Ch 2.8 Haemorrhoids

Question 1

What are haemorrhoids ?

Answer 1

Swollen veins, which protrude into the anal canal (internal piles). They may swell so much they hang outside the anus (external piles)

Question 2

What symptoms can haemorrhoids cause? (6)

Answer 2

Itching
Burning
Pain
Swelling
Discomfort
in the perianal area and anal canal and rectal bleeding.

Question 3

Why causes or exacerbates haemorrhoids?

Answer 3

inadequate dietary fibre or fluid intake - constipation

Question 4

Another symptom may be Tenesmus. what does this mean?

Answer 4

the desire to defecate when there is no stool present in

the rectum - Urgent referral

Question 5

When would you refer a patient? (5)

Answer 5

1. Duration of longer than 3 weeks
2. Presence of blood in the stools
3. Change in bowel habit (persisting alteration from normal bowel habit)
4. Suspected drug-induced constipation
5. Associated abdominal pain/vomiting

Question 6

What is the treatment time scale before a patient should be referred?

Answer 6

1 week

Question 7

What are the symptomatic treatment options? Give examples and how they work.

Answer 7

1. Local anaesthetics - benzocaine, lidocaine (to reduce pain & itching)
2. Skin Protectors - zinc oxide and kaolin. emollients/gels to form protective barrier
3. Topical Steroids- hydrocortisone (ointment or suppositories). reduces inflammation & swelling. Age 18 and above only.
4. Astringents - zinc oxide, witch hazel and bismuth salts.
5. Antiseptics
6. Laxatives - to help constipation whilst increasing fibre/fluid intake

Question 8

In addition to medical treatment, what else can the patient do?

Answer 8

Hygiene - itching can be improved by good anal hygiene.
Washing with warm water. soap can cause drying.
Use moist toilet tissues

Increased dietary fibre and fluid intake

Question 9

How should patients use the OTC products?

Answer 9

Ointments/Creams - applied morning, night and after each bowel movement.

Suppositories - for internal haemorrhoids. morning, night and bowel movements. Insertion is easier if patient is lying or crouching down.