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What to know about hemorrhoids

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Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum. When the walls of these vessels are stretched, they become irritated.

Although hemorrhoids can be unpleasant and painful, they are easily treated and very preventable. As hemorrhoids generally get worse over time, doctors suggest that they should be treated as soon as they appear.

Treatments

In the majority of cases, simple measures will alleviate symptoms while hemorrhoids get better without treatment. However, medicines and even surgery may sometimes be needed.

Home treatments

Symptoms can be relieved in the following ways. However, they will not eliminate the hemorrhoids:

  • Topical creams and ointments: Over the counter (OTC) creams or suppositories, which contain hydrocortisone, are available to buy online. There are also pads which contain witch hazel, or a numbing agent that can be applied to the skin.
  • Ice packs and cold compresses: Applying these to the affected area may help with the swelling.
  • A sitz bath using warm water: A sitz bath is placed over the toilet. Some pharmacies sell them, and they may relieve the burning or itching symptoms.
  • Moist towelettes: Dry toilet paper may aggravate the problem.
  • Analgesics: Some painkillers, such as aspirin, ibuprofen, and acetaminophen may alleviate the pain and discomfort.

Medicines

Most hemorrhoid medicines are OTC. These include ointments, pads, or suppositories.

Active ingredients as hydrocortisone and witch hazel are known to relieve itching and pain. Consult with a doctor if these medicines do not show results after a week of treatment.

Nonsurgical treatment options

The most common type of nonsurgical hemorrhoid removal technique is rubber band ligation.

This is an outpatient procedure for internal hemorrhoids, where an elastic band is placed on the base of the hemorrhoid to cut off blood supply. The hemorrhoid will either shrink or fall off.

Another procedure is sclerotherapy, where a solution is injected into an internal hemorrhoid. This produces a scar that cuts off blood supply to the hemorrhoid.

Infrared photocoagulation and electrocoagulation are two other options.

Surgical options

Surgery may involve a complete removal of the hemorrhoids, known as a hemorrhoidectomy.

It may also involve stapling, where a prolapsed hemorrhoid is tacked back into place. These procedures are performed under general anesthesia, and most people can go home on the same day as the surgery.

Causes

Enlargement of the veins around the anus causes hemorrhoids.

They can occur for the following reasons:

  • Pregnancy: They occur more commonly in pregnant women because, as the uterus enlarges, it presses on the vein in the colon, causing it to bulge.
  • Aging: Hemorrhoids are most common among adults aged 45 to 65 years. This does not mean, however, that young people and children do not get them.
  • Diarrhea: Hemorrhoids can occur after cases of chronic diarrhea.
  • Chronic constipation: Straining to move stool puts additional pressure on the walls of the blood vessels.
  • Sitting for too long: Staying in a seated position for long periods of time can cause hemorrhoids, especially on the toilet.
  • Heavy lifting: Repeatedly lifting heavy objects can lead to hemorrhoids.
  • Anal intercourse: This can cause new hemorrhoids or worsen existing ones.
  • Obesity: Diet-related obesity can cause hemorrhoids.
  • Genetics: Some people inherit a tendency to develop hemorrhoids.

Symptoms

Symptoms of hemorrhoids often include:

  • painless bleeding
  • itching or irritation in the anal area
  • discomfort, pain, or soreness in the same area
  • lumps and swelling in the anal region
  • leaking feces

Symptoms can be unpleasant or alarming, but they are usually not a cause for concern.

Types

Hemorrhoids can be either internal or external.

Internal hemorrhoids

Internal hemorrhoids are deep inside the rectum and not visible from outside. They are normally painless. Often, the first sign that internal hemorrhoids are present is rectal bleeding.

Straining can sometimes push an internal hemorrhoid so that it protrudes through the anus. This is called a protruding or prolapsed hemorrhoid and can be painful.

External hemorrhoids

External hemorrhoids are under the skin around the anus and are therefore visible. Because there are more sensitive nerves in this part of the body, they are normally more painful. Straining when passing a stool may cause them to bleed.

Diagnosis

Anyone experiencing the symptoms outlined above should contact a doctor. Bear in mind that other things, including colorectal and anal cancers, can cause rectal bleeding.

A doctor can carry out a physical examination and perform other tests to determine whether or not hemorrhoids are present. These tests may include a digital rectal exam. This is a manual inspection by the doctor using a gloved, lubricated finger.

If symptoms include significant amounts of bleeding, dizziness, and a fainting sensation, the individual should seek emergency care immediately.

Prevention

The risk of developing hemorrhoids is greatly reduced when stools are kept soft. This can be helped in the following ways:

  • Nutrition: Eating plenty of foods rich in fiber, such as fruits and vegetables, as well as whole grains, means stools will nearly always be soft. Similarly, drinking plenty of fluids helps keep stools soft. OTC fiber supplements also ease constipation.
  • Avoiding over-straining: When using the toilet, try not to strain. This creates pressure in the veins in the lower rectum.
  • Going to the toilet when needed: People should not wait if they need to use the toilet. The longer the wait, the drier the stools will be.
  • Physical activity: Sitting or standing still for long periods puts pressure on the veins. Physical activity also helps stool move through the bowel, so bowel movements are more regular.
  • Maintaining a healthy body weight: Being overweight significantly raises the risk of having hemorrhoids.

