Hemorrhoids drug information page

Hemorrhoids ( piles )

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What is Hemorrhoids ?

• Hemorrhoids are varicose veins (swollen veins) that appear in the rectal area

• condition in which the veins around the anus or lower rectum are swollen and inflamed

• Refer to abnormally large, bulging, dilated blood vessels

• hemorrhoids represent downward displacement of anal cushions that contain arteriovenous anastomoses. Although hemorrhoids are considered a minor medical problem


Types of Hemorrhoids

1-Internal Hemorrhoids

First degree

Second degree

Third degree

Fourth degree

2-External Hemorrhoids

3-Mixed HemorrhoidsDrug information page

1-Internal Hemorrhoids

exaggerated vascular cushions located above the dentate line and covered with mucous membrane

Second degree First degree

descend with defecation but returns spontaneously with relaxation mild discomfort and bleeding

does not descend or prolapsed during straining on defecation. Painless bleeding is present.

Fourth degreeThird degree

is permanently prolapsed and cannot be manipulated manually. Thrombosis often occur.

requires manual replacement into the rectum after prolapsed. Pain, bleeding, and discharge of mucus are present.


2-External Hemorrhoids

• is a dilated vein of the inferior hemorrhoid plexus located below the dentate line

3-Mixed Hemorrhoids

• exhibit simultaneous characteristics of internal and external hemorrhoids


Dentate line Line which divides the upper 2/3rds of the anal canal

And lower 1/3rds of the anal canalInternal Hemorrhoid located above dentate line External Hemorrhoid located below dentate line


Causes

1-Common cases

irregular bowel habits (constipation or diarrhea) Nutritional factors (low- Fibers diets) heavy lifting increased intra-abdominal pressure(prolonged straining , pregnancy ) increased pressure in the veins of your anus or rectum Genetics Aging Obesity Chronic cough


2-Diet that may cause Hemorrhoid

-ALCOHOL-SALTY FOODS

such as French fries, potato chips, pretzels, canned soups and salted nuts

-FATTY FOODSlike sausage, beef, fried chicken, ham and lamb

-SUGARY FOODSsugary foods such as muffins, doughnuts, cakes, cookies, sodas, candy and ice cream

-SPICY FOODS


3-Rare causes

In patients with liver disease, varices may occur because of the dual blood supply to the rectum.

When viewed Endoscopically, rectal varices occur in the rectum and hemorrhoids are located in the anus. In such cases, treatment of the liver disease and portal system decompression is the primary goal


Pregnancy & Hemorrhoids

During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. Delivery also leads to increased intra-abdominal pressures

Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery.


Symptoms

1. Painless bleeding (the most common sign/symptom). The blood is usually bright red an d may be visible on the stool

2. Prolapsed(the second most common sign/symptom)

3. Pain is unusual unless thrombosis involving external tissue is present

4. Discomfort, Pruritis, swelling


Tests and diagnosis

The diagnosis of hemorrhoids is based on a medical history and physical exam. A digital rectal exam and anoscopy may be the only tests needed at first. Your doctor will decide which tests to use.


• To make sure nothing else (like colon cancer) is causing your symptoms, you may need other tests, such as:

Flexible sigmoidoscopy. This test allows a doctor to look inside the anus,rectum, and lower part of the large intestine (colon) for abnormal growths or other signs of disease.

Barium enema.

Colonoscopy.


Conditions like Hemorrhoids• Proper diagnosis is important, because there are a

number of conditions that like hemorrhoids in symptoms like:

1. An anal abscesses: usually staphylococcus infection2. An anal fissures :is an unnatural crack or tear in the skin of

the anal canal3. An anal fistula :is an abnormal connection between the

epithelialised surface of the anal canal and (usually) the perianal skin


Conditions like Hemorrhoids

4. Inflammatory bowel diseases

5. Polyps: begnin tumor of the large intestine.

6. Colorectal cancer


Treatment1-Non-Pharmacological

• Most hemorrhoids can be treated with simple changes to diet and bowel habits. Most do not require surgery or other treatment unless the hemorrhoids are very large and painful.

• Acquiring enough fiber is the first step inside your hemorrhoid treatment. Fiber helps keep clean your bowel and could make bowel movement less difficult

• carbonated drinks as we as alcohol.

• have a large quantity of water as your hemorrhoid treatment.


High Fibers DietThe American Dietetic Association recommends 20 to 35 grams of fiber each

day. Over 35 grams of fiber a day may cause excess bowel gas


1-Non-Pharmacological

• Drink a lot of fruit juice and after that vegetable juice also, as each of these contain Vitamin C that can empower your immune system, that will aid inside your restoration.



