Analrectal Flashcards
Definition
• Engorged blood vessels in the anal area can be itchy and/or painful
Contributing Factors
- Erect posture
- Pregnancy
- Prolonged standing or sitting
- Lack of dietary fiber
- Constipation
- Diarrhea
Contributing Factors Cont
- Heavy lifting with straining
- Toilet habits
- Hereditary
- Socioeconomic factors
- Cultural factors
- Geographic location
- Age
Internal
Above the dentate line
Nerve fibers endless feeling of pain
External
Below the dentate line
Bluish bumps
Minor Disorder S&S
- Itching
- Discomfort
- Irritation
- Burning
- Inflammation
- Swelling
Referral required
• Pain • Bleeding Crohn’s Colitis Anal fissure CA • Seepage • Change in bowel patterns • Prolapse • Thrombosis
Exclusions to Self-Treatment
- <12 y.o.
- Known GI diseases
- Family hx of colon cancer
- Potentially serious anorectal disorder
- Patients with serious signs/symptoms
- Minor anorectal sx unresponsive after 7 days of treatment
Treatment Goals
- Alleviate symptoms
- Prevents reoccurrence of symptoms
- Prevent complications that could lead to adverse consequences
General Treatment Approaches
- Nonpharmacologic measures
- Nonprescription meds
- Prescription meds/intervention
- Surgery
Non-pharm Treatments
• Well-balanced diet
o High fiber/bulk
o If unable, then bulk laxative
• Good perianal hygiene
o Clean with soap and water or hygiene wipes or pads
o Don’t scrub when bathing/showering
o Sitz bath – warm water BID-TID for 15 minutes
Non-pharm cont.
• Avoid prolonged sitting on toilet o No more than 10 minutes • Avoid lifting heavy objects • Avoid food that may irritate or aggravate sx • Exercise
Local Anesthetic location
- External Only
* Topical anesthetics
LA - function
- Itching
- Irritation
- Burning
- Discomfort
- Pain
LA- MOA
- Rapid absorption through rectal mucosa and abraded perianal skin
- Numb the area
LA- cautions
- Caution with allergic reactions
- Not for internal use
- Contact dermatitis common with benzocaine – may be used in the mouth
LA - types
- Benzocaine
- Benzyl alcohol
- Dibucaine HCl
- Dyclonine HCl
- Lidocaine
- Pramoxine HCl
- Tetracaine HCL
- Tertracaine
Vasoconstrictors - location
Internal:
• Ephedrine sulfate
• Phenlphrine
VC - function
- Itching
- Discomfort
- Irritation
VC- MOA
• Reduction of swelling and slight anesthetic effect
VC - avoid
- Diabetic
- Thyroid disease
- Hypertension
- Angina Pectoris
- Enlarged prostate
- Antidepressants
- Antihypertensives
- Cardiac Meds
VC - types
- Ephedrine sulfate
- Epinephrine HCl
- Epinephrine
- Phenylephrine HCl – min effects on cardiac rhythm, and for bags under eyes
Protectants location
• Glycerin: external only
Pro - function
- Irritation
- Itching (kaolin and AlOH gel)
- Burning
- Discomfort
Pro -MOA
- Form a physical barrier on the skin
* Protective coat, soften area (moisture)
Pro - cautions
• Must be a 50% conc. if a single protectant is used in a combination product
Pro - types
- AlOH gel
- Cocoa butter
- Glycerin
- Hard fat
- Kaolin
- Lanolin (sheep)
- Astringents
- Others, multiple active ingredients
Astringents location
- Witch hazel – external only
* Calamine and ZnO – external and internal
Ast function
- Itching
- Burning
- Irritation
Ast MOA
- Promote coagulation of the skin cells protects underlying tissue and cell vol
- Thin layer of protection
- Contracting, wrinkling, blanching, and secretion = dryness
Ast types
- Witch hazel
- Calamine
- ZnO
Keratolytocs location
External Only
Ker Function
- Itching
* Discomfort
Ker MOA
• Desquamation and debridement (sloughing)
Ker cautions
- Should not be used internally
* Resorcinol – allergic reactions, do not apply to open wounds
Ker Types
- Al chlorhydroxy allantoinate
* Resorcinol
Analgesics/Anesthetics/Antipruitis location
External Only
A/A/A function
- Pain
- Itching
- Burning
- Discomfort
A/A/A MOA
• Produce a local sensation (cool, warm, tingling) that distracts
A/A/A cautions
- Menthol – allergic reaction
* Do not use internally
A/A/A Types
- Menthol
- Juniper Tar
- Camphor
Corticosteroids location
External Only
CS - function
- Itching
* Pain
CS - MOA
- Vasoconstrictor
- Antipruitic
- Onset – 12 hours but longer effect than others
CS - cautions
- Do not use internally
* Can mask symptoms of fungal and bacterial infections
CS - types
• Hydrocortisone 1%
internal dosage forms
- Ointments
- Creams
- Suppositories
- Gels
- Foams
external dosage forms
- Creams
- Ointments
- Gels
- Pastes
- Liquids
- Foams
Diet and LS
- Consume sufficient dietary fiber and fluids, exercise, and proper perianal hygiene
- Avoid lifting heavy objects
- Avoid foods that irritate/aggravate symptoms
Product Selection
- Fewest active ingredients possible to minimize side effects
- Special Population
- Proper Use
Pregnant/breastfeeding use
External use products except protectants (internal)
<12 use
Refer
Peru Balsam
• Suppository to treat hemorrhoids
Plantain
- Pulverized seeds mixed with oil applies topically or taken orally as bulk laxative
- Reduces bleeding and pain during defecation
Witch Hazel
• FDA approved
Butcher’s Broom
• Supportive therapy for itching and burning
Sweet Clover
• Supportive therapy for itching and burning
Polar bud
• Semisolid preps approved to aid in wound healing
Manna. black/blonde psyllium seed husks
• Prevents further irritation/development of hemorrhoids because of their laxative effects