Outlook

Hemorrhoids are often treated successfully and without complications, especially if treatment starts early. However, the following rare complications can arise:

  • Strangulated hemorrhoid: If the blood supply to the hemorrhoid is cut off, it may become strangulated. This can cause significant pain.
  • Anemia: Significant, chronic blood loss from hemorrhoids can lead to anemia. This occurs when there are not enough red blood cells in a person’s circulation.
  • Blood clots: Sometimes, blood may clot in the anus, which can be painful. The area will swell and become inflamed.
Sours: https://www.medicalnewstoday.com/articles/73938

How long do hemorrhoids last? What to know

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Hemorrhoids are swollen, irritated veins around the anus or rectum that can last for varying lengths of time. In some people, hemorrhoids clear up on their own after a few days. In other cases, they can become a regular occurrence.

Some people may need medication or medical procedures to minimize their symptoms and shrink the hemorrhoids.

Hemorrhoids can cause pain and make simple activities, such as sitting or walking, uncomfortable or challenging.

In this article, learn more about how long hemorrhoids last and how to get relief.

Duration

There is no set duration for hemorrhoids. Small hemorrhoids may clear up without any treatment within a few days.

Large, external hemorrhoids may take longer to heal and can cause significant pain and discomfort. If hemorrhoids have not resolved within a few days, it is best to see a doctor for treatment.

Risk factors for severe or recurrent hemorrhoids include:

  • not getting enough fiber
  • being overweight or obese
  • being pregnant
  • having chronic constipation
  • having chronic diarrhea
  • aging muscles
  • sitting on the toilet for too long
  • straining while having a bowel movement
  • having anal intercourse
  • overusing or abusing enemas or laxatives

Some of the above factors can also make it difficult for hemorrhoids to heal, allowing the problem to persist for longer.

Treatment

Some hemorrhoids do not require treatment and will clear up on their own within a few days. During this time, a person should rest and avoid doing anything that strains or puts pressure on the area.

Over-the-counter (OTC) treatments may work for some people. Medicated creams, such as phenylephrine gel (Preparation H), can help relieve itching and discomfort.

If OTC treatments have little or no effect, a doctor may be able to prescribe more effective ointments.

People who often have hemorrhoids or experience complications, such as blood in the stool, should speak to a doctor. The doctor may recommend alternative treatments or run tests to rule out underlying causes.

People who experience severe hemorrhoids may need more intensive treatment, including medical procedures. These procedures may include:

  • Rubber band ligation, which is the most common nonsurgical procedure for removing hemorrhoids. A doctor will place a small, tight band around the hemorrhoid to cut off circulation to the tissue and allow it to fall off.
  • Sclerotherapy, during which a doctor injects a chemical medication into the hemorrhoid to shrink it. Doctors may also use heat, light, or freezing temperatures to achieve this.
  • Surgical removal, which doctors only recommend in cases where hemorrhoids do not respond to at-home or in-office methods. Surgery is usually successful and prevents the hemorrhoids from coming back.

There is a selection of hemorrhoid treatments available for purchase online.

Recovery

For people who get hemorrhoids regularly, some dietary and lifestyle changes may help with healing and prevention.

Diet

Straining during bowel movements is a common cause of hemorrhoids, but people can make dietary adjustments to reduce their need to strain.

Including plenty of fiber-rich foods in the diet is generally beneficial. Plant fibers from fruits, vegetables, nuts, and grains help collect water in the stool, making it softer and easier to pass.

Supplementing the diet with soluble fiber, such as methylcellulose (Citrucel) or psyllium (Metamucil), may reduce constipation.

Drinking plenty of water throughout the day helps ensure that the body has enough water for healthy digestion, which can also ease constipation.

Lifestyle

Making a few small lifestyle changes can help minimize the symptoms of hemorrhoids. Some tips include:

  • Using a small stool to prop up the legs while having a bowel movement. This will change the position of the anal canal, which may make it easier to pass stool.
  • Avoiding delaying a bowel movement when the need arises.
  • Taking regular showers.
  • Gently washing the anus in the shower after each bowel movement or using moist toilet wipes or water from a bidet.
  • Taking a warm sitz bath to relieve symptoms.
  • Sitting on an ice pack to reduce pain or discomfort.
  • Exercising regularly to help stimulate bowel movements.

Spending too much time on the toilet can cause the blood to pool in the veins in the rectum or put unnecessary pressure on them.

While making dietary changes can reduce toilet time, people should also avoid taking a smartphone, newspaper, or book into the restroom.

Understanding hemorrhoids

Hemorrhoids come from small clusters of veins near the mucous membranes of the anus and lower rectum. They develop when the veins become swollen or irritated.

Internal hemorrhoids appear inside the lower rectum and are not visible to the naked eye. This type of hemorrhoid may not cause any pain or irritation, but a person may have other symptoms.

