HAEMORRHOIDS(piles)
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OUTLINEWhat are haemorrhoids?
The causes of haemorrhoids
Symptoms of haemorrhoids
Treatment of haemorrhoids & products for treating
How can they be prevented & products for prevention
Complementary medications
Adjunct products
Counselling
When to refer
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Haemorrhoids are also known as piles
Haemorrhoids are engorged blood vessels (or varicose veins) that occur under the lining of the anus & appear on the inside, on or just outside the anus
They can become inflamed, painful & swollen in the lower portion of rectum or anus
The Gastrointestinal Tract
What Are Haemorrhoids?For Professional Use Only
What Are HaemorrhoidsHaemorrhoids may be inside or outside the body
Many patients have both internal and external haemorrhoids
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Incidence Of HaemorrhoidsHaemorrhoids can occur in anyone
Haemorrhoids become large in size & cause problems to only 4 % of the worlds population
It usually affects people aged 45 –65 years and decreases after age 65
Only 1 in 3 go to see a doctor about their condition
It rarely affects people <20 years old
Occur commonly during pregnancy
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DIAGNOSIS1st symptom of a haemorrhoids is bleeding from the rectum
Typically, the blood is bright red and occurs at the end of a bowel movement. The bleeding is often described as blood on the paper, dripping or spraying into the toilet bowl
The bleeding is NOT associated with any pain
However, there are many other conditions which are much more serious (including bowel cancer) which can result in bleeding
Any patient who comes into the pharmacy seeking treatment or advice regarding any fresh blood from the bowel should be referred immediately to their medical practitioner so they can be examined for both haemorrhoids and to have other serious conditions excluded
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Internal HaemorrhoidsInternal haemorrhoids occur just inside the anus, at the beginning of the rectum
are usually painless
can cause intermittent rectal bleeding during or following a bowel motion
may produce mucous discharge
may protrude (prolapse) outside the anus, & appear as small, grape-like masses
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External HaemorrhoidsExternal haemorrhoids occur at the anal opening & may hang outside the anus
can be very painful & cause hygiene problems after a bowel movement resulting in irritation and itchiness
Swelling & discomfort may occur intermittently.
External haemorrhoids sometimes develop a blood clot "thrombosis" inside after diarrhoea or constipation
In that case, it produces a sudden firm and painful swelling or lump around the rim of the anus
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Causes Of HaemorrhoidsThe exact cause of symptomatic haemorrhoids is unknown however contributing factors include:
Straining during bowel movements
Irregular bowel habits constipation or diarrhoea
Sitting for long periods of time
Genetics
Anal infections
Certain diseases - liver cirrhosis, Irritable Bowel Syndrome, Crohn’s Disease and Ulcerative Colitis
Lack of exercise
Obesity
Pregnancy pressure from the foetus and hormonal changes cause many blood vessels to swell including the haemorrhoidal vessels
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Symptoms Of HaemorrhoidsAnal itching and/or burning This is related to leaking of mucous from the engorged blood vessels which can lead to itchiness and burning discomfort in the skin around the anus
Anal ache or pain, especially while sitting
Bright red fresh blood on toilet tissue, stool, or in the toilet bowl
Pain during bowel movements
One or more hard tender lumps near the anus
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Duration Of Haemorrhoid Symptoms
Haemorrhoid flare-ups, (swelling, irritation & mild discomfort) are usually brief & most symptoms disappear within a few days
Pregnant women symptoms usually improve dramatically or disappear after childbirth
Intermittent slight bleeding from haemorrhoids may carry on for months or years
Painful swelling from thrombosis of an external haemorrhoid usually resolves over a period of days to weeks
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Treatment Of HaemorrhoidsForms of treatment available
Ingredients include:ProtectantsBarrier medicationsCorticosteroidsLocal anaestheticsStool softenersWitch hazel
Sitz bathCold compresses
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SuppositoriesRectal gelsRectal ointments
OINTMENT & SUPPOSITORIESAnusol
Anusol is available as an Ointment & Suppositories Unscheduled or an open seller
Contains: Zinc Oxide mild antiseptic
used to discourage growth of certain bacteria
Peru Balsam very mild antiseptic action to prevent bacterial infection
