external hemorrhoids

Introduction

Enlarged vein(s) in the perianal region.

Etiology

• prolapsed internal hemorrhoids
• perianal hematoma or remaining residual skin tag

Complications

• acute thrombosis

Management

• avoid constipation
  • fiber first line: wheat bran, psyllium (Metamucil, Fiberall)
  • stool softener: sodium docusate (Colace)
• topical preparations with hydrocortisone:
  • anusol HC TID
  • protofoam-HC
  • some preparation H formulations contain hydrocortisone
• topical anesthetics
  • lidocaine 2.5%
  • dibucaine (Nupercainal)
  • pramoxine
• no evidence that preparation H is effective
• systemic analgesics
• sitz baths
• avoid direct pressure
• acute thrombosis: incision, extraction of clot, compression of incised area following clot removal

More general terms

• hemorrhoids (piles)

Additional terms

• cortisol/pramoxine rectal (Anusol HC, Pramosone, Proctofoam-HC)
• dibucaine
• lidocaine (Xylocaine)
• psyllium (Metamucil, Fiberall)
• sodium docusate (Colace, DOSS, DSS)