Hemorrhoid Preparations

About 10 million Americans suffer from hemorrhoids. The occurrence of hemorrhoids is more prevalent among men than women, especially between the ages of 45 and 74 years, and increases with age.1 Hemorrhoids are varicose (swollen or dilated) veins that can be classified as internal (inside the anus) or external (around the exterior of the anus).1,2 Some patients may experience both types simultaneously.Symptoms of HemorrhoidsThe symptoms associated with hemorrhoids vary from mild to severe. The most common symptoms of mild hemorrhoids include itching, pain, burning, discomfort, and inflammation. Symptoms such as bleeding, changes in bowel habits, severe pain, thrombosis, and seepage are indications of a more severe case of hemorrhoids or other anorectal disorders that may require medical evaluation by a physician.^{1 Various factors can be attributed to the etiology of hemorrhoids, including lack of dietary fiber, episodes of prolonged sitting or standing, pregnancy, history of constipation or diarrhea, and obesity.}1,2TreatmentCurrently, there are a host of OTC hemorrhoid preparations on the market in formulations that include gels, creams, ointments, medicated wipes, and suppositories. These preparations may contain one or more of the following1: Local anesthetics?benzocaine, benzyl alcohol, dibucaine, lidocaine, pramoxineVasoconstrictors?ephedrine, epinephrine, phenylephrineProtectants?zinc oxide, shark liver oil, coca butter, topical starch, lanolinAnalgesics/anesthetics/antipruritics?menthol, juniper tar, camphorAstringents?calamine, zinc oxide, witch hazelCorticosteroids?hydrocortisone 1%Kerolytics?resorcinolThese OTC products are intended for the self-treatment of mild cases of hemorrhoids. Individuals with preexisting conditions, such as diabetes, hypertension, cardiovascular disease, hyperthyroidism, and enlarged prostate, should avoid the use of preparations that contain vasoconstrictors. In addition, patients taking monoamine oxidase inhibitors, tricyclic antidepressants, or antihypertensive agents should avoid the use of topical vasoconstrictors.1 Pregnant or breast-feeding women should use only products designed for external use and should consult their primary care physicians prior to use.ConclusionBefore recommending any of these products, pharmacists should ascertain the appropriateness of self-treatment and refer patients to seek medical care when warranted. Pharmacists should determine if the patient has any allergies or preexisting medical conditions. It is imperative that patients adhere to the recommended directions for use of the selected product. Pharmacists can assist patients in the selection of the dosage form that best suits their needs. Pharmacists can also make recommendations of nonpharmacologic measures, including eating a well-balanced diet, ensuring adequate fluid intake, increasing dietary fiber, or the use of a fiber supplement and/or stool softener. Pharmacists can advise patients to practice good personal hygiene, avoid lifting heavy objects or straining, take sitz baths if needed, and incorporate an exercise regimen into their daily routines. Patients should be encouraged to immediately seek medical care if symptoms worsen or new ones appear, such as severe pain or blood in the stool, or if symptoms are not showing signs of resolution after 7 days of self-treatment.1 Children under 12 years of age and patients with a history of colon cancer should always be referred to their primary care physician.

References

1. Berardi RR, Kroon LA, McDermott J, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006: 351-369.

2. Hemorrhoids. WebMD Web site. Available at: www.webmd.com/a-to-z-guides/digestive-disease-hemorrhoids. Accessed June 17, 2007.

3. www.drugstore.com.