Benzyl Benzoate associated with inflamed, oozing haemorrhoids
normally used in scabies as it can kill these parasites
it also has mild antiseptic properties which may protect against developing infections
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OINTMENT & SUPPOSITORIES How to use Anusol
Anusol Ointment 1st clean & dried the area as much as is possible
Apply to the area every 4 hours as needed or after each bowel motion
Attach the nozzle to insert ointment internally
Anusol Suppositories Insert ONE suppository into the rectum in the morning and the evening
Application is preferable after a bowel motion though this may be difficult to predict
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OINTMENT & SUPPOSITORIES Proctosedyl
Proctosedyl is available as Ointment & Suppositories
Pharmacy Medicine
Contains: Hydrocortisone Corticosteroid
relieves inflammation & burning
Cinchocaine Local anesthetic
Numbs pain, reduces itching & burning symptoms
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OINTMENT and SUPPOSITORIESHow to use Proctosedyl
Proctosedyl Ointment can be used up to THREE times a day for the first 7 days
If used for more than seven days reduce to twice daily
Longer term use; can cause thinning of the skin because of the corticosteroid
Attach the nozzle to insert ointment internally
Proctosedyl Suppositories Insert morning and night preferably after a bowel motion
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OINTMENT & SUPPOSITORIES Rectinol
Rectinol is available as an OintmentPharmacy Medicine
Contains: Zinc Oxide is a mild antiseptic
used to discourage growth of certain bacteria
Cinchocaine Local anesthetic
Numbing affect on the tissue
reduces pain, itching & burning symptoms
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OINTMENT and SUPPOSITORIESHow to use Rectinol
Rectinol Ointment Apply up to THREE times a day and preferably after each bowel motion
Attach the nozzle to insert ointment internally
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OINTMENTHemocane
Hemocane is available as an OintmentPharmacy Medicine
Contains: Zinc Oxide is a mild antiseptic used to discourage growth of certain bacteria
Lignocaine Local anesthetic Numb the pain, reduce itching & burning symptoms
Allantoin Moisturiser which may aid in soothing any irritation
Hamamelis extract (witch hazel) Astringent has been used to relieve swelling, minor pain, burning
associated with haemorrhoids
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OINTMENTHemocane
Contains: Chlorhexidine antiseptic
Helps to reduce infections
Castor oil, Local anesthetic
Numb the pain, reduce itching & burning symptoms
Allantoin Moisturiser which may aid in soothing any irritation
Hamamelis extract (witch hazel) Astringent has been used to relieve swelling, minor pain,
burning associated with haemorrhoids
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OINTMENT and SUPPOSITORIESHow to use Hemocane
Hemocane Ointment Apply morning & night and after each bowel motion
Attach the nozzle to insert ointment internally
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OINTMENTSoov It
Soov It is available as an OintmentPharmacy Medicine
Contains: Hydrocortisone Corticosteroid
relieves swelling, inflammation & itching
Lignocaine Local anesthetic
Numb the pain, reduce itching & burning symptoms
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OINTMENTHow to use Soov It
Soov It Ointment Apply a small quantity to the fingers
Apply up to three times daily preferably after each bowel motion
Attach the nozzle to insert ointment internally
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OINTMENTHemoclin Gel
Hemoclin is available as an Ointment
Contains: A derivative of Aloes Plant Binds to bacteria, preventing bacteria form adhering to the skin or
internal mucosa of the bowel – may reduce incidence of infection
Gel also lubricates stools making them easier to pass
Gel has a cooling effect which can reduce inflammation and thus
the associated pain
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OINTMENTHow to use Hemoclin Gel
Hemoclin Gel Apply the gel using the applicator in and around the affected area
The applicator is for internal usage
Use at least twice per day or when required for a period of 2 weeks
But should NOT be used continuously for longer than 30 days for one treatment period
It has no known side effects or interactions and can be used during pregnancy and breastfeeding
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PREVENTIONConstipation and straining during bowel movements
raise the risk for developing haemorrhoids.
To prevent constipation and haemorrhoids:Stay hydrated
Drink plenty of fluids, at least eight glasses per day.
Avoid or limit alcohol and caffeine intake these promote the loss of water from your body and can cause hard stools and increase the pain of haemorrhoids.