External hemorrhoids appear on the outside of the anus and commonly cause pain and discomfort.

The symptoms of hemorrhoids may vary from person to person, but often include:

  • a lump external to the anus
  • pain or discomfort
  • itching, even after wiping the area clean
  • swelling near the anus
  • a burning sensation when having a bowel movement or at rest

A person may also notice blood in the toilet or stool.

During pregnancy

Hemorrhoids are a common problem during pregnancy. The extra weight that a woman carries during pregnancy may place a strain on the veins in the anus and rectum.

As the uterus grows, it also puts pressure on the veins near the rectum.

Hormonal changes may relax the veins in this area, which can also make hemorrhoids more likely.

Hormonal and physical changes can also cause gastrointestinal problems, such as constipation or diarrhea, which increase a person’s risk of hemorrhoids.

Outlook

Hemorrhoids are usually not severe, but they can be bothersome and make daily life difficult.

How long hemorrhoids last can vary from person to person, but a range of OTC remedies and medical options are available to treat them.

There are also some simple changes that people can make to their diet and lifestyle to achieve symptom relief and prevent new hemorrhoids from forming.

Sours: https://www.medicalnewstoday.com/articles/322976
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Hydrocortisone for piles and itchy bottom - Cream, ointment and suppositories

1. About hydrocortisone for piles and itchy bottom

Hydrocortisone is used in some medicines to treat:

These treatments do not cure piles, but they can help with the pain and itching.

Hydrocortisone is a type of medicine known as a steroid (corticosteroid). Corticosteroids are not the same as anabolic steroids.

Hydrocortisone treatments for piles come as creams, ointments and suppositories. You can buy some smaller sizes from a pharmacy, but others are only available on prescription. Some of these medicines also contain local anaesthetics and other medicines to soothe the symptoms.

Other types of hydrocortisone

There are different types of hydrocortisone, including injections and tablets.

Find out more about other ways you can use hydrocortisone for different health conditions.

2. Key facts

  • Some hydrocortisone products creams and ointments can only be used on the outside of your body. The best type of treatment for you depends on your symptoms.
  • You'll usually apply treatments several times a day – first thing in the morning, last thing at night and after you've done a poo. Always follow advice from a pharmacist or doctor, or the leaflet that comes with your medicine.
  • Do not use hydrocortisone treatments for longer than recommended, or use more than you're supposed to. The local anaesthetic in them can make your skin sensitive. Also, long-term use can make your skin thinner.
  • Do not let children use hydrocortisone unless their doctor prescribes it for them.
  • Hydrocortisone treatments for piles can be called by a variety of brand names including the Anusol range, Anugesic, Germaloids, Perinal, Proctosedyl, Uniroid and Xyloproct.

3. Who can and cannot use hydrocortisone for piles and itchy bottom

Hydrocortisone treatments for piles and itchy bottom can be used by most adults (aged 18 years and older).

Young people aged 16 to 17 years can only use some products. Do not use these treatments on children under the age of 16 unless a doctor prescribes them.

Hydrocortisone treatments are not suitable for some people. To make sure they are safe for you, tell your pharmacist or doctor if you:

  • are allergic to hydrocortisone or any other medicine
  • have a skin infection
  • are pregnant, trying to get pregnant or you're breastfeeding
  • are taking other medicines, such as codeine, which might be making you constipated. Being constipated means you're more likely to get piles.

4. How and when to use hydrocortisone for piles and itchy bottom

You'll usually use most treatments for piles or itchy bottom several times a day – first thing in the morning, last thing at night and after you've done a poo. Check the leaflet which comes with the product you are using.

Some treatments are only used on the skin around your anus – such as creams, ointments and sprays. These are for piles on the outside (called external piles) or itchy bottom.

Some piles treatments, such as hydrocortisone suppositories, are used inside your anus. These are for piles on the inside (internal piles).

Do not use hydrocortisone treatments for more than 7 days. Make an appointment to see your doctor if your symptoms:

  • have not got better
  • come back quickly after treatment

How to use cream or ointment for external piles

Read the instructions in the leaflet that comes with the cream or ointment.

  1. Wash your hands before and afterwards.
  2. Squeeze the tube of cream or ointment and put a small amount on your finger.
  3. Apply the cream or ointment around the outside of your anus with your finger.

How to use spray for external piles and itchy bottom

Read the instructions in the leaflet that comes with the spray.

Before using the spray for the first time you need to get it ready. Push the pump down once or twice to do this.

  1. Wash your hands before and afterwards.
  2. Separate your buttocks and spray the area once.

How to use suppositories for internal piles

Read the instructions in the leaflet that comes with the suppositories.

  1. Go to the toilet beforehand if you need to.
  2. Wash your hands before and afterwards. Also clean around your anus with mild soap and water, rinse and pat dry.
  3. Unwrap the suppository.
  4. Stand with one leg up on a chair or lie on your side with one leg bent and the other straight.
  5. Gently push the suppository into your anus with the pointed end first. It needs to go in about 2cm to 3cm (1 inch).
  6. Sit or lie still for about 15 minutes. The suppository will melt inside your anus.