• Take warm sitz-baths :

a bath where the pelvic region is immersed in warm water. It is recommended for 15 minute three or four times daily. prolonged bath should be avoided



• Lastly, you possibly can begin using an ice pack on top of the painful region for your hemorrhoid treatment. The ice would probably cool-down the aggravation, forcing the puffiness to decline and relieving you of the pain and rawness connected with hemorrhoids.


First & second-degree internal hemorrhoids treatment

a. Reduce straining and downward pressure

b. Correction of constipation

c. Sitz baths

d. OTC hemorrhoidal ointments, creams, foams, suppositories


Higher degree internal hemorrhoidstreatment

a. Hemorrhoid banding: is a procedure in which the physician puts a tight band around the hemorrhoid to control bleeding



b. Infrared photocoagulation: infrared light is focused at the base of hemorrhoids thereby cutting off the blood supply to the hemorrhoids and destroying them.

Video to show itttps://www.youtube.com/watch?v=0aNTFMQrthE


https://www.youtube.com/watch?v=0aNTFMQrthE







c. Sclerotherapy: injection of a sclerosing agent into the hemorrhoids



d. Cryotherapy: freezing the hemorrhoids

e. Surgical hemorrhoidectomy: (surgical remove of hemorrhoides)


What to treat hemorrhoids during pregnancy?

• Soak in warm water.

• Try witch hazel.

• Use ice.

• Keep anal area clean.

• Avoid sitting for long periods of time

• Drink plenty of liquids.

• Eat foods high in fiber.

• Don't gain too much weight.


Medications to treat Hemorrhoids

1-Local AnesthetisesLike: (benzocine , dibucaine , lidocaine , benzyl alcohol )

Not to be used for more than 7 days

Not to be applied to broken skin

Should be used for pain , itching & burning in the anal canal (not in the rectum because the rectum contains no sensory pain receptors


2-Vasoconstrictors

-For a temporary relief of itching and irritation, these agents have a local anesthetic effect of unknown mechanism.

-agents Like: (Ephedrine , Epinephrine , Phenylephrine )

-Care should be taken to patients with cardiovascular disease, high blood pressure, hyperthyroidism, diabetes, and prostate enlargement.

-high doses may cause: nervousness, tremors, sleeplessness, nausea, and loss of appetite. Cardiac arrhythmias, irregular heart rate, and elevation of blood pressure are potentially serious effects, but less likely at recommended doses.


3-Protectants

-Provide a protective coating over skin or mucous membranes.

-They prevent irritation of anorectal tissue and prevent water loss from the stratum corneum.

-Agents like :aluminum hydroxide gelcocoa butterlanolinhard fatmineral oilshark liver oilcod liver oil white petrolatum glycerine( external use only) zinc oxide


4-Astringents

-Protect underlying tissue through protein coagulation.

provide temporary relief of itching, discomfort, irritation, and burning.

Agents like : (calamine & zinc oxide )

5-Keratolytics

Cause desquamation of the surface cells of the epidermis

provide temporary relief of discomfort and itching. Agents like : (Resorcinol )for external use only. Resorcinol should not be used on an open wound


6-analgesics , anesthetics

& antipruitics ( inhibit itching )

-temporary relief of burning, discomfort and pain.

-The FDA classified them as counterirritants.

-agent like : (menthol , juniper tar ,Camphor )

- These agents should not be used to treat internal hemorrhoids

7-Wound healing agents :

-Live cell yeast derivative (LYCD: skin respiratory factor)

- FDA removed them from the list of safe and effective ingredients


8-Hydrocortisone

-used to reduce itching, inflammation and discomfort.

- Adverse effects: it may mask bacterial and fungal infections

promoting their progress.


How To Get Rid Of Hemorrhoids | Self Healing Techniques Series

First find most painful points on areas corresponding to the rectum according to figure 1.

Now find a little stick with a not too sharp edge Press these points with a moderate effort and begin a slow rotation of the stick in two directions. Carry out this massage for several minutes. See figure 2.


Hemorrhoids bleeding treatment Diosmin and Hesperidin is used ( Daflon tab ® )

For more information read this article

http://www.life-enhancement.com/magazine/article/472-no-more-bleeding-hemorrhoids














Products used in Egyptian market

1-Anusol ® (Zinc oxide , Bisthmus subgallate , balsam peru , bisthmus oxide )

balsam peru is demulcent

Bisthmus subgallate is astrigents


Products used in Egyptian market • Anuso-HC ® (Anusol ® + Hydrocortisone )

• Faktu ® (Policresulen and cinchocaine )

Policresulen as antiseptic

Cinchocaine as local anesthetic


I hope that you got a total idea about Hemorrhoids and will understand it as a

pharmacist Forgive me if I missed anything !

Thanks for your kindly watching !!

Dedicated by : Ibrahim Gomaa’

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Hemorrhoids drug information page