haemorrhoids

Question 1

what are they

Answer 1

Abnormal swellings of the vascular mucosal anal cushions around the anus

Question 2

internal haemorrhoids are usually painless unless…

Answer 2

strangulated

Question 3

which piles tend to be painful

Answer 3

external

Question 4

external piles tend to be

Answer 4

itchy and painful

Question 5

true or false - females are predisposed to developing these during pregnancy

Answer 5

true

Question 6

non drug treatment

Answer 6

ensure stools are soft and easy to pass to minimise straining - dietary fibre, fluid intake
advice about perianal hygiene to aid healing and reduce irritation and itching

Question 7

drug treatment

Answer 7

• treat constipation (1st line bulk forming laxative)
• simple analgesic for pain relief
• topical preparations or haemorrhoids

Question 8

Should you avoid NSAIDs if haemorrhoids present?

Answer 8

avoid if rectal bleeding

Question 9

which analgesic should be avoided if pt has piles and why

Answer 9

opioids can cause constipation

Question 10

max duration of use for any topical preparations that contain LA (e.g. lidocaine, benzocaine, cinchocaine, pramocaine)

Answer 10

only for a few days
may cause sensitisation of anal skin
LA can be absorbed through rectal mucosa (thus theoretical risk of systemic SE) and also rarely causes increased irritation - avoid excessive application

Question 11

why is use of CC containing preparations restricted to 7 days only

Answer 11

continuous or excessive use = risk of adrenal suppression and systemic effects
also long term use can cause ulceration or permanent damage due to thinning of perianal skin

Question 12

can you use bulk forming laxatives in pregnancy

Answer 12

yes

Question 13

Are there any topical haemorrhoidal prerarations licensed for use in pregnancy

Answer 13

No
If treatment is required, consider a soothing prep containing simple, soothing products - not LA or CC