Hemorrhoids: Self-care vs. Physician Care

, Professor of Nonprescription Products and Devices, School of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK

US Pharmacist. 2001;26(5) 

In This Article


The degree of discomfort experienced by the patient is dependent on the type of hemorrhoids and their severity. Internal hemorrhoids lack nerves and are painless. When they bleed, the blood is usually bright red and seen on the outer part of stools after defecation. The patient does not usually bleed at other times. The internal tissues may enlarge and push below the dentate line to protrude from the anal opening, especially after defecation. The patient may describe this protrusion to the pharmacist as a soft bit of tissue that shrinks back to normal shortly after defecation or that requires the patient to manually push the tissue back to its normal position above the dentate line after each bowel movement (in more severe cases).

Eventually, the patient with long-standing prolapse may discover that the tissue can no longer be replaced. This condition is known as permanent prolapse. Because the protruding tissue interferes with proper closure of the anal sphincter, the patient with permanent prolapse may notice fecal staining of underwear. The irritant effect of the fecal material may in turn cause perianal dermatitis, in the same way that exposure to fecal material in infants causes diaper dermatitis. Any patient with prolapse or bleeding should seek a physician's care. Nonprescription products cannot reverse prolapse and rectal bleeding is a sign of colorectal carcinoma. In fact, rectal bleeding must always be considered possible colorectal carcinoma until proven otherwise.

External hemorrhoids are fully innervated. Patients asking the pharmacist for assistance may be experiencing any degree of pain from minor discomfort or burning to severe pain. When they first occur, external hemorrhoids are often merely small skin tags, hardly noticed by the patient.[2] However, external hemorrhoids usually enlarge until the patient begins to notice perianal irritation, persistent moisture in the area, and increasing difficulty in cleansing after defecation. If a vessel thromboses, the resultant perianal hematoma can cause severe and acute pain. Although the hematoma usually subsides slowly over several weeks, the patient experiences extreme pain in the interim. Thrombosis may be induced by diarrhea, constipation, or an unusual physical activity such as riding an unfamiliar bicycle with a seat that places undue pressure on the anal area.


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