2017 HCHB_digital

CONTINUING OTC EDUCATION
Treatment of haemorrhoids
Treatment generally relieves symptoms such as itching, pain and swelling, but
will not cure haemorrhoids. The choice of treatment depends on the severity of
symptoms and if the haemorrhoids are internal or external.
Suppositories or topical ointments that are packaged with a nozzle for
internal rectal use are used to treat internal haemorrhoids. Initially it may be
more comfortable to apply ointment with a finger rather than use the nozzle,
particularly if the haemorrhoids are very inflamed and painful. Topical ointments
can be applied directly to external haemorrhoids using a fingertip.
Products are best applied after defecation once the anal area has been
thoroughly cleaned (unfragranced wet wipes are usually more effective and
kinder at cleaning the region than toilet paper).
It can take up to one week for external haemorrhoids to disappear or improve.
Many patients will require further specialised therapy, such as sclerotherapy
(injection of a substance into the haemorrhoid), rubber-band ligation therapy
(small rubber bands are placed around the haemorrhoid causing it to shrink), laser
or infrared coagulation (causes the haemorrhoid to harden and shrivel), stapled
haemorrhoidopexy (staples are used to anchor the haemorrhoid in place) or surgery
for persistent haemorrhoids.
Advice for customers
• Keeping the stools soft helps prevent haemorrhoids from occurring.
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Eat a diet high in fibre (fruit, vegetables, wholegrains).
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Maintain a reasonable fluid intake (six glasses of water a day).
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Treat any constipation if present (see Constipation) and avoid straining
when passing a bowel motion if possible.
• Avoid foods and drinks that may make haemorrhoids worse, including spicy
foods, nuts and seeds, and alcohol.
• Get plenty of exercise and avoid sitting for long periods.
• Do not ignore the urge to go to the toilet (“holding-on” can lead to increased
pressure inside the anus).
• Use unfragranced wet wipes instead of toilet paper to clean the anal area.
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Avoid soap as this may further aggravate the problem.
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Ensure used wipes are discarded appropriately and not flushed as they can
easily block sanitary systems.
• Apply products only as directed and for the recommended time. If treatment
fails to improve haemorrhoids, seek further medical advice.
• A cold compress applied to the area may help with symptoms.
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Alternatively sitting in a warm bath for 15–20 minutes at a time (a sitz
bath) after each bowel movement may provide relief.
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Gently pat the area to dry afterward, or alternatively use a hair dryer.
• Wear cotton underwear to minimise discomfort.
• Avoid scratching the anal area.
• Sit on a cushion rather than a hard surface to reduce the swelling of existing
haemorrhoids and prevent the formation of new ones.
Refer to
PHARMACIST
Generally, all patients with rectal bleeding who have not received
a formal diagnosis should be referred to a doctor. Pharmacists
should also refer any customers with “yes” answers to the following
questions to a doctor.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) that may be causing constipation?
• Is the person unsure of the diagnosis?
• Is there any rectal bleeding not related to bowel motions?
• Is blood mixed into the stool (not just sitting on top of it)?
• Have the symptoms lasted more than three weeks?
• Have the symptoms not improved after a week of treatment?
• Does the haemorrhoid prolapse and have to be pushed back in, or
can’t be pushed back in with a finger?
• Is there any pus or other signs of infection around the anal area?
• Is there any severe sharp pain with bowel motions or a feeling of
not being able to completely empty the bowel?
• Are any other symptoms present (eg, abdominal pain, fever,
vomiting, nausea, loss of appetite)?
• Has the person with the haemorrhoids noticed an unexplained
weight loss or feels tired all the time?
• Have there been any recent changes in bowel habits (eg, onset of
constipation or diarrhoea for the first time)?
• Is the person buying for a child with supposed haemorrhoids?
• Does the person have any allergies to topical medicines?
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