Patient's Self-Treatment Guide

Keywords: treatment for hemorrhoids, treatment of hemorrhoids, hemorrhoid treatment, haemorrhoids, internal hemorrhoid, external hemorrhoid, piles

Funny Bone

A man was walking along a sidewalk in a very gentle manner, almost as if he were walking on eggs. Two doctors, also on foot, were across the street. They spotted the man and began to discuss his condition. “Prostrate trouble,” said the first doctor.

“Oh no, not at all. That’s a case of hemorrhoids if ever I saw one”, said the other.

They tossed it back and forth until one of them suggested going over to talk to the man. “Mister, this gentleman and I are both doctors,” said one, “and if you’ll pardon our intrusion, I figured you have a bad prostrate problem, but my colleague thought it to be hemorrhoids. Might you state the problem so that we can solve our little dilemma?”

“Well”, said the man, “all three of us were wrong. I thought it was gas.”

- taken from DoctorJokes.net

Introduction to Hemorrhoids

Occasionally, we’ll get a patient in the urgent care with a hemorrhoid flare and do not know what to do.  So it’s worth adding it as a topic here.

Hemorrhoids: these are vascular structures in the anal canal composed of arteries and veins.  Normally, they do not cause any pain.  They become problematic when they get swollen or inflamed.  Pain is in or around the rectum.

You can develop hemorrhoids if you have a history of any condition that caused long term intra-abdominal pressures:

• constipation where you had to bear down a lot
• multiple pregnancies
• long term coughing like smoker’s cough

Hemorrhoids can form inside the anal canal where you cannot see them, or form external to the anus.  The internal hemorrhoids can cause bleeding, but are usually not painful.  Once formed, the external hemorrhoids may just hang around and still not cause any problems.  It may feel like a “pea” at the anus.

For more information about the causes, pathophysiology, and epidemiology of hemorrhoids, visit Wikipedia.  Below is a discussion of self-treatment for your hemorrhoids.

Red Flags for Hemorrhoids

If you have any of these symptoms, go and see your doctor for evaluation to ensure you do not have a serious underlying medical condition:

• hemorrhoids with severe rectal bleeding
• hemorrhoids with severe pain
• hemorrhoids with tissues coming out of the anus
• hemorrhoids interfering with your voiding
• hemorrhoids with fevers, chills, body aches, or sweating

Self Treatment for Hemorrhoids

If you do not have any of the red flags above for hemorrhoids, and your rectal discomfort is only mild to moderate, you may try self treating your hemorrhoids first.

“Hemorrhoids” is a diagnosis, not a symptom; but it is a diagnosis that many patients make on their own.  It is never a good idea to diagnose and treat yourself without first verifying the diagnosis with your doctor because if you get the wrong diagnosis, you might be delaying the appropriate treatment and end up with complications.

For example, I had a couple of patients over the years who came in complaining of “hemorrhoids” after trying to treat themselves for a week or so.  Both of them did not have hemorrhoids, but in fact had peri-rectal abscesses.  I had to admit one of them to the hospital for strong antibiotics and surgical debridement because the infection has gotten so bad.

So it’s always better to see your doctor first and get the correct diagnosis. Once you know that you have hemorrhoids, you’re ready to self-treat the next time it flares up.  If in doubt, take a look at what hemorrhoids look like by clicking below:

Click Here for Hemorrhoid Pictures

(Be warned!  The pictures are graphic.  Your google search filters will be applied).

Preventing Constipation: If you have hemorrhoids, your first and foremost goal is to never be constipated.  Constipation is your enemy for the rest of your life, for even one bout of constipation can cause you much sorrow.  See the Self-Treatment Guide for Constipation for more details on how to treat and prevent constipation.  A combination of drinking water, adding fibers to your diet, and a daily stool softener may be needed to keep your stool a soft consistency and make it easy to void.

Medications at the Pharmacy for Your Hemorrhoids

The top FDA approved medications recommended by pharmacists are listed below, according to Pharmacy Times’ OTC Guide.  Brand names are given with generic names (in italics) in case you want a cheaper alternative.  Always follow dosing instructions on the bottle.

Topical medications:  The first step in treating the itching, pain, and swelling associated with a hemorrhoid flare is to use the topical medications.

Preparation H or Anusol (hydrocortisone):  These are the lower potency steroid creams that you can buy without a precription.  Steroids are very good at calming inflammation, and most patients will do well to manage their early hemorrhoid flares with just these medications.  Do not use this if you get worsening of swelling or itching with its use.  Also, do not use it for longer than 1 week to avoid further complications with the skin.  If your hemorrhoid flare have persisted for 1 week, you should see your doctor.

Tucks Medicated Pads (pramoxine) and Ointment (pramoxine,paraffinum, zinc oxide):  The ointment has additional ingredients that helps to coat and protect the rectal surface.  They may make you more comfortable, but they do not calm the inflammation as well as the steroid creams above.  The pads are less messy than the creams or ointment and may be a better option than having to apply the cream to your rectum right before going to that office lunch.

Suppositories: If the hemorrhoids are deeper in the anal canal, you might need to use suppositories as well to reach them.

Tucks Suppositories (topical starch): Tucks also makes suppositories, but this is more of a coating suppository with not much activity in the ingredient.

Others:  You might be able to find some generic brand suppositories that have phenylephrine, which is a vasoconstrictor and may reduce the swelling quicker.  Suppositoies work well because they go right to the site of the problem.  However, the better ones need a prescription to buy.  If the over-the-counter brands didn’t work for you, you should see your doctor to see if you need something stronger.

When Should You See Your Doctor for Your Hemorrhoids?

• If you have any of the red flags above
• When your pain is getting worse instead of better
• When you can no longer void
• When you’ve tried the over-the-counter medications without any luck for 1 week

What Can Your Doctor Do for Your Hemorrhoids?

• Examine you and confirm whether you do have hemorrhoids or something else
• Stage your hemorrhoids and provide you with the proper treatment and plans
• See if your hemorrhoids have thrombosed (form blod clots) that may need to be numbed an incised to open and relieve the pain
• See if you might have a skin infection or abscess associated with the hemorrhoids and prescribe you antibiotics for it
• Prescribe you stronger hemorrhoid medications including prescription strength suppositories or foams
• Do an anoscope and/or a digital rectal exam to see if you might have internal hemorrhoids as well.
• Check your stool to see if you might have occult bleeding (cannot be seen but is there on a chemical test) that may need to be addressed as well.
• If necessary, help push a protruding internal hemorrhoid back inside the anus if it is stuck outside (after numbing it up of course).
• Refer you to a specialist to band, ligate, or excise the hemorrhoids if it is in an advanced stage.

Danh H. Nguyen, M.D.
Patient’s Self Treatment Guide
“Written For Today’s Self-Empowered Patients”
Last Updated 07/18/2011

©  www.selftreatmentguide.com

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