.5 mm, which distinguishes this device from electrocoagulators.

When performing hemorrhoidectomy using an ultrasonic scalpel, the first stage is dissection of the perianal skin using an electrocoagulator and separation of the external hemorrhoid from the fibers of the subcutaneous portion of the external sphincter. Then, using the coagulation and cutting mode, the external and internal hemorrhoids are excised en bloc. The vascular pedicle is treated only in coagulation mode. The remaining hemorrhoids are removed in a similar way. The wounds are not sutured, but left open.

Reliable coagulation and virtually bloodless excision of hemorrhoids allows reducing the time of surgical intervention. Shallow thermal damage to tissue leads to a decrease in pain response in the postoperative period. All this has a positive effect on the incidence of dysuric disorders and reduces the postoperative rehabilitation period for patients.

Hardware-controlled bipolar electrocoagulation

Designed for bipolar electrocoagulation and vascular division, the LigaSure electrothermal system delivers controlled energy to the jaws of the clamp. As a result, denaturation of collagen and elastin occurs in the tissues with the formation of a zone of coagulative necrosis. In addition, the clamp mechanically compresses the tissues, to which electric current is dosed. The strength of the treatment zone, consisting of partially denatured protein, is comparable to the strength of stitched fabric. In this regard, there is no need to isolate and additionally ligate the vascular pedicle of the hemorrhoid. The whole process takes about 5 seconds. The device allows you to coagulate vessels up to 7 mm in diameter. The depth of thermal effect on tissue, according to the characteristics, is 2 mm.

The LigaSure electrothermal system allows hemorrhoidectomy to be performed almost bloodlessly, without using suture material. At the same time, the operation time is significantly reduced. However, in some patients, in the immediate postoperative period, a fairly intense pain reaction develops, which may be associated with a deep thermal effect on the tissue of the anal canal. In this regard, this device, in our opinion, is most appropriate to use for hemorrhoidectomy of large hemorrhoids.

Radio wave scalpel

Some researchers suggest using a radio wave scalpel for hemorrhoidectomy, which has proven itself in cosmetic surgery.

The device emits a radio wave, which causes the formation of heat in the tissues, under the influence of which the breakdown of cellular structures occurs and tissue separation occurs. In this regard, the device has good dissection properties. Thermal damage to tissue is minimal, which creates optimal conditions for wound healing. However, the hemostatic properties of a radio wave scalpel are low, especially in the presence of biological fluids, which does not allow the use of this device alone (without an electrocoagulator) to perform hemorrhoidectomy.

Operation Longo

This operation differs from other methods of surgical treatment of patients with hemorrhoids in that the hemorrhoids are not removed. Due to circular excision of a section of the mucous membrane of the distal rectum, using a circular stapler, the hemorrhoids are proximally tightened and fixed in the anal canal. In this case, the terminal branches of the hemorrhoidal arteries are crossed, which leads to a significant decrease in the blood supply to the cavernous plexuses. All this determines the relief of clinical manifestations of hemorrhoids after this operation. The method was proposed in 1998. Italian surgeon A. Longo.

Indications for this type of surgical intervention are grade III-IV hemorrhoids. with loss of nodes, but without a pronounced external component, as well as relapse of the disease. Contraindications: inflammatory diseases of the anal canal and perineum, rectal fistula, prolapse of only one hemorrhoid.

The advantage of hardware hemorrhoidopexy is low trauma and short duration of the operation, mild postoperative pain syndrome, and short rehabilitation time for patients. However, it should be mentioned that in some patients, intense hemorrhage was noted in the postoperative period, requiring reoperation.

Despite the widespread use of this technique abroad, in Russia this operation is performed relatively rarely. Limiting factors are the high cost of the device and the lack of data on long-term treatment results. Of course, it is necessary to have information about what happens to the remaining hemorrhoids in long-term follow-up. It remains unclear whether revascularization of the remaining cavernous tissue occurs after a few years, whether the fixation of hemorrhoids in the anal canal is reliable, or whether the clinical manifestations of the disease will return in the long-term follow-up period.

