haemarroids

Question 1

what are symptoms are haemorrids?

Answer 1

● Pain, discomfort
● Bleeding
● Itching, burning
● Swelling, soreness

Question 2

what are the red flags for haemorrhoids?

Answer 2

● Excessive bleeding, especially if accompanied by a change in bowel habit or weight loss
● Patients >40 years with rectal bleeding that has lasted >3 weeks
● Patients >60 years with symptoms that have lasted >3 weeks
● Blood mixed with stool, rather than on the surface of the stool
○ Possible sign of colon cancer, gastric ulcer or gastric carcinoma
● Patient unresponsive after 1 week of OTC treatment
● Abdominal pain, nausea and vomiting
● Pregnancy
○ Many OTC preparations are not licensed for use in pregnancy, so pregnant women will require lifestyle advice similar to that for constipation (see ‘constipation’). If this does not help, then a referral to the doctor is advised.

Question 3

what are the non-drug treatment options haemorrhoids?

Answer 3

● Keep the anal area clean and free of faeces – this can be achieved by using moist toilet wipes
● Cold compresses can be used to shrink the haemorerhoids
● Warm baths can soothe the perianal area

Question 4

what are the drug treatment options for haemorrhoids?

Answer 4

• Astringents
• Bland soothing agents
• Local anaesthetics
• Topical corticosteroids

Question 5

what are examples of antistrigents?

Answer 5

Zinc oxide, Witch Hazel (Hamamelis), Bismuth subgallate

Question 6

how do antistrigents work?

Answer 6

● It is thought that these agents cause proteins in the anal area to aggregate
● A protective layer is believed to be formed over mucous membranes after application of
these agents

Question 7

what are examples of bland soothin agents?

Answer 7

Zinc oxide, Kaolin, Allantoin, Balsam of Peru

Question 8

how do bland soothing agents work>

Answer 8

Act as emollients and protect the delicate skin

● Prevent local irritation in the anal skin caused by faecal matter and mucus ● Available as creams and ointments

Question 9

what are examples of local anaesthetics?

Answer 9

Lidocaine, Benzocaine

Question 10

how do local anaesthetics work?

Answer 10

● Provide symptomatic relief from pain and symptoms of soreness and itching
● May cause skin sensitisation in prolonged use and therefore should not be used longer
than 3-4 days

Question 11

when can zinc oxide not be used?

Answer 11

● Children under the age of 18 years
● Pregnancy
● Breastfeeding
● Rectal bleeding
● Blood in the stools