OTC - haemorrhoids

Question 1

Symptoms?

Answer 1

• swollen veins
• protrudes into anal canal (internal)
• or prolapses outside anus (external)
• dull pain on defecation or sitting
• slight rectal bleeding (bright red blood)
• perianal itching and burning
• swelling and soreness in perineum

Question 2

Referral criteria?

Answer 2

• blood in stools (dark and tarry stools = upper GI bleed. bright red blood on surface = anal fissures or haemorrhoids)
• • mild local bleeding can be caused by haemorrhoids and can be treated by pharmacists
• abdominal pain, n+v, fever, malaise, loss of apetite (IBD?)
• altered bowel habit (colorectal cancer?)
• tenesmus (urge to deficate when no stool is present - rectal tumour?)
• severe sharp pain on defecation (anal fissures?)
• symptoms >3weeks (eliminate any underlying pathology)
• unresponsive >1 week OTC failure
• constipating meds (constipation is a contributory factor in haemorrhoids)

Question 3

OTC products?

Answer 3

SOOTHING AGENTS e.g anusol
- zinc oxide, benzoyl benzoate, allantoin, peru balsam

MILD ASTRINGENTS e.g. preparation H
- bismuth, zinc oxide, hamamelis (witch hazel)

LOCAL ANAESTHETICS 12+ e.g. germaloids
- lidocaine

PRODUCTS WITH HYDROCORTISONE 18+

• e.g Anusol HC
• max 7 days use
• avoid in preg/breastfeeding

Question 4

Advice?

Answer 4

• increase dietary fibre
• treat constipation if present
• clean with attention to minor faecel soiling
• pregnancy increases risk of haemorrhoids