Haemorrhoids

• SImple analgesics for pain
• Local anaesthetics e.g Lidocaine, Benzocaine and Cinchocaine
• Bismuth oxide and zinc oxide to reduce inflammation and astringents
• Patients preference to: Creams, Ointments or Suppositories
• Bright red blood after defecation
• May be itchy but not painful unless prolapsed
• Symptoms for more than 3 weeks should be referred
• Patient should increase fibre (30g) and fluid (2l) intake
• Codine based painkillers cause constipation and may make the problem worse
• Local anaesthetics used for ma 7 days]
• Patients should go to the toilet when required and avoid straining
• Topical hydrocortisone for 7 days may relieve pain and inflammation
• Laxatives if constipation is present
• Refer to gp for removal
• Dark tarry or black blood required urgent referral due to internal bleeding