What if I forget to use it?

If you forget a treatment, do it as soon as you remember. If you do not remember until you are within a few hours of the next application, do not worry. Just skip the missed treatment and go back to your usual treatment routine.

6. Pregnancy and breastfeeding

Hydrocortisone creams that you buy from a pharmacy can be used in pregnancy and while you are breastfeeding.

Important

For safety, tell your pharmacist or doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Here's more information on how to treat piles in pregnancy.

For more information about using hydrocortisone during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.

7. Cautions with other medicines

Taking other medicines should not affect the way hydrocortisone treatments for piles or itchy bottom work.

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

8. Common questions about hydrocortisone

Sours: https://www.nhs.uk/medicines/hydrocortisone-for-piles-and-itchy-bottom/
Is There a Way to Get Rid of Hemorrhoids for Good?

The 7 Best Over-the-Counter Hemorrhoid Treatments of 2021

Final Verdict

When it comes to hemorrhoid relief, the single, must-have product is Doctor Butler's Hemorrhoid & Fissure Ointment (view at Amazon). It will treat the majority of your symptoms and can be used anywhere, any time of day. If you need serious soothing and have the time and a tub, Thena Sitz Bath Soak (view at Amazon) is an almost guaranteed pain relief. If you have hemorrhoids regularly, take Naticura Hem-Control Herbal Hemorrhoid Remedy (view at Amazon) to help soften your stool—and go see your doctor for what else you can do.

What to Look for in an Over-the-Counter Hemorrhoid Treatment

Ingredients:

What to look for in a hemorrhoid treatment depends on the product. Ointments and creams can help ease the pain and itching. Witch hazel in particular is quite soothing, as is aloe vera, coconut oil, or even vitamin E, Dr. Childs adds. A topical anesthetic like lidocaine can be helpful, too. Hydrocortisone, a corticosteroid, can help with itching and irritation, if that's your main concern.

Form:

When you have a hemorrhoid, it can be extra painful to try and have a bowel movement; natural stool softeners with ingredients like psyllium (which is just fiber) work well, she adds. If you're not trying to add any more pills to your daily regimen, opt for a cooling pad or seat cushion that can relieve some of the pain naturally. Bath salts for soaking are another great way to ease the itch without medication.

Frequently Asked Questions

  • Yes, OTC hemorrhoid treatments are effective. Henry Govekar M.D., a colon and rectal surgeon at Rush University Medical Group in Chicago, suggests first seeing a doctor to make sure you do have a hemorrhoid, and not something potentially more serious. Then he suggests doing a warm sitz bath for about 10 minutes a day to reduce swelling. He also encourages patients to get on a fiber diet through vitamins or food changes to maintain a soft stool that’s easy to pass. He says over-the-counter creams and ointments are a good option, but don’t use it for more than a week if there’s no improvement. 


    He advises avoiding steroid creams because they can irritate the skin. He says some ointments on the market include zinc oxide, which helps protect skin and helps with discomfort. 


  • It depends on the type of hemorrhoid. Internal hemorrhoids are treated with sitz baths, diet modifications and OTC products. Dr. Govekar usually waits four to six weeks and many patients see symptoms disappear in about a month. External hemorrhoids can take a few weeks to a month to go down in size.

What the Experts Say

“Most people come to doctors after seeing blood in the toilet. Don’t try to treat it. If you have this bleeding going on you should see your doctor to make sure it’s not something more serious.  When I hear about a patient with rectal bleeding, I wonder about what it could be. Especially as we’re seeing younger and younger people diagnosed with colon and rectal cancer.”—Henry Govekar M.D., a Colon and Rectal Surgeon at Rush University Medical Group

Why Trust Verywell Health?

Rachael Schultz is a freelance writer with a focus in health and nutrition. Her articles have appeared on a handful of other Health sites, and she has a degree from the Savannah College of Art and Design. She specializes in breaking down science and medical jargon into digestible information.

Additional reporting to this story by Marlene Lenthang

As a health writer, Marlene Lenthang knows just how important it is to find the right product for your body and mind. Over the years she has written about health crises, vaccines and product guides. She takes careful note of doctor recommendations, medical research and customer reviews in every product review to assure readers can choose quality products and understand the science behind them.

Sours: https://www.verywellhealth.com/best-over-the-counter-hemorrhoid-treatments-4172472

Applied when cream hemorrhoid burns

hydrocortisone rectal (cream, ointment, suppository)

What is the most important information I should know about hydrocortisone rectal?

The information in this medication guide is specific to hydrocortisone rectal cream, ointment, or suppository.

Do not take hydrocortisone rectal by mouth. It is for use only in your rectum.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. You may need to use this medication for up to 8 weeks.

Call your doctor at once if you have any bleeding from your rectum, feeling short of breath (even with mild exertion), swelling of your ankles or feet, or rapid weight gain.

There may be other drugs that can interact with hydrocortisone rectal. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Call your doctor if your symptoms do not improve or if they get worse after using this medicine for a few days.

