Haemorrhoids

Question 1

What are 4 symptoms of haemorrhoids?

Answer 1

1. Painless bleeding during bowel movements (small amounts of bright red blood on toilet paper is normal)
2. Itching and irritation of the anal area
3. Pain and discomfort
4. A lump near the anus

Question 2

Do haemorrhoids require a counselling room?

Answer 2

Yes

Question 3

What are 5 causes of haemorrhoids?

Answer 3

1. Straining on the toilet (during bowel movements)
2. Constipation or diarrhoea
3. Pregnancy
4. Low fibre diet
5. More common in the elderly due to a higher incidence of constipation.

Question 4

What are 8 red flags for referral with haemorrhoids?

Answer 4

1. Large amount of blood loss
2. Abdominal pain
3. Fever
4. Dark-coloured blood on toilet paper
5. Leakage of mucous
6. Sharp stabbing pain on defecation
7. > 3 weeks, not resolved with treatment
8. Need to be manually reduced

Question 5

Do haemorrhoids have a PSA self-care card?

Answer 5

Yes (Haemorrhoids)

Question 6

What is the preferred over-the-counter treatment combination for haemorrhoids?

Answer 6

Zinc Oxide 10.75% w/w, Balsam Peru 1.88% w/w, Benzyl benzoate 1.25% w/w (Anusol Ointment) with paracetamol for pain (not NSAIDs as they may increase the risk of bleeding), and an aperient if required

Question 7

What are the directions for Zinc Oxide 10.75% w/w, Balsam Peru 1.88% w/w, Benzyl benzoate 1.25% w/w (Anusol Ointment) in haemorrhoids?

Answer 7

Apply a small amount of ointment TWICE daily for no more than a week. For deeper applications, attach the cannula to the tube, gently insert into the rectum to the full extent and squeeze the tube from the lower end while withdrawing the cannula

Question 8

What are 2 non-preferred over-the-counter options for haemorrhoids and why?

Answer 8

1. Cinchocaine 5mg/g + Hydrocortisone 5mg/g (Proctosedyl Ointment): cannot be used if bleeding
2. Anusol suppository: less likely to be acceptable to patients

Question 9

Is Zinc Oxide 10.75% w/w, Balsam Peru 1.88% w/w, Benzyl benzoate 1.25% w/w (Anusol Ointment) safe in pregnancy?

Answer 9

Yes

Question 10

Is Zinc Oxide 10.75% w/w, Balsam Peru 1.88% w/w, Benzyl benzoate 1.25% w/w (Anusol Ointment) safe in breastfeeding?

Answer 10

Yes

Question 11

What is the age range for Zinc Oxide 10.75% w/w, Balsam Peru 1.88% w/w, Benzyl benzoate 1.25% w/w (Anusol Ointment)?

Answer 11

Safe in adults over 18

Question 12

What are 11 pieces of non-pharmacological advice for haemorrhoids?

Answer 12

1. Pat with damp toilet paper rather than wipe to reduce irritation
2. Warm baths
3. Avoid sitting for extended periods
4. Treat underlying cause i.e., constipation:
5. Increase water intake
6. Increase fibre intake
7. Increase daily exercise
8. Don’t suppress the urge to defecate
9. Drink less caffeine and alcohol
10. Lose weight
11. Avoid medications that cause constipation i.e., opioids if possible

Question 13

What the 2 types of haemorrhoids?

Answer 13

1. Internal haemorrhoids
2. External haemorrhoids

Question 14

What are 4 symptoms of internal haemorrhoids?

Answer 14

1. Cannot be felt
2. More likely to bleed
3. With straining can become external
4. Less painful

Question 15

What are 3 symptoms of external haemorrhoids?

Answer 15

1. Can feel haemorrhoids
2. More likely to cause pain, itchiness and discomfort
3. Apply ointment after a bowel motion as this will ensure longest time in contact with area.