Haemorrhoids

Question 1

What groups of people commonly get haemorrhoids?

Answer 1

Elderly

Pregnant women

Question 2

Symptoms?

Answer 2

Swollen veins 
Full pain on defecation or sitting
Slight rectal bleeding (bright red blood)
Perinatal itching and burning
Swelling and soreness in perineum

Question 3

What are internal haemorrhoids?

Answer 3

Swollen veins that protrude into anal canal

Question 4

What are external haemorrhoids?

Answer 4

Swollen veins that prolapse outside the anus

Question 5

Referral criteria

Answer 5

Blood in stools (Dark and tarry stools = upper GI bleed. Bright red blood on stool surface =anal fissures or haemorrhoids) note: mild local bleeding e.g specks of blood on toilet paper caused by haemorrhoids can be treated OTC!!
Abdominal pain, nausea, vomiting, fever, malaise, loss of appetite (IBD?)
Altered vowel habit(colorectal bleeding- more common in middle aged men?)
Tenesmus- urge to defecate when no stool is present-rectal tumor?)
Severe sharp pain on defecation(anal fissures?)
Symptoms > 3 weeks(eliminate any underlying pathology)
Unresponsive >1 week OTC failure
Constipating medications(constipation is a contributory factor in haemorrhoids)

Question 6

OTC PRODUCTS?

Answer 6

Suppositories - internal haemorrhoids

Creams and ointment - internal and external

Choice depends on patient

Question 7

Age for OTC product?

Answer 7

12 yrs and over

But as haemorrhoids occur more commonly in elderly it’s good practice to refer anyone <20 yrs as it is rare

Question 8

Soothing agents- OTC
Example
What they do?
Ingredients?

Answer 8

E.g., anusol
Soothe the area

Zinc oxide, benzyl benzoate, allantoin, Peru balsam

Question 9

Mild astringents-otc
Example
What the do?
Ingredients?

Answer 9

E.g., preparation H

Shrink haemorrhoids and help put a protective layer over them

Bismuth, zinc oxide, hamamelis (witch hazel)

Question 10

Local anaesthetics
Example 
How they work 
Age licensing?
Ingredient

Answer 10

E.g., germaloids

Age: 12+

Ease pain and itchy anus

Lidocaine

Question 11

Products with hydrocortisone
Example 
Age
Ingredient 
How they work?
Group of pts. To avoid in
Max. Days to use for

Answer 11

E.g., anusol plus HC
Age: 18+
Contain hydrocortisone
Avoid in pregnancy and breast feeding
Reduce inflammation and swelling 
Max. 7days use

Question 12

Advice

Answer 12

Increase dietary fibre - constipation can cause haemorrhoids

Increase fluid intake

Treat constipation if present

Clean with attention to minor faecal soiling

Pregnancy increases risk of haemorrhoids