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external hemorrhoids
Enlarged vein(s) in the perianal region.
Etiology:
1) prolapsed internal hemorrhoids
2) perianal hematoma or remaining residual skin tag
Complications:
- acute thrombosis
Management:
1) avoid constipation
a) fiber first line: wheat bran, psyllium (Metamucil, Fiberall)
b) stool softener: sodium docusate (Colace)
2) topical preparations with hydrocortisone:
- anusol HC TID
- protofoam-HC
- some preparation H formulations contain hydrocortisone
3) topical anesthetics
a) lidocaine 2.5%
b) dibucaine (Nupercainal)
c) pramoxine
4) no evidence that preparation H is effective
5) systemic analgesics
6) sitz baths
7) avoid direct pressure
8) acute thrombosis: incision, extraction of clot, compression of incised area following clot removal
Related
cortisol/pramoxine rectal (Anusol HC, Pramosone, Proctofoam-HC)
dibucaine
lidocaine (Xylocaine)
psyllium (Metamucil, Fiberall)
sodium docusate (Colace, DOSS, DSS)
General
hemorrhoids (piles)
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 1423-24
- Principles of Ambulatory Medicine, 4th edition, Barker
et al (eds), Williams & Wilkins, Baltimore, 1995, pg 1354