Haemorrhoids Flashcards
What are haemorrhoids?
swollen veins, rather like varicose veins, which protrude into the anal canal (internal piles)
They may swell so much they hand down outside the anus (external piles)
Treatment timescale of haemorrhoids
With treatment, should resolve within 1 week
Symptoms of haemorrhoids
itching burning pain (not always present) swelling discomfort in the perianal area and anal canal rectal bleeding blood in stools irritation persistent change in bowel habit abdominal pain vomiting weight loss
Describe the 3 degree stages of haemorrhoids
Stage 1 - where it is confined
Stage 2 - where it prolapses on defecation
Stage 3 - where it remains persistently prolapsed
In what population of patients is there a high incidence of haemorrhoids?
Pregnant women
Referral criteria for haemorrhoids
- duration longer than 3 weeks
- presence of blood in the stools, especially if mixed in with stools as indicates bleeding higher up in GIT
- persisting alteration from normal bowel habit (could be bowel cancer)
- associated abdominal pain/vomiting
- also if patient feels they need to defecate but cannot (tenesmus)
- distention or suspected drug-induced constipation (warfarin and anticoagulants)
Lifestyle advice regarding haemorrhoids
- itching can be improved with good anal hygiene as small amounts of faecal matter can cause irritation
- the perianal area can be washed with warm water, ideally after each bowel movement
- mild soap, which will not dry the skin as much as normal soap, can be used
- increase intake of dietary fibre will increase bowel output, so patient needs to be careful when wiping the perianal area, using soft toilet paper, to avoid soreness
- can use moist toilet tissue where washing is not available
List 4 treatments for haemorrhoids
- anusol cream
- germaloids cream (and suppositories)
- anusol plus HC ointment (hydrocortisone) and soothing relief suppositories
- senna
what is the active ingredient(s) in anusol cream?
Zinc oxide
Bismuth oxide
Balsam Peru Ph Eur
what is the active ingredient(s) in germaloids cream?
lidocaine hydrochloride
zinc oxide
Anusol cream for haemorrhoids
directions for use
warnings
counselling
Adults and elderly: apply at night and in morning PRN
Warning: not for children
Counselling: For internal use, there is a rectal nozzle provided
germaloids cream
directions for use
warnings
12+: 2x daily at 3-4 hour intervals after bowel movement
Max 4 applications in 24 hours
not for under 12s
germaloids suppositories
directions for use
counselling
warnings
1 inserted at night and in morning or at 3-4 hour intervals
max 4 in 24 hours
don’t use for longer than 2 weeks
not for use in under 12s
Side effects of germaloids cream
counselling
May cause sensitisation
not to be used for longer than 2 weeks
Anusol plus HC ointment (hydrocortisone)
symptoms and directions
to decrease inflammation and swelling to give relief of itching and pain
Apply sparingly on a gauze dressing to affected area at night and morning after each bowel movement
for internal use - use rectal nozzle provided
Max 4 applications in 24hours
