Haemorrhoids Flashcards Preview

A - A OTC: GI > Haemorrhoids > Flashcards

Flashcards in Haemorrhoids Deck (12)
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1
Q

Symptoms:

A

Swollen veins which protrude into the anal canal (internal piles) or extend outside the
anus (external piles) together with itching, burning, pain, swelling and soreness in
the perianal area and anal canal. May also be associated with rectal bleeding.

2
Q

Cautions and when to refer:

A

• Symptoms for longer than 3 weeks
• Unresponsive to 1 week of OTC treatment
• Blood in the stools may indicate an underlying condition e.g. gastric ulcer or
gastric carcinoma
• Abdominal pain, nausea and vomiting
• Haemorrhoid preparations are not licensed during pregnancy. Although
commonly used, a referral to the GP may be necessary, bearing in mind
treatment would usually be short-term. Also, only when the baby is structurally
formed would the mother potentially experience haemorrhoids, thus reducing
chances of birth defects if treated.

3
Q

Treatment:

A

• Local anaesthetics (e.g. benzocaine, lidocaine)
• Skin protecting agents (e.g. zinc oxide, kaolin)
• Astringents (zinc oxide, hamamelis (witch hazel), bismuth) theoretically cause
aggregation of proteins to constitute a protective layer across mucous
membranes
• Topical corticosteroids (e.g. hydrocortisone) reduces inflammation and
swelling but use should be restricted to those over 18 years of age and for
maximum 7 days

4
Q

Side-effects:

A

Local anaesthetics may cause sensitisation and so they should be used for a
maximum of 2 weeks.

5
Q

Commonly used OTC preparations:

A

Anusol, Germoloids, Preparation H

6
Q

Counselling points:

A

Pregnancy presents a heightened risk of developing haemorrhoids as there is
increased pressure on the haemorrhoidal blood vessels and meanwhile constipation
is a common problem which exacerbates the symptoms of haemorrhoids. Dietary advice similar to that for constipation is recommended, especially to prevent straining.

7
Q

Rectal bleeding

A

Slight rectal bleeding is often associated with haemorrhoids. Blood appears bright red and
might be visible in the toilet bowl or on the surface of the stool. The presence of blood is
usually a direct referral sign but if the cause is haemorrhoids this could be treated unless
the patient is unduly anxious in which case referral is appropriate
Blood mixed in the stool has to be referred to eliminate a GI bleed
Large volumes of blood or blood loss not associated with defecation must be referred to
eliminate possible carcinoma

8
Q

Pain

A
  • Pain, if experienced, with haemorrhoids tends to occur on defecation. It can occur at other times, for example when sitting. - Pain is usually described as a dull ache
  • Sharp or stabbing pain at the time of defecation can suggest an anal fissure or tear
9
Q

Ulcerative colitis and Crohn’s disease

A

Other symptoms besides blood in the stool are usually
present with ulcerative colitis and Crohn’s disease. These
symptoms tend to be as follows: stools that are watery,
abdominal pain in the lower left quadrant, weight loss
and fever. Patients will appear unwell and also find that they have urgency, nocturnal diarrhoea and early morning
rushes. In the acute phase patients will have malaise.

10
Q

TRIGGER POINTS indicative of referral:

Haemorrhoids

A
  • Persistent change in
    bowel habit in patients
    over 40 years of age
    Unexplained rectal bleeding
  • Patients who have
    to reduce their
    haemorrhoids manually (OTC treatment will not help)
- Severe pain associated
with defecation (anal fissure?)
  • Blood mixed in the stool
    Fever (Suspect GI bleeds or
    IBD)
11
Q

Diet advice

A

Those with diets low in fibre should be

encouraged to increase their fibre and fluid intake, as this
will help produce softer stools and reduce constipation.
Patients should try to eat more fruit, vegetables, bran and

wholemeal bread. If this is not possible, then fibre supple-
mentation with a bulk-forming laxative could be recom-
mended. Bulk-forming laxatives will take 2 to 3 days to

relieve constipation and may take up to 6 weeks to im-
prove symptoms of haemorrhoids.

12
Q

When to refer - age group

A

< 20 years (not common to have piles)