So, the modern possibilities of surgical treatment of patients with chronic hemorrhoids are significant. The arsenal of methods for treating this common disease is large. It is impossible to adapt any one treatment method available in the clinic to all stages of hemorrhoids. It is necessary to skillfully determine the indications for treatment and, depending on the stage of the disease, choose the most appropriate method. It should be remembered that minimally invasive treatment methods, which patients readily agree to, especially those used on an outpatient basis, are most effective in the initial stages of hemorrhoids. When the stage of the disease increases, as well as when hemorrhoids are combined with other diseases of the anal canal and pararectal tissue, surgical treatment is indicated.

Troxevasin

Troxevasin ointment relieves the symptoms of hemorrhoids. In addition, it is a local anesthetic, astringent and anti-inflammatory agent. The drug combines troxerutin and magnesium stearate and is used externally:

• to relieve burning, itching around the anus;
• with inflammation of hemorrhoids;
• anal thrombophlebitis;
• inflammation of the rectum.

A local drug as an anti-inflammatory, decongestant. Troxerutin has a protective effect on veins, reduces the permeability of capillary walls, reduces swelling and exudation.

The gel should not be used if you have an individual intolerance to active substances or fillers, or an allergy to troxerutin. Like all medicines, Troxevasin ointment can cause side effects, such as hypersensitivity reactions and local skin irritation. Skin reactions may occur - rash, redness. However, the expected benefits are greater than the harm associated with the occurrence of undesirable effects.

Information on how to use the drug is in the instructions. The ointment is applied with uniform and gentle massage movements in a thin layer (approximately 2.5 g or half a teaspoon) twice a day (morning and evening) until completely absorbed. It is advisable to reapply to the affected area of ​​skin after defecation.

Brief classification

Hemorrhoids are a painful enlargement of the cavernous cavities of the venous plexus of the rectum.
These cavities fill with blood when straining, performing the function of a kind of “pillow” that protects tissues from the traumatic effects of solid feces during the act of defecation. Hemorrhoids are a pressing problem for humanity; about 60% of Earth's citizens experience at least one episode of painful enlargement of hemorrhoids throughout their lives. It must be said that this percentage is much higher in countries that are commonly called civilized.

Anatomically, internal hemorrhoids - hemorrhoidal nodes in the distal (terminal) part of the rectum, and external hemorrhoids , when the nodes are located outside in the anal area.

According to the nature of the course, hemorrhoids can be acute , associated with thrombosis of the hemorrhoidal veins, and chronic , caused by constant overflow of distended veins with blood.

Relief and Relief Advance

Relief ointment. Contains: shark liver oil, which has anti-inflammatory, immunomodulatory and wound-healing properties; Phenylephrine hydrochloride is a vasoconstrictor.

When applied topically, it reduces the lumen of blood vessels, reduces swelling, serous discharge and exudative phenomena in hemorrhoids and diseases of the anorectal area. Application: Using the supplied applicator, apply a small amount of ointment inside the anus or on the affected areas around it. Dosage: up to 4 times a day (morning, evening and after each bowel movement).

Contraindications: granulocytopenia, increased blood clotting, individual hypersensitivity to the components of the drug.

Relief Advance ointment will help relieve pain and discomfort due to the presence of an anesthetic in the composition. Use after hygiene procedures. Squeeze out a small amount to lubricate the applicator. Apply the ointment carefully through the applicator to the affected areas outside or inside the anus up to 4 times a day in the morning, evening and after each bowel movement.

Contraindications: allergic reactions to local anesthetics, hypersensitivity to the components of the drug.

Treatment methods for hemorrhoids and anal fissures

To eliminate the causes that caused the formation of hemorrhoids and anal fissures, an integrated approach is required. Of primary importance in this case is the normalization of nutrition and the prevention of constipation, which consists of enriching the diet with fiber, increasing the volume of fluid entering the body and improving intestinal motility. It is also recommended to start drug treatment starting from the first stage of the disease.