What is hydrocortisone rectal?

Hydrocortisone is a steroid medicine that reduces inflammation in the body.

The information in this medication guide is specific to hydrocortisone rectal cream, ointment, or suppository.

Hydrocortisone rectal is used to treat itching or swelling caused by hemorrhoids or other inflammatory conditions of the rectum or anus.

Hydrocortisone rectal is also used together with other medications to treat ulcerative colitis, proctitis, and other inflammatory conditions of the lower intestines and rectal area.

Hydrocortisone rectal may also be used for purposes not listed in this medication guide.

What should I discuss with my health care provider before using hydrocortisone rectal?

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

  • congestive heart failure;
  • a history of tuberculosis;
  • stomach ulcer or diverticulitis;
  • a colostomy or ileostomy;
  • fever or any type of infection;
  • kidney disease;
  • high blood pressure; or
  • myasthenia gravis.

Also tell your doctor if you have diabetes. Steroid medicines may increase the glucose (sugar) levels in your blood or urine. You may also need to adjust the dose of your diabetes medications.

FDA pregnancy category C. It is not known whether hydrocortisone rectal will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether hydrocortisone passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use hydrocortisone rectal?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Do not take hydrocortisone rectal by mouth. It is for use only in your rectum.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. You may need to use this medication for up to 8 weeks.

Wash your hands before and after using this medicine.

Try to empty your bowel and bladder just before using hydrocortisone rectal.

Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands. The rectal suppository can stain clothing or other fabrics it comes into contact with.

For best results from the suppository, lie down after inserting it and hold in the suppository. The suppository will melt quickly once inserted and you should feel little or no discomfort while holding it in.

For best results from the cream, use only the applicator provided with the medication. Otherwise, follow the directions provided with your rectal cream.

Avoid using the bathroom for one to three hours after inserting the cream or suppository.

Apply the ointment to the rectum and surrounding skin of the rectal area as directed on the package label.

Call your doctor if your symptoms do not improve or if they get worse after using this medicine for a few days.

Store the rectal cream at room temperature away from moisture and heat.

Store the rectal suppositories at cool room temperature away from moisture and heat. Do not refrigerate or freeze them.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of hydrocortisone rectal is not expected to produce life-threatening symptoms. However, long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using hydrocortisone rectal ?

Avoid getting a vaccine during your treatment with hydrocortisone rectal. Vaccines may not work as well while you are using a steroid medicine.

What other drugs will affect hydrocortisone rectal ?

Before using hydrocortisone rectal, tell your doctor if you also use insulin or take oral diabetes medication.

There may be other drugs that can interact with hydrocortisone rectal. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about hydrocortisone rectal cream, ointment, or suppository.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 3.02. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read, understood and agree to the End-User License Agreement, which can be accessed by End-User License Agreement, which can be accessed by clicking on this link.

Sours: https://www.uofmhealth.org/health-library/d03205n1
How to Apply Preparation H Multi-Symptom Pain Relief Cream

Counseling Patients With Hemorrhoids


US Pharm
. 2011;36(12):12-15. 

Hemorrhoids are swollen veins in the anal canal that cause a variety of symptoms.1-3 Anorectal problems such as hemorrhoids cause untold misery for many people at one time or another.1,4,5 Some persons may put off a pharmacist or physician consultation until the symptoms become unbearable. Unfortunately, many patients who initially seek relief through the use of a nonprescription product will require referral to a physician. 

Prevalence

The number of people with hemorrhoids is impossible to determine, as many who experience the symptoms consider them too embarrassing to share with a physician or pharmacist. However, at least 50% of people will have experienced hemorrhoidal symptoms by the time they reach the age of 50 years.2 

The Anatomy of Hemorrhoids

The anal opening is also referred to as the anal verge. Approximately 2 to 3 cm above this is an anatomical landmark known as the dentate or pectinate line, which is distinguished by a circular row of glands that secrete mucus that acts to lubricate the anal canal. Groups of normal submucosal vascular beds composed of supportive connective tissue, smooth muscle, and blood vessels surround the anal canal. When these beds enlarge, the result is hemorrhoids.2 The exact cause of the enlargement is open to further dispute, although the “straining” theory asserts that straining interrupts the tissues that support the vascular bundles, displacing them and leading to their congestion.4 

Classifications

Hemorrhoids are divided into three broad categories, depending on the point of origin.4 If the hemorrhoidal tissue originates above the dentate line, it is classified as an internal hemorrhoid, even if some of the tissue extends below.2,6 External hemorrhoids originate below the dentate line. Mixed hemorrhoids have features of both.2 

Manifestations

The degree of discomfort experienced by the patient is dependent on the type of hemorrhoids and the extent of their severity. Internal hemorrhoids lack nerves and are painless. When they cause bleeding, it is usually bright red and seen on the outer part of stools after defecation.6 The patient does not usually bleed at other times. The internal tissues may enlarge and push below the dentate line to protrude from the anal opening, especially after defecation.2 The patient may describe this to the pharmacist as a soft bit of tissue that shrinks back to normal shortly after defecation or requires the patient to manually push the tissue back into its normal position above the dentate line after each bowel movement (in more severe cases). 

