II. Prevention: Avoid Constipation (mainstay of therapy)

  1. Goal is soft bulky stool that is easily passed without straining
  2. High bulk diet (Dietary Fiber) 30 grams per day
  3. Increased volume of fluids 64 ounces non-caffeinated fluid per day
  4. Stool Softener (e.g. Colace)
  5. Avoid Irritant Laxatives

III. 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

IV. Prevention: Minimize anorectal local inflammation

  1. Practice good hygiene
    1. Witch hazel Tucks
    2. Baby wipes without Alcohol
  2. Avoid topical irritant or allergens
    1. Use only hypoallergenic soaps
    2. Use only white toilet tissue

V. 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

VI. 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 [PubMed]
  5. Hussain (1999) Prim Care 26(1):35-51 [PubMed]

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Ontology: Hemorrhoids (C0019112)

Definition (MEDLINEPLUS)

Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are either inside the anus or under the skin around the anus. They often result from straining to have a bowel movement. Other factors include pregnancy, aging and chronic constipation or diarrhea.

Hemorrhoids are very common in both men and women. About half of all people have hemorrhoids by age 50. The most common symptom of hemorrhoids inside the anus is bright red blood covering the stool, on toilet paper or in the toilet bowl. Symptoms usually go away within a few days.

If you have rectal bleeding you should see a doctor. You need to make sure bleeding is not from a more serious condition such as colorectal or anal cancer. Treatment may include warm baths and a cream or other medicine. If you have large hemorrhoids, you may need surgery and other treatments.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Definition (MSHCZE) Hemoroidy – řitní žilní městky, „zlatá žíla“. Rozšíření žilních struktur, které jsou v okolí dolní části konečníku a řitního kanálu. Na jejich vzniku se podílejí značnou měrou poruchy vyprazdňování, zejm. dlouhodobá zácpa. Vnitřní h. se projevují krvácením a v pozdější době mohou vyhřezávat do řitního kanálu. V léčbě je důležitá péče o stolici, úprava stravy, místní léčba (koupele, masti, čípky), někdy lze použít sklerotizace (njekčního podání látky, která vede k jejich uzávěru a zjizvení), v těžších případech se operují. Zevní h., které jsou viditelné pouhým okem, mohou někdy způsobit velmi bolestivý zánět. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by the presence of dilated veins in the rectum and surrounding area.
Definition (NCI) Dilated veins in the anal canal.(NICHD)
Definition (NCI_NCI-GLOSS) An enlarged or swollen blood vessel, usually located near the anus or the rectum.
Definition (MSH) Swollen veins in the lower part of the RECTUM or ANUS. Hemorrhoids can be inside the anus (internal), under the skin around the anus (external), or protruding from inside to outside of the anus. People with hemorrhoids may or may not exhibit symptoms which include bleeding, itching, and pain.
Concepts Acquired Abnormality (T020)
MSH D006484
ICD9 455
ICD10 I84 , K64
SnomedCT 155477004, 195472000, 155469003, 70153002
HL7 HEM
LNC LP30519-0, MTHU015043
English HAEMORRHOIDS, HEMORRHOIDS, Haemorrhoids NOS, Hemorrhoids, hemorrhoids (diagnosis), hemorrhoids, Hemorrhoids [Disease/Finding], hemorrhoid (pile), haemorrhoid, pile, Hemorrhoids NOS (disorder), Haemorrhoid (disorder), Haemorrhoids NOS (disorder), hemorrhoid, Piles, Hemorrhoid, Haemorrhoid, Haemorrhoids, Piles - haemorrhoids, Piles - hemorrhoids, Hemorrhoids (disorder), Haemorrhoids, NOS, Hemorrhoids, NOS, Piles, NOS, Hemorrhoids NOS, piles, haemorrhoids
Portuguese HEMORROIDAS, Hemorroidas, Hemorróidas
Spanish HEMORROIDES, Almorranas, hemorroides, SAI (trastorno), Hemorrhoids NOS, Haemorrhoids NOS, hemorroides, SAI, hemorroides (trastorno), hemorroides, Hemorroides
German HAEMORRHOIDEN, Haemorrhoiden, Hämorrhoiden
Dutch aambeien, Hemorroàden, hemorroïden, Hemorroïden, Aambei, Aambeien, Hemorroïd
Japanese 痔核, ジカク
Swedish Hemorrojder
Czech hemoroidy, Hemoroidy, zlatá žíla
Finnish Peräpukamat
Russian GEMORROI, ГЕМОРРОЙ
French HEMORROIDES, Hémorroïdes
Korean 치질
Polish Hemoroidy, Żylaki odbytu, Guzki krwawnicze
Hungarian Haemorrhoidok, Aranyerek, Aranyeres csomók
Norwegian Hemoroider
Italian Emorroidi