By taking drugs with local and systemic effects, it is possible to eliminate the causes of hemorrhoids and anal fissures, mitigate the consequences of their negative impact on the vessels and tissues of the rectum, and eliminate the symptoms of the disease.

Preparations for oral administration

Tablets for hemorrhoids and anal fissures are divided into several groups, each of which has a specific area of ​​influence:

• drugs that strengthen vascular walls and make them less permeable - Detralex, Ginkor forte, Phlebodia 600, Venarus, Troxevasin;
• medications that stimulate mucosal regeneration - Litovit B;
• painkillers and anti-inflammatory drugs - Diclofenac, Ketoprofen, Indomethacin;
• drugs that stop bleeding (hemostatics) - Vikasol, Dicynon, Etamzilat;
• laxatives - Lactulose, Duphalac, Macrogol 4000 and others.

The main feature of drugs for oral administration is the complex restoration of processes occurring in the body and the possibility of adverse reactions. They are good for eliminating the underlying causes of the disease and relieve symptoms not very actively. Their use requires a doctor's approval.

Rectal suppositories

Rectal suppositories are topical preparations. Their use for hemorrhoids and anal fissures helps relieve symptoms of the disease, improve the condition of the hemorrhoidal plexuses, as well as reduce inflammation and accelerate tissue regeneration.

The following suppositories are considered the most popular and effective:

• Proctosan;
• Posterisan;
• Poctosedyl;
• Natalsid.

The main advantage of rectal suppositories is the absence of a systemic effect on the body. In most cases, they do not affect the condition of internal organs in any way. Another advantage of suppositories is ease of use. To improve the condition, they are used before bed once a day, rarely - twice a day.

Ointments for hemorrhoids and fissures

Using ointment for hemorrhoids and fissures is much more convenient than, for example, suppositories. In terms of the strength of their effect on the vessels and mucous membrane of the rectum and anus, they are not inferior to oral drugs, but differ from them in the absence of a systemic effect on the body.

Pharmaceutical companies produce several dozen ointments for hemorrhoids and fissures, among which the following drugs are considered the most effective:

Any ointment for hemorrhoids and fissures is prescribed by a doctor, since the drugs listed in the table have contraindications and indications that must be taken into account when prescribing them to an individual patient.

Hepatrombin

Includes sodium heparin, which has an antithrombotic effect and the ability to relieve swelling and pain. The regenerative properties of the drug are ensured thanks to allontoin, a component that stimulates tissue healing and increases cellular metabolism. Prednisolone acetate allows you to treat inflammation, has an antiallergic effect, and reduces the release of fluid during inflammation (exudate).

Apply Hepatrombin to previously cleansed skin in a thin layer with light massaging movements. The course of therapy is from 7 to 10 days. It is prohibited to use the drug in patients who are allergic to the components of the product, in case of bleeding or during infection of wounds. The ointment is contraindicated for children under 5 years of age.

Diagnostics

Even with a single bleeding from the anus, the patient urgently needs to consult a proctologist! In addition to the initial digital examination of the rectum, the diagnostic appointment ideally includes colonoscopy - an endoscopic examination of the large intestine.

The main goal of medical procedures is to exclude cancer.

Remember that timely diagnosis is much more effective than any expensive treatment in the later, advanced stages of the disease. Don't forget to monitor your health and don't lose sight of even the smallest problems!

Heparin ointment

Heparin ointment has been on the pharmacological market for quite some time and is used not only for the treatment of varicose veins of the rectum. The effect of the medicine is much broader: varicose veins of the lower extremities with and without complications, thrombophlebitis, lymphangitis, trophic ulcers, etc. At the same time, heparin ointment has all the advantages of a medicinal product designed to reduce the severity of hemorrhoid symptoms:

1. The analgesic effect of the drug is provided by the local anesthetic present in the ointment - benzocaine.
2. Due to the main active ingredient - the direct anticoagulant heparin, an antithrombotic and anticoagulant effect is achieved (heparin prevents the formation of blood clots and promotes the resorption of existing ones);
3. Due to the vasodilating properties of benzonicotinic acid, which is part of the heparin ointment, heparin is absorbed more quickly to its destination;
4. The anti-inflammatory effect is also based on the action of heparin supplied to the site of inflammation.

