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Hemorrhoids
OVERVIEW: Hemorrhoids, or piles, are varicose or enlarged veins of the rectum. They may be internal or external. Hemorrhoids may be acute (of short duration), chronic (long-lasting), or relapsing.
SIGNS AND SYMPTOMS: • Rectal bleeding
• Anal protrusion
• Anal pain
• Itching
• Constipation
• Straining with defecation
• Bowel incontinence
• Blood or mucus in stool
• Sensation of incomplete emptying of the bowel
• Anal fissure
• Anal infection
• Anal ulceration
CAUSES: Dilated veins of rectum
SCOPE: Common
MOST OFTEN AFFECTED: Hemorrhoids primarily affect adults, although they may occur at any age. Males and females are affected with equal frequency.
RISK FACTORS: • Pregnancy
• Colon cancer
• Liver disease
• Constipation
• Occupations that require prolonged sitting
• Loss of muscle tone in old age, rectal surgery, episiotomy, anal intercourse
• Obesity
DIAGNOSIS PHYSICAL EXAMINATION: The Physician will perform a physical examination to identify the presence of hemorrhoids.
TESTS AND PROCEDURES: The colon may be examined by anoscopy or sigmoidoscopy.
TREATMENT GENERAL MEASURES: • Hemorrhoids are managed in the outpatient setting except when surgery is required.
• Mild symptoms or prevention:
• Avoid prolonged sitting on toilet
• Avoid straining
• Avoid constipation by using stool softeners
• Use soap and water for clean-up after stool
• For pain: sitz baths with soapy water or Epson salts
• Surgery may be needed for persistent and severe disease.
• Other treatments include incision of hemorrhoid, rubber band ligation, injection therapy, cryosurgery, and laser surgery.
ACTIVITY: • No restrictions
• Physical fitness is encouraged.
• Avoid prolonged sitting and straining on the toilet.
DIET: High-fiber diet
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Prevention:
• Fiber supplements
• Stool softeners
• Pain:
• Analgesic sprays or ointments: benzocaine (Hurricaine), dibucaine (Nupercainal)
• Itching
• Hydrocortisone ointment (Anusol-HC; Cortifoam)
• Bleeding:
• Astringent suppositories (Preparation H)
• Hydrocortisone ointment (Anusol; Cortifoam)
CONTRAINDICATIONS: Read drug product information.
PRECAUTIONS: Read drug product information.
DRUG INTERACTIONS: Read drug product information.
Other Drugs: N/A
FOLLOW UP PATIENT MONITORING: The Physician should be seen as often as needed, depending on treatment.
PREVENTION/AVOIDANCE: • Avoid constipation
• Lose weight, if overweight
• Avoid prolonged sitting on the toilet.
• Avoid prolonged sitting at work. Get up and move around periodically.
COMPLICATIONS: • Prevention:
• Fiber supplements
• Stool softeners
• Pain:
• Analgesic sprays or ointments: benzocaine (Hurricaine), dibucaine (Nupercainal)
• Itching
• Hydrocortisone ointment (Anusol-HC; Cortifoam)
• Bleeding:
• Astringent suppositories (Preparation H)
• Hydrocortisone ointment (Anusol; Cortifoam)
WHAT TO EXPECT: • Spontaneous improvement
• Recurrence
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: Hemorrhoids are uncommon in infants and children. Occasionally, hemorrhoids may result from chronic constipation, fecal impaction, and straining at stool. Surgery is rarely required.
GERIATRIC: Hemorrhoids are common in the elderly along with rectal prolapse.
OTHERS: N/A
PREGNANCY: Hemorrhoids are common in pregnancy, and they usually resolve after pregnancy. No treatment is required unless they are extremely painful.
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