Among gastroenterological disorders, haemorrhoids are diagnosed in outpatients as frequently as diverticular disease and only less frequently than gastroesophageal reflux disease, abdominal-wall herniation, and functional intestinal disorders. The most common complications of haemorrhoids are heavy bleeding, chronic unremitting prolapse of mucosal tