Hemorrhoid Management

Aka: Hemorrhoid Management

1. See also
   1. Hemorrhoid
   2. Internal Hemorrhoid
   3. External Hemorrhoid
   4. External Thrombosed Hemorrhoid
2. Prevention: Avoid Constipation (mainstay of therapy)
   1. Goal is soft bulky stool that is easily passed without straining
   2. High bulk diet (Dietary Fiber)
   3. Increased volume of fluids
   4. Stool Softener (e.g. Colace)
   5. Avoid Irritant Laxatives
3. Prevention: Avoid increased anorectal pressure
   1. Do not strain at stool
   2. Do not sit on toilet for prolonged periods
      1. Do not read on toilet
4. Prevention: Minimize anorectal local inflammation
   1. Practice good hygiene
      1. Witch hazel Tucks
      2. Baby wipes without Alcohol
   2. Avoid topical irritant or allergans
      1. Use only hypoallergenic soaps
      2. Use only white toilet tissue
5. Management: Pain (External Hemorrhoids)
   1. Hydrocortisone (no proven benefit if no inflammation; avoid prolonged use)
      1. Anusol HC
      2. ProctoFoam HC
   2. Analgesics
   3. Cold pack applied to anal area
   4. Hot sitz bath in tub for 20-30 minutes twice daily
      1. No evidence that this has benefit
6. References
   1. Pickard in Dornbrand (1992) Ambulatory Care, p. 225-6
   2. Goroll (2000) Primary Care, p. 430-1
   3. Schrock in Feldman (1998) Sleisenger GI, p. 1964-7
   4. Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97
   5. Hussain (1999) Prim Care 26(1):35-51