20. Hemorrhoids (Piles)

Question 1

What?

Answer 1

Internally or externally, Enlarged, congested veins under your rectum

Question 2

Symptoms?

Answer 2

Swollen, painful and inflamed (‘flare up’) and bleed

Question 3

Why?

Answer 3

Prolonged straining to pass a bowel motion, as can happen when you are constipated
Being very overweight
Sitting on the toilet for a long time
Pregnancy and childbirth.

Question 4

Treatment?

Answer 4

Non Pharmacological Options: Fibre intake, Fluid intake (check hydration status), Stool softener,Avoid straining,Regular Exercise, Avoid long period on toilet.
Pharmacological Options: Proctosedyl (Hydrocortisone+Cinchiocaine) locally treatment TDS for 7 days + Stool softener (if constipated) BD bedtime daily

Question 5

How to use Proctosedyl?

Answer 5

Suppositories and ointment are ideally used after a bowel motion.
Ointment may be applied with a finger. For deeper application attach the cannula, insert in the rectum,
and squeeze tube from the lower end whilst withdrawing.

Question 6

Self Care?

Answer 6

Tell your patient hemarroids are common during pregnency
A warm salt bath may help painful haemorrhoids
Use fragrance-free wet wipes instead of toilet paper to clean the anal area
Avoid soap as this may further aggravate the problem
Wear cotton underwear to minimise discomfort
Treat any constipation or diarrhoea
Keep stools soft to avoid straining, Eat a high-fibre diet and drink plenty of fluids, Exercise regularly
Always go toilet as soon as you feel the need to go. ‘Holding-on’ can make haemorrhoids worse.

Question 7

Red Flags Refferel?

Answer 7

<12 years old
>50 years of old
IBD
Family history of polyps or colorectal cancer
Pregnent with serious discomfort
Black or turry stool
Symptoms causing serious discomfort for pregnent patient
Symptoms being present more than 7 days despite treatment
Frequent, recurrent episodes of bleeding