II. 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 Hemorrhoidal 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. Polyethylene Glycol) if needed
- Avoid Irritant Laxatives
- 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
- Practice good hygiene
III. Medications: Topical agents (typically found in combination agents)
- Region cleaning and and to decrease burning
- Witch hazel Tucks (astringent)
- Decrease bleeding, swelling, itching or burning
- Phenylephrine (Decongestant, e.g. preparation H)
- May be used internally, externally
- Skin protectants
- Zinc Oxide
- Petrolatum (e.g. vaseline)
- Topical Anesthetics
- Antiinflammatory to decrease significant itching or pain
- Low potency Topical Corticosteroids (e.g. Hydrocortisone 1%)
- Consider if other agents are ineffective, and avoid use more than 7 days
- Efficacy
- Evidence is lacking for any specific topicals
- No evidence for benefit of more expensive prescription items (e.g. proctofoam, anusol HC) over OTC agents
- References
- (2024) Presc Lett 31(9): 50
IV. 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
V. Management
-
General
- See individual preparations listed above
- Most topical Hemorrhoidal agents are combinations of these preparations
- No evidence for prescription topicals (anusol-HC) over OTC Medications (Preparation-H)
- Pain (External Hemorrhoids, esp. Thrombosed Hemorrhoids)
- 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
- Preparation-H (contains Phenylephrine)
- Analgesics
- Topical Anesthetics (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
- Not evidence-based, but readily available, and unlikely to cause harm
- Fisher and Swaminathan (2023) MacGyver Moves: Anal Care, EM:RAP
- 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]
- Oral Bioflavinoid supplements or Phlebotonics (e.g. Hidrosmin, hesperidin)
VI. 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]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MEDLINEPLUS) |
Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are either inside the anus or under the skin around the anus. They often result from straining to have a bowel movement. Other factors include pregnancy, aging and chronic constipation or diarrhea. Hemorrhoids are very common in both men and women. About half of all people have hemorrhoids by age 50. The most common symptom of hemorrhoids inside the anus is bright red blood covering the stool, on toilet paper or in the toilet bowl. Symptoms usually go away within a few days. If you have rectal bleeding you should see a doctor. You need to make sure bleeding is not from a more serious condition such as colorectal or anal cancer. Treatment may include warm baths and a cream or other medicine. If you have large hemorrhoids, you may need surgery and other treatments. NIH: National Institute of Diabetes and Digestive and Kidney Diseases |
| Definition (MSHCZE) | Hemoroidy – řitní žilní městky, „zlatá žíla“. Rozšíření žilních struktur, které jsou v okolí dolní části konečníku a řitního kanálu. Na jejich vzniku se podílejí značnou měrou poruchy vyprazdňování, zejm. dlouhodobá zácpa. Vnitřní h. se projevují krvácením a v pozdější době mohou vyhřezávat do řitního kanálu. V léčbě je důležitá péče o stolici, úprava stravy, místní léčba (koupele, masti, čípky), někdy lze použít sklerotizace (njekčního podání látky, která vede k jejich uzávěru a zjizvení), v těžších případech se operují. Zevní h., které jsou viditelné pouhým okem, mohou někdy způsobit velmi bolestivý zánět. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI_CTCAE) | A disorder characterized by the presence of dilated veins in the rectum and surrounding area. |
| Definition (NCI) | Dilated veins in the anal canal.(NICHD) |
| Definition (NCI_NCI-GLOSS) | An enlarged or swollen blood vessel, usually located near the anus or the rectum. |
| Definition (MSH) | Swollen veins in the lower part of the RECTUM or ANUS. Hemorrhoids can be inside the anus (internal), under the skin around the anus (external), or protruding from inside to outside of the anus. People with hemorrhoids may or may not exhibit symptoms which include bleeding, itching, and pain. |
| Concepts | Acquired Abnormality (T020) |
| MSH | D006484 |
| ICD9 | 455 |
| ICD10 | I84 , K64 |
| SnomedCT | 155477004, 195472000, 155469003, 70153002 |
| HL7 | HEM |
| LNC | LP30519-0, MTHU015043 |
| English | HAEMORRHOIDS, HEMORRHOIDS, Haemorrhoids NOS, Hemorrhoids, hemorrhoids (diagnosis), hemorrhoids, Hemorrhoids [Disease/Finding], hemorrhoid (pile), haemorrhoid, pile, Hemorrhoids NOS (disorder), Haemorrhoid (disorder), Haemorrhoids NOS (disorder), hemorrhoid, Piles, Hemorrhoid, Haemorrhoid, Haemorrhoids, Piles - haemorrhoids, Piles - hemorrhoids, Hemorrhoids (disorder), Haemorrhoids, NOS, Hemorrhoids, NOS, Piles, NOS, Hemorrhoids NOS, piles, haemorrhoids |
| Portuguese | HEMORROIDAS, Hemorroidas, Hemorróidas |
| Spanish | HEMORROIDES, Almorranas, hemorroides, SAI (trastorno), Hemorrhoids NOS, Haemorrhoids NOS, hemorroides, SAI, hemorroides (trastorno), hemorroides, Hemorroides |
| German | HAEMORRHOIDEN, Haemorrhoiden, Hämorrhoiden |
| Dutch | aambeien, Hemorroàden, hemorroïden, Hemorroïden, Aambei, Aambeien, Hemorroïd |
| Japanese | 痔核, ｼﾞｶｸ |
| Swedish | Hemorrojder |
| Czech | hemoroidy, Hemoroidy, zlatá žíla |
| Finnish | Peräpukamat |
| Russian | GEMORROI, ГЕМОРРОЙ |
| French | HEMORROIDES, Hémorroïdes |
| Korean | 치질 |
| Polish | Hemoroidy, Żylaki odbytu, Guzki krwawnicze |
| Hungarian | Haemorrhoidok, Aranyerek, Aranyeres csomók |
| Norwegian | Hemoroider |
| Italian | Emorroidi |
