Rectum
Hemorrhoid Management
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Hemorrhoid Management
See also
Hemorrhoid
Internal Hemorrhoid
External Hemorrhoid
External
Thrombosed Hemorrhoid
Prevention
Avoid
Constipation
(mainstay of therapy)
Goal is soft bulky stool that is easily passed without straining
High bulk diet (soluble
Dietary Fiber
) 30 grams per day or fiber supplement (e.g.
Citrucel
or
Metamucil
)
Decreases overall symptoms as well as decreases
Hemorrhoid
al bleeding by 50%
Alonso-Coello (2005) Cochrane Database Syst Rev (4):CD004649 [PubMed]
Increased volume of fluids 64 ounces non-caffeinated fluid per day
Stool Softener
(e.g.
Colace
)
Avoid
Irritant Laxative
s
Avoid increased anorectal pressure
Do not strain at stool
Do not sit on toilet for prolonged periods
Do not read on toilet
Minimize anorectal local inflammation
Practice good hygiene
Baby wipes without
Alcohol
Avoid topical irritant or allergens
Use only hypoallergenic soaps
Use only white toilet tissue
Medications
Topical agents (typically found in combination agents)
Decrease bleeding and swelling
Witch hazel Tucks (astringent)
Phenylephrine
(
Decongestant
)
Skin protectants
Zinc Oxide
Antiinflammatory
Topical Corticosteroid
s
Topical Anesthetic
s
Topical
Lidocaine
or other agents
Medications
Topical Agents in Pregnancy
Topical external medications considered safe in pregnancy
Witch Hazel (Tucks)
Petrolatum (topical protectant)
Hydrocortisone
1%
Thin layer twice daily for up to 10 consecutive days is considered safe
Lidocaine
Considered safe after first trimester
Pramoxine (
Topical Anesthetic
, Proctofoam HC)
Considered safe in third trimester
Ebrahimi (2011) J Obstet Gynaecol Can 33(2): 153-8 [PubMed]
Precautions
Avoid internal use or regular use of topical agents
Avoid
Phenylephrine
containing products (e.g. preparation H)
May decrease uterine perfusion
References
(2019) Presc Lett 26(8):45
Management
Gene
ral
See individual preparations listed above
Most topical
Hemorrhoid
al agents are combinations of these preparations
No evidence for prescription topicals (anusol-HC) over
OTC Medication
s (Preparation-H)
Pain (
External Hemorrhoid
s, esp.
Thrombosed Hemorrhoid
s)
Manage
Thrombosed Hemorrhoid
if present
Topical astringent wipes (e.g. Witch Hazel Tucks)
Sooths burning pain and clean the area
Hydrocortisone
(no proven benefit if no inflammation; avoid prolonged use)
Preparation-H (contains
Phenylephrine
)
Anusol HC
ProctoFoam HC
Analgesic
s
Topical Anesthetic
s (e.g. 5%
Lidocaine
ointment)
Short-term use externally only
Best used prior to having a
Bowel Movement
As an alternative, small amount of shaving cream may be applied to the anus prior to
Bowel Movement
Cold pack applied to anal area
Warm sitz bath in tub for 20-30 minutes twice daily
No evidence of benefit, but may be soothing and is without risk
A plastic bed pan with warm water can be used by patients when not at home (e.g. at work, in bathroom stall)
Other measures
Oral Bioflavinoid supplements or Phlebotonics (e.g. Hidrosmin, hesperidin)
Some studies suggest decreased bleeding,
Pruritus
or fecal leakage
Not FDA approved
Perera (2012) Cochrane Database Syst Rev (8):CD004322 +PMID: 22895941 [PubMed]
References
Pickard in Dornbrand (1992) Ambulatory Care, p. 225-6
Goroll (2000) Primary Care, p. 430-1
Schrock in Feldman (1998) Sleisenger GI, p. 1964-7
Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97 [PubMed]
Hussain (1999) Prim Care 26(1):35-51 [PubMed]
Mott (2018) Am Fam Physician 97(3): 172-9 [PubMed]
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