Eventually, the patient with long-standing prolapse may discover that the tissue can no longer be replaced, a condition known as permanent prolapse. This tissue interferes with proper closure of the anal sphincter, and the patient may notice fecal staining of underwear. The irritant effect of the fecal material may in turn cause perianal dermatitis, in the same way that exposure to fecal material in infants causes diaper dermatitis. The patient with prolapse or bleeding is well advised to seek a physician’s care.2 Rectal bleeding must always be considered possible colorectal carcinoma until proven otherwise, and nonprescription products cannot reverse prolapse.7 

External hemorrhoids are fully innervated. Patients asking the pharmacist for assistance may be experiencing any degree of discomfort from minor itching or burning to severe pain.6 When they first occur, external hemorrhoids are often no more than small skin tags hardly noticed by the patient. However, they usually enlarge until the patient begins to notice perianal irritation, persistent moisture in the area, and increasing difficulty/pain in cleansing after defecation.2 If a vessel thromboses, the resultant perianal hematoma can cause severe and acute pain. It usually subsides slowly over several weeks, but the patient experiences extreme pain in the interim.6 Thrombosis may be induced by diarrhea, constipation, or physical activity such as riding a bicycle with a seat that places undue pressure on the anal area.2,4 

Nonprescription Treatments

For most minor hemorrhoids, conservative therapy may be all that is needed (e.g., adding fiber to the diet, drinking more water, using stool softeners).2,4,8 Pharmacists can advise patients to wash well with soap and water following each bowel movement, blotting the area rather than rubbing to minimize irritation. Patients should also take sitz baths, sitting in warm water 2 to 3 times daily for 15 to 30 minutes.1,6 

If these simple methods do not provide relief, the pharmacist may suggest nonprescription products unless their use is contraindicated. Contraindications include prolapse (especially prolapse that must be manually replaced or cannot be reduced), any rectal bleeding, use in patients less than 12 years old, or a problem that has persisted for more than 7 days.1,2,7 Due to the chronic nature of hemorrhoids, the 7-day rule regarding self-therapy means that many patients with hemorrhoidal symptoms will require physician referral when they initially speak to the pharmacist. These products should be recommended cautiously for the pregnant patient. Products that are placed above the dentate line (e.g., suppositories, ointments with a long applicator tube) could be absorbed, and could be toxic to the fetus. Thus, they are contraindicated in pregnancy. Products that are applied externally do not require the warning.  

If there are no contraindications, several ingredients and products may provide relief. Some anorectal product ingredients are safe enough to be used internally or externally, and can be found in ointments, suppositories, and wipes. Other ingredients are not suitable for internal use, and they are limited to external products (e.g., ointments and wipes). TABLE 1 presents examples of selected hemorrhoidal products.1

Protectants: Protectants are useful ingredients due to their ability to form a protective coating over the skin that prevents tissues from drying out; protect irritated areas; relieve burning and skin irritation; protect inflamed, irritated anorectal areas from abrasion and pain during bowel movements; and protect inflamed perianal skin.1,2 Cocoa butter, hard fat, lanolin, mineral oil, petrolatum, and topical starch may be used internally or externally. Glycerin may only be applied externally. Some protectants are internal or external but are only to be used in combination products. These include calamine, cod liver oil, shark liver oil, and zinc oxide. Protectants are applied after each bowel movement or as needed, up to 6 times daily; however, petrolatum may be applied liberally whenever needed. 

Local Anesthetics: Local anesthetics are not appropriate for internal use, as the mucosal lining of the rectum does not contain sensory nerve fibers.1 Thus, anesthetics are not included in suppositories or ointments meant for internal use, but they are included in external creams, gels, ointments, and wipes. They relieve pain, itching, soreness, burning, irritation, and discomfort.1,6 Benzocaine, benzyl alcohol, dyclonine, lidocaine, and tetracaine may be applied up to 6 times daily; pramoxine up to 5 times daily; and dibucaine 3 to 4 times daily. Patients may develop contact dermatitis to local anesthetics, leading to the following required warning: “Certain persons can develop allergic reactions to ingredients in this product. If the symptom being treated does not subside, or redness, irritation, swelling, pain or other symptoms develop or increase, discontinue use and consult a physician.”1 

Astringents: These ingredients exert a local and limited protein coagulant effect, temporarily protecting irritated anorectal areas and relieving irritation and burning. Calamine and zinc oxide have astringent activity (in addition to being protectants) and may be applied internally or externally. Witch hazel is applied only externally.6 Astringents may be used after each bowel movement or as needed, up to 6 times daily. 

Vasoconstrictors: These products constrict the blood vessels underlying tissues where they are applied, temporarily reducing the swelling associated with irritated hemorrhoidal tissues.1 Phenylephrine is the only vasoconstrictor in widespread use, and it is appropriate for internal or external use, applied up to 4 times daily. Products containing phenylephrine should not be recommended for patients with heart disease, hypertension, thyroid disease, diabetes, or difficulty in urination caused by an enlarged prostate. These products should also be avoided in patients taking prescription medications for hypertension or depression. 

