Treatment
Patients complaining of hemorrhoidal symptoms should be referred if they mention prolapse (especially prolapse that must be manually replaced or cannot be reduced) or bleeding, are under the age of 12 years, or if the problem persists for more than seven days. Due to the chronic nature of hemorrhoids, the seven-day rule regarding self-therapy means that many patients will require physician referral. This month's patient leaflet describes the different ingredients available in nonprescription products for the self-treatment of hemorrhoids.
Physician treatment of internal hemorrhoids depends on the degree of severity.[5] If the hemorrhoids do not yet prolapse, or prolapse but spontaneously reduce, experts suggest hydrocortisone, bulk laxatives, and institution of a high-fiber diet with increased liquid intake to keep stools soft.[2] Should symptoms persist or worsen (e.g., occurrence of prolapse that requires manual replacement or irreducible prolapse), the physician may choose from several office procedures, including injection sclerotherapy (injection of a sclerosing agent such as sodium morrhuate into the tissues), rubber band ligation (placement of a tiny rubber band at the base of each internal hemorrhoid), photocoagulation using infrared light, electrocoagulation, laser coagulation, or cryotherapy (using a liquid nitrogen probe inserted via an anoscope). Each treatment modality has relative advantages and disadvantages (e.g., offensive discharge with cryotherapy) when compared to the other options. In light of the wide variety of office procedures available, surgical hemorrhoidectomy is usually reserved for only the most severe hemorrhoid cases.
If the patient complains of severe pain, the pharmacist should consider the presence of a thrombosed external hemorrhoid. These usually resolve in 7-10 days, but if they persist beyond this period, office excision and the application of a pressure dressing may be the treatment of choice.
When self-treating hemorrhoids, it is wise to follow directions on the labels of the products that advise use for no more than seven days. If the problem persists for longer than one week from the time it began, you should see a physician to ensure that you do not have a more serious problem that requires physician management.
It is also important to note that if you have rectal bleeding, you must see a physician to determine the cause. Never assume that rectal bleeding is a minor problem that will disappear on its own. Rather, view it as a cause for alarm that requires an immediate physician appointment to screen you for such problems as colorectal cancer. If you experience protrusion (your rectal tissues protruding from the anal opening after a bowel movement), you should also see a physician. These prolapsed internal hemorrhoids should be checked to see if they require surgical correction.
In addition, because hemorrhoids occur with greater frequency as a person ages, symptoms in children may be due to a birth abnormality, pinworm, or be signs of sexual abuse, among many other causes. Thus, OTC hemorrhoid products should never be used on anyone under the age of 12 years.
US Pharmacist. 2001;26(5) © 2001 Jobson Publishing
Cite this: Hemorrhoids: Self-care vs. Physician Care - Medscape - May 01, 2001.
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