Heparin ointment is used for external and internal uncomplicated and complicated hemorrhoids. It is also indicated in case of thrombosis of the hemorrhoidal plexus. However, damage to the integrity of the skin and bleeding are the main contraindications to the use of this medication. Heparin ointment is prescribed with extreme caution if the patient has a history of pathology of the hemostatic system, accompanied by a decrease in blood clotting and a tendency to bleeding, as well as during pregnancy and lactation (although data on the penetration of heparin into human milk have not yet been obtained).

What ointment is allowed during pregnancy and after childbirth?

Pregnancy is an absolute contraindication for the use of most remedies for hemorrhoids. You can read more about this in the annotation to the drug. However, there are medications for topical use that are approved during pregnancy and after childbirth; they are listed in the table. These drugs should be selected together with a proctologist. A brief description of medicines and features of use are provided.

Aurobin

Ointment for hemorrhoids "Aurobin" is a combination preparation based on corticosteroids - hormones of the adrenal cortex, which are distinguished by their immunosuppressive effect. Thanks to this, the drug has its antiallergic and anti-inflammatory effect.

It also contains lidocaine, which has a local analgesic (pain-relieving) effect and relieves itching and burning sensation in the perineal area. Triclosan, which is part of Aurobin, is a broad-spectrum antiseptic and protects the affected perianal area from fungi and bacteria, and dexpanthenol promotes the regeneration of the affected epithelium and mucous membrane of the rectum. The components of the drug effectively complement each other, which helps to successfully combat the unpleasant symptoms of hemorrhoids.

It is worth noting that the drug has a number of contraindications, including:

• age up to 1 year;
• taking lidocaine for other purposes (excessive concentration in the body is fraught with bradycardia);
• skin infections (in this case, corticosteroids are not used);
• hypersensitivity to individual components of the drug.

It is important! Due to the corticosteroids contained in Aurobin, long-term use of the drug by children of any age is prohibited due to the possibility of adrenal insufficiency.

What are hemorrhoids and anal fissure

Hemorrhoids are varicose veins of the hemorrhoidal plexuses located under the mucous membrane of the rectum. The localization of nodes can be internal or external, depending on which vessels have undergone changes. Anal fissure is a common companion to hemorrhoids. Occurs on the mucous membrane of the rectum, mainly on the back of the anal sphincter.

Symptoms of the disease include acute pain during defecation, bleeding, itching and burning in the rectum (at the initial stage - after defecation, at stages 3-4 - at any time, including at rest).

An anal fissure is characterized by pain in the anus after defecation, which can persist for a long time - from a few minutes to 12 hours or longer. In addition, anal fissure is characterized by scanty bleeding during bowel movements and small traces of blood on toilet paper. Severe bleeding is extremely rare.

Externally, internal hemorrhoids look like protrusions of a red or bright pink color, external hemorrhoids look like round, elastic-soft formations near the anus, which become bluish in color when thrombosis occurs. An anal fissure is a rupture of the mucous membrane of the anal canal, in most cases it is located along the posterior surface, the rupture of the mucous membrane has the shape of a triangle with the base outward.

Levomekol

Levomekol is a combined drug for external use. Among its properties are anti-inflammatory, bactericidal and restorative. Often, exacerbations of hemorrhoids are accompanied by some kind of infection (since the intestines contain various microbes that can penetrate inflamed hemorrhoids, as well as injured tissues, during the process of defecation).

As a result, an infectious process develops, a complication of which can be purulent inflammation. The components contained in the ointment clean the damaged surface, and also accelerate the process of its healing and restoration of the mucous membrane.