Hydrocortisone: Hydrocortisone relieves anal itching.1,6 It is found in Preparation H Hydrocortisone 1% Cream and Tucks Hydrocortisone Ointment. 

Internal Analgesics: OTC internal analgesics may also help. Acetaminophen reduces minor pain, and ibuprofen and naproxen can help with pain and inflammation.1,2 They may be used concomitantly with the topical products in TABLE 1 (e.g., creams or ointments). 

Physician Treatments

Physician treatment of internal hemorrhoids depends on the degree of severity.5,8 If they have not yet prolapsed, or if they have prolapsed but spontaneously reduce, some medical experts suggest hydrocortisone, bulk laxatives, and institution of a high-fiber diet with increased liquid intake to keep stools soft.1,6 Should symptoms persist or worsen (e.g., prolapse requiring manual replacement or irreducible prolapse), the physician may choose from several procedures, such as sclerotherapy (injection of a sclerosing agent such as sodium morrhuate into the tissues); rubber band ligation (placement of a tiny rubber band at the base of each internal hemorrhoid); photocoagulation using infrared light; electrocoagulation; laser coagulation; or cryotherapy (using a liquid nitrogen probe inserted via an anoscope).1,2 Each treatment modality has it relative advantages and disadvantages (e.g., offensive discharge with cryotherapy) when compared to the other options. In light of the wide variety of office procedures available, surgical hemorrhoidectomy is usually reserved for only the most severe cases.2 

If the patient complains of intense pain, the pharmacist should consider the presence of a thrombosed external hemorrhoid.8 These hemorrhoids usually resolve in 7 to 10 days, but if they persist beyond this period, office excision and the application of a pressure dressing may be the treatment of choice. 


Causes of Hemorrhoids

The main cause of hemorrhoids is straining to pass a bowel movement. Since constipation is a major factor in causing people to strain to pass feces, it is a major factor in developing hemorrhoids. Similarly, bouts of diarrhea cause straining and can also lead to hemorrhoids. Sitting for long periods of time also leads to hemorrhoids, as do certain anal infections and some medical conditions, such as cirrhosis of the liver. 

Who Is More Prone to Hemorrhoids?

Hemorrhoids are especially common in pregnancy and the postpartum period. This is partly due to the changes that occur during pregnancy. It is also caused by the strain of pushing during labor, which can cause new hemorrhoids and also worsen existing ones. Overweight individuals and those with a family history of hemorrhoids are more likely to develop them. The risk increases with aging, with at least half of people who are 50 years or older seeking some form of care for them. 

Symptoms of Hemorrhoids

The classic symptoms of hemorrhoids are anal itching, aching or pain (especially when sitting), bright red blood on the rectal tissues or in the stool, painful bowel movements, protruding tissues, and one or more hard lumps in the anal area. 

When to See a Physician

If you experience anorectal discomfort of some type (such as burning, itching, or pain), the first thing to consider is that it may be a more serious condition, such as a fissure, abscess, or fistula, or simple anal irritation caused by allergies or incomplete cleansing following a bowel movement. For this reason, it is wise to follow directions on the product labels that advise use for no more than 7 days. If the problem persists for longer than 1 week from the time it began, see a physician to ensure that you do not have a more serious condition. 

It is also important to note that rectal bleeding requires an immediate physician appointment. Never assume that rectal bleeding is a minor problem that will disappear on its own. Rather, view it as a cause for alarm that requires an immediate physician appointment to screen you for such problems as colorectal cancer. 

Hemorrhoids occur with greater frequency as a person ages. Thus, hemorrhoid products should never be used on anyone under the age of 12 years. If you experience protrusion (your rectal tissues protrude from the anal opening after a bowel movement), you should also see a physician. These are prolapsed internal hemorrhoids that should be checked to see if they require surgical correction. 

Nonprescription Products

If none of the above situations apply, you may be able to safely use nonprescription products such as ointments, creams, gels, wipes, and suppositories (e.g., Preparation H, Tronolane, Tucks). Consult Your Pharmacist for assistance in choosing an appropriate OTC product to treat your hemorrhoids. 

REFERENCES

1. Pray WS. Nonprescription Product Therapeutics. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.
2. Hemorrhoids. WebMD. www.webmd.com/a-to-z-guides/hemorrhoids-topic-overview. Accessed October 31, 2011.
3. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol. 2010;30:231-237.
4. Hemorrhoids. Definition. Mayo Clinic. www.mayoclinic.com/health/hemorrhoids/DS00096. Accessed October 31, 2011.
5. Chen JS, You JF. Current status of surgical treatments for hemorrhoids—systematic review and meta-analysis. Chang Gung Med J. 2010;33:488-500.
6. Hemorrhoids. PubMed Health. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001337/. Accessed October 31, 2011.
7. Khan R, Hyman D. Hematochezia in the young patient: a review of health-seeking behavior, physician attitudes, and controversies in management. Dig Dis Sci. 2010;55:233-239.
8. Arezzo A, Podzemny V, Pescatori M. Surgical management of hemorrhoids. State of the art. Ann Ital Chir. 2011;82:163-172. 

