Info

Other Tests: Barium enema, protoscopic ultrasound, virtual colonoscopy.

^ PLANNING AND IMPLEMENTATION Collaborative

Generally, hemorrhoids can be managed pharmacologically. Conservative treatments include application of cold packs to the anal region, sitz baths for 15 minutes twice a day, and local application of over-the-counter treatments such as witch hazel (Tucks) or dibucaine (Nupercainal) ointment. If conservative treatment does not alleviate symptoms in 3 to 5 days, more invasive management may be needed.

Invasive treatment may be indicated for thrombosis or severe symptoms. Sclerotherapy obliterates the vessels when the physician injects a sclerosing agent into the tissues around the hemorrhoids. With elastic band ligation, rubber bands are put on the hemorrhoids in an outpatient setting. The banded tissue sloughs. Successive visits may be necessary for many hemorrhoids. Although rubber band ligation has a high success rate, it may temporarily increase local pain and cause hemorrhage. In cryosurgery, the physician freezes the hemorrhoid with a probe to produce necrosis. Cryosurgery is used only for first- and second-degree hemorrhoids.

The most effective treatment is hemorrhoidectomy, the surgical removal of hemorrhoids, which is performed in an outpatient setting in 10% of patients. When the patient can resume oral feedings, administer a bulk medication such as psyllium. This medication is given about 1 hour after the evening meal to ensure a daily stool, which dilates the scar tissue and prevents anal stricture from developing. Postoperative care includes checking the dressing for excessive bleeding or drainage. The patient needs to void within the first 24 hours. If prescribed, spread petroleum jelly on the wound site and apply a wet dressing. Complications include urinary retention and hemorrhage. The newest surgical technique for treating hemorrhoids is stapled hemorrhoidectomy. The surgery does not actually remove hemorrhoids but rather the supporting tissue that causes hemorrhoids to prolapse downward.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Docusate sodium

100 mg bid PO

Stool softener

Eases defecation

(Colace)

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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