A hemorrhoid is a symptomatic dilation of the hemorrhoidal venous plexus resulting in perianal swelling, itching, pain, hematochezia, and fecal soiling.
_ Dilated rectal venous plexus with varying degrees of inflammation.
_ Pregnancy, obesity, chronic cough, constipation, heavy lifting, sedentary work or lifestyle, hepatic disease, colon malignancy, portal hypertension, loss of muscle tone resulting from age, surgery, episiotomy, anal intercourse, or neurologic disease (multiple sclerosis).
SIGNS & SYMPTOMS
Anal itching and pain (especially with thrombosis or ulceration)
Constipation and straining for bowel movement
Rectal incontinence and soiling
Hematochezia and stool mucus
Anal fissure, infection, or ulceration
_ Surgical therapy is appropriate for those patients with debilitating symptoms or for whom medical therapy has failed (15% to 20% of patients). Banding of internal hemorrhoids is better accepted by patients than traditional surgical therapy. Hemorrhoidal banding requires a minimum of equipment and is well suited to the office or outpatient surgical setting. Some aching is generally experienced for several days after hemorrhoid banding procedures. Sitz baths and topical analgesics such as witch hazel are generally sufficient.
_ Increased dietary fiber.
_ Avoid prolonged sitting, straining, or heavy lifting. Encourage physical fitness.
DRUGS OF CHOICE
Dietary fiber supplements. Stool softeners—docusate sodium (Colace, Dialose, Sof-Lax) 50 to 300 mg PO daily (larger doses are generally divided over the day).
Topical analgesic sprays or ointments—benzocaine (Americaine, Hurricaine) 20% spray or gel, dibucaine (Nupercainal) 1% ointment.
Antipruritics and anti-inflammatory agents—hydrocortisone (Anusol-HC, Analpram-HC, Cortenema, Cortifoam, Epifoam, Proctofoam-HC), pramoxine 1% (Fleet rectal pads, Analpram-HC), witch hazel 50% (Tucks pads or gel).