Increase fibre intakeEat a high fibre diet - fruits, vegetables, and whole grains supply natural fibre
Consider fibre supplements – eg Metamucil, Benefiber
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PREVENTIONTo prevent constipation and haemorrhoids continued:
Stool softenersstool softeners to prevent straining - Coloxyl
ExerciseBegin a program of regular exerciseAs little as 20 minutes of brisk walking daily can stimulate your bowel to move regularly
RegularityTrain your digestive tract to have regular bowel movementsSchedule a time to sit on the toilet at approximately the same time each dayThe best time to do this is usually right after a mealDo not sit on the toilet for long periods (it tends to make haemorrhoids swell up and push out)Respond immediately to the urge to have a bowel movementDo not postpone until the time is more convenient
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FIBRE SUPPLEMENTSAlso known as bulk-forming laxatives
Fibre should be taken ONCE OR TWICE DAILY after meals, swallowed with plenty of fluid
Fibre supplements swell when they come into contact with fluids and work by increasing the volume of contents in the gut
Stimulates the muscular movement of the gut, which helps to move the stool through the intestines
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FIBRE SUPPLEMENTSIt is essential to drink plenty of water when using fibre supplements. Otherwise, the stool will not stay soft and easy to pass during a bowel movement. With none or little water the stools can become hard and even impacted. This will exacerbate haemorrhoids
There are no known harmful effects if used during pregnancy or breastfeeding
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FIBRE SUPPLEMENTS
Psyllium HuskMetamucil
Wheat dextrinBenefiber
SterculiaNormacol
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PSYLLIUM HUSKS (METAMUCIL)Powder
Recommended dose for adults is 1 rounded teaspoon
or 1 rounded tablespoon for the Smooth Texture,orange-flavoured Metamucil
Dissolve the powder in 240 mL of cool liquid (water, fruit juice, lemonade, iced tea), stir it briskly, and drink right away
CapsulesRecommended dose is FIVE capsules up to THREE times a dayTake the capsules with at least 240 mL of cool liquid. Swallow the capsules one at a time
NOTE: These products can affect how other medications are absorbed from the stomach, do not take it TWO hours before or after taking other medications
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WHEAT DEXTRIN (BENEFIBER)Powder
Mix one tablespoon with at least 250ml of any liquid
or soft food and stir well
Begin with one serve daily and increase as required
You can mix Benefiber Powder into any hot or cold beverage such as water, coffee, or juice and into soft foods such as pudding or yogurt
Add it to recipes such as muffins, sauces or soups, and it will not affect the taste or consistency.
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STERCULIA (NORMACOL)Sterculia is a vegetable gum from the karaya tree
It is not absorbed or digested in the stomach or intestines
The granules should be taken once or twice a day after meals
They should be placed dry on the tongue and swallowed immediately without chewing or crushing, with plenty of water or a cool drink
The granules may also be sprinkled onto soft food such as yoghurt and swallowed without chewing or crushing, wash down with a drink.
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Faecal SoftenersDocusate sodium (Coloxyl Tablets)
Docusate is a stool softener or emollient laxative
Is a surfactant which works by drawing water out from the surface of the intestines and thus increases the penetration of fluid into the faeces, thereby softening the stool
Take two or three tablets twice daily
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Sitz BathsHistorically, Sitz baths have been used to treat haemorrhoids
Patients would sit in either a warm or cold bath to relieve itching and inflammation. Baths could contain only water or have salt, baking powder or Epsom’s salts added to them
Patients would have to be careful if sitting in water that is too warm as this could lead to the blood vessels dilating and causing more swelling of the haemorrhoid
Salts such as baking powder can effervesce and this was expected to be soothing to the skin. There is no firm evidence that adding any salts to the bath can improve itching, swelling or inflammation
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Cold Compresses
Cold compresses can reduce the inflammation and swelling associated with haemorrhoids
More effect with external haemorrhoids rather than internal haemorrhoids because of the difficulty in accessing internal haemorrhoids with cold compresses
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COMPLEMENTARY PRODUCTS
Witch Hazel Liquid
Witch hazel is an astringent and has been used to relieve swelling, minor pain, burning associated with haemorrhoids
The liquid can be rubbed on external haemorrhoids but products available in Australia are not specifically designed for haemorrhoidal use
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Oral Pain Relief PreparationsParacetamol
Paracetamol 500mg tablets or capsules – two tablets every four hours (no more than EIGHT per day)
Nonsteroidal anti-inflammatoriesDiclofenac (Voltaren Rapid, 12.5 or 25mg)
• 50mg (4 of the12.5mg tabs or 2 of the 25mg tabs) for the first dose then 25mg every 8 hours with food. Maximum 200mg per day
Ibuprofen (Nurofen , Advil, Nurofen Zavance)• Two tablets/capsules for the first dose then one to two tablets or
capsules every 4-6 hours with food. Do not exceed six tablets per daily.
Codeine containing products are not recommended as they can cause constipation
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COUNSELLINGAvoid toilet tissue with perfumes or colors, use
baby wipes instead
Try not to scratch the area
When pregnant, lie on the left side when resting or sleeping to help reduce pressure on certain veins that can lead to vein swelling and haemorrhoids
Report to a medical practitioner if the symptoms change
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WHEN TO REFERBleeding
Haemorrhoids must first be diagnosed by a doctor
Any bleeding from the rectum could be the result of more serious conditions or conditions other than haemorrhoids
Only patients who have been diagnosed with haemorrhoids should be treated in the pharmacy
Change in symptomsf the symptoms associated with haemorrhoids changes in the patient (more severe bleeding, increased pain (with bowel motions or at other times), impacted motions or the symptoms suddenly become more severe or intense
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