To comment on this article, contact [email protected]

Sours: https://www.uspharmacist.com/article/counseling-patients-with-hemorrhoids

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Lidocaine for piles and itchy bottom - Cream, ointment, spray and suppositories

1. About lidocaine treatments for piles

Lidocaine is a local anaesthetic. It's used in some medicines to treat:

These treatments do not cure piles but they can help with the pain and itching.

Lidocaine treatments for piles come as creams, ointments, sprays and suppositories. You can buy them from a pharmacy.

Some treatments contain lidocaine mixed with a corticosteroid like hydrocortisone. If you're using hydrocortisone treatments for piles, read the leaflet that comes with your medicine as the instructions are different.

Other types of lidocaine

There are different types of lidocaine, including medicated plasters, injections and gels.

Find out more about using lidocaine for mouth ulcers, teething and sore throat or lidocaine skin cream for numbing the skin before a procedure involving a needle.

2. Key facts

  • Lidocaine treatments are used in different ways. Some creams and ointments are for internal use only, while others go on your skin. Always check the instructions.
  • You'll generally use lidocaine for piles several times a day – first thing in the morning, last thing at night and every time you poo.
  • Do not use lidocaine for longer than recommended. The local anaesthetic can make your skin sensitive over time or if you use it for too long.
  • Do not use lidocaine to treat piles in children under the age of 12 years – unless their doctor prescribes it.
  • There are a number of brand names, including the Anusol range, Boots haemorrhoid range, Germaloids range, Perinal and Xyloproct.

3. Who can and can't use lidocaine for piles

Most adults and children from the age of 12 years can use lidocaine treatments for piles.

Do not give this medicine to children younger than 12 years, unless they have a prescription from a doctor.

Lidocaine treatments are not suitable for some people.

To make sure this medicine is safe for you, tell your doctor or pharmacist if you are:

  • allergic to lidocaine or any other medicine
  • taking other medicines, such as codeine, which might be making you constipated. Being constipated means you're more likely to get piles

4. How and when to use it

It's usual to use most treatments for piles several times a day – first thing in the morning, last thing at night and every time you poo. Check the patient information leaflet that comes with your medicine.

Some piles treatments are only for use on the skin near your bottom (anus) – including sprays. These are for piles on the outside (called "external piles").

Some piles treatments come with an applicator so you can use the medicine inside your bottom – including suppositories. These are for piles on the inside (called "internal piles").

How to use it

Read the instructions that come with your medicine first.

Wash your hands before and after using lidocaine.

Cream or ointment for external piles

  1. Squeeze the tube and put a small amount of cream or ointment on your finger.
  2. Gently put it around the outside of your anus with your finger.
  3. Replace the cap on the tube.

Spray for external piles and itchy bottom

  1. Before using your spray for the first time you need to get it ready – push the pump down once or twice to do this.
  2. Separate your buttocks.
  3. Spray the area around the outside of your anus once.

Cream or ointment for internal piles

  1. Clean around your anus with mild soap and water, rinse and pat dry.
  2. Gently insert the applicator into your anus.
  3. Squeeze a small amount of the medicine into your anus.
  4. Remove the applicator, take it apart and wash it with soap and water.

Suppositories for internal piles

  1. Go to the toilet beforehand if you need to.
  2. Clean around your anus with mild soap and water, rinse and pat dry.
  3. Unwrap the suppository – which is a small plug of medicine.
  4. Stand with one leg up on a chair or lie on your side with one leg bent and the other straight.
  5. Gently push the suppository into your anus with the pointed end first. It needs to go in about 2cm to 3cm.
  6. Sit or lie still for about 15 minutes. The suppository will melt inside your bottom. This is normal.
Information:

Giving suppositories to children

If your child has a prescription for lidocaine for piles, visit the Medicines for Children website for advice on how to give rectal medicines.

What if I forget to use it?

If you forget a treatment, do it as soon as you remember. If you do not remember until you are within a few hours of the next one, do not worry – just skip the missed treatment and go on with your usual treatment routine.

6. Pregnancy and breastfeeding

It's safe to use lidocaine treatments for piles while you're pregnant or breastfeeding.

However, check with your doctor, midwife or a pharmacist first.

Here's more information on how to treat piles in pregnancy.

Important

Tell your pharmacist or doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

7. Cautions with other medicines

Lidocaine can potentially affect the way other medicines work. However, this is more likely when you're using lidocaine at higher doses or if you're having lidocaine injections.

If you're using your lidocaine treatment for piles as directed, it will not usually affect any other medicines.

Speak to your pharmacist if you have any questions.

Mixing lidocaine with herbal remedies and supplements

There's very little information about taking herbal medicines and supplements with lidocaine.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

8. Common questions

Sours: https://www.nhs.uk/medicines/lidocaine-for-piles-and-itchy-bottom/


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