OIA2004 MANAGEMENT OF HAEMORRHOIDS

Haemorrhoids (Piles)

Swollen vascular cushions in the anal canal, may be internal or external.

Internal haemorrhoids

Occur above the dentate line; can prolapse, bleed (haematochezia), or discharge mucus; usually less painful.

External haemorrhoids

Occur below the dentate line; can thrombose → painful swelling or large skin tags.

Symptoms of haemorrhoids

Bleeding, anal itching (pruritus), swelling, pain (especially with thrombosis), mucus discharge.

Haemorrhoid triggers

Increased intra-abdominal pressure (e.g. pregnancy), straining, prolonged sitting, low-fiber diet, certain medications.

Low-fiber diet

Leads to hard stools → straining during defecation.

Prolonged sitting

Reduces venous return → engorgement of hemorrhoidal veins.

Pregnancy/Ascites

Increases intra-abdominal pressure → impairs venous return from rectum.

Constipating medications

E.g. opioids, iron supplements, anticholinergics — increase haemorrhoid risk.

Relieve symptoms

Focus on easing pain, bleeding, itching, and swelling.

Reduce straining

Via stool softeners and high-fiber diet.

Prevent recurrence

By addressing lifestyle factors and bowel habits.

Sensitive condition

Handle discussions privately and respectfully.

Assess red flags

Severe pain, heavy bleeding, prolapse, or suspected malignancy → refer.

Recommend OTC

Match symptoms with product type: topical, oral, or stool softener.

Counsel on use

Educate on correct product use, hygiene, and when to seek medical care.

Flavonoids (Daflon®)

Micronized diosmin + hesperidin; improve venous tone, lymphatic drainage, reduce inflammation.

Daflon® dosing

Diosmin 450 mg + Hesperidin 50 mg per tablet.

Flavonoids’ benefits

Decrease capillary permeability and venous congestion.

Topical corticosteroids

Reduce inflammation and itching; e.g. hydrocortisone.

Topical local anaesthetics (LA)

Provide symptomatic relief of pain and itching; e.g. lidocaine.

Topical use caution

Limit use to 7–14 days due to risk of skin thinning and sensitization.

Common topical products

Proctosedyl®, Anusol®, Xyloproct®, Hyalufil®.

Docusate sodium

Softens stool, easing defecation and reducing straining; dose: 100–200 mg/day.

Oral fiber supplements

E.g. psyllium (Fybogel®), methylcellulose (Metamucil®); encourage stool bulk and softness.

Fiber dosing tip

Take with plenty of water to avoid worsening constipation or obstruction.

Warm sitz baths

Soothes irritation and eases muscle relaxation around the anus.

Cold compresses

Ice packs reduce swelling and numb pain.

High-fiber diet

Fruits, vegetables, whole grains → improve stool consistency.

Good toilet habits

Avoid straining, prolonged sitting, and excessive wiping.

Hydration

Essential to support fiber action and bowel movement.

Reduce alcohol/caffeine

These can contribute to dehydration and constipation.

Exercise regularly

Promotes bowel motility and weight control.

Duration of symptoms

Persistent symptoms >7 days despite OTC treatment.

Prolapsed haemorrhoids

Grade 3–4 (require manual reduction or remain prolapsed).

Thrombosed or strangulated haemorrhoids

Acute pain, bluish swelling → urgent referral.

Signs of malignancy

Unexplained rectal bleeding, weight loss, anemia, or abnormal stool appearance.

OTC treatment

Topical agents + oral flavonoids + stool softeners offer symptomatic relief.

Prevention is key

Long-term success depends on dietary and behavioral changes.

Pharmacist’s impact

Timely advice and appropriate product recommendation can prevent complications and improve quality of life.