Desarterization

Termination of access of arterial blood supply to the hemorrhoidal node is the main goal of disarterization. Treatment of hemorrhoids is carried out by “flashing” the arteries that supply the node.

From two to six arteries are sutured by a proctologist using special, state-of-the-art equipment. The coloproctologist learns about the detection of a hemorrhoidal node by the signal that comes from the Doppler, a special sensor placed in the anal canal.

The doctor does the firmware through the anoscope, or more precisely, through its side window. The manipulation lasts up to half an hour, and the patient then needs up to two hours to recover. The procedure is done without general anesthesia.

In the day hospital, the patient is observed for one to two hours after treatment. One procedure is enough to obtain effective treatment for hemorrhoids using the disarterization method.

Proctosan

The ointment is based on bismuth subgallate and titanium dioxide. Proctosan promotes the healing of cracks, has a local astringent effect and dries out weeping in the anal area. The analgesic function is assigned to lidocaine, and bufexamak relieves inflammation. The ointment is indicated for use for hemorrhoids of any location; for ease of administration, an applicator is provided. The cost of the ointment is 250–300 rubles.

Vishnevsky ointment

Vishnevsky ointment can be used to treat the external form of the disease. The presented medicine helps eliminate various ailments of the human body, but Vishnevsky must be used correctly, strictly following the instructions. Only then will the ointment have the necessary effect.

1. First, you should put lotions on the external nodes with the addition of a solution of potassium permanganate. Such actions must be performed within three days.
2. Then you are allowed to start using Vishnevsky’s composition. The ointment should be added to a compress and applied to the sore spot. Do not remove the compress from Vishnevsky for 12 hours.

Vishnevsky's drug is absolutely safe, so it can be used to treat the disease by pregnant women and nursing mothers. The only negative is its smell, but this is a temporary phenomenon.

Ointment for hemorrhoids during pregnancy

During pregnancy, as well as during lactation, women are prohibited from taking most medications. This is primarily due to the fact that the biologically active compounds included in the chemical composition of the drugs, not only of synthetic but also of natural origin, can harm the health of the child.

It is for this reason that during pregnancy, as well as during breastfeeding, a woman should not self-medicate without the knowledge of her doctor. This rule applies to all medicines without exception. However, the vast majority of pregnant and postpartum women face such an unpleasant problem as hemorrhoids.

Safe ointments are drugs that include natural ingredients that are not capable of causing harm to the body, especially during pregnancy and in young children.

Popular means:

1. Ichthyol ointment is a sulfur-based medicine that has an analgesic, anti-inflammatory, drying, and wound-healing effect on hemorrhoids;
2. Troxerutin - has a similar effect to Troxevain, eliminates swelling, prevents congestion, and restores blood flow.
3. Fleming's ointment is a homeopathic preparation that includes extracts of calendula, witch hazel, and horse chestnut. Natural components in the composition of the medication allow you to quickly and safely eliminate the inflammatory process and pain.

Vishnevsky ointment, Heparin ointment, Levomekol, Troxevasin are allowed during pregnancy.

Pros and cons of ointments

The main advantages of ointments are:

1. Thanks to the medicinal components included in the ointment, pain, itching, burning in the anal area are quickly relieved, bleeding stops, and the regeneration of anal fissures is also accelerated.
2. Most ointments for hemorrhoids are made with petroleum jelly and lanolin. There can be several active substances, which expands their spectrum of action.
3. When treating hemorrhoids, ointments differ from other medications in their simplicity and ease of use.
4. In addition, ointments have a local effect, and not a systemic effect, as in the case of treatment with tablets, which means that there will be significantly fewer side effects from use. For this reason, ointments are most often chosen when treating hemorrhoids in women during pregnancy or breastfeeding.

The disadvantages include:

1. The most common drawback of all ointments is their high fat content, due to which the ointment takes a long time to be absorbed into the anal tissue and leaves greasy stains on clothes.
2. Please note that treatment with ointments alone will only eliminate the symptoms and not the cause of hemorrhoids. Therefore, treatment must be comprehensive!