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Pediatric: fiber-containing laxative (e.g. psyllium powder 5 mL PO QD–TID)
Special cases:
n history of successful nitroglycerin therapy: nitroglycerin ointment (0.2%,
applied BID)
n post-hemorrhoidectomy pain: diltiazem gel (700 mg of a 2% preparation
applied BID); NSAIDs (e.g. ibuprofen 400–600 mg PO QID) with consideration
of opioid rescue (e.g. oxycodone 5–10 mg PO q4–6h)
n failure of local therapy: NSAIDs (e.g. ibuprofen 400–600 mg PO QID) with
opioid rescue (e.g. oxycodone 5–10 mg PO q4–6 h)
n any case in which opioids are prescribed: stool softeners should be prescribed
(e.g. docusate 50–300 mg PO, with dose halved and divided into
1–4 daily PO administrations for children); patients should be warned that
constipation-associated discomfort can offset analgesic efficacy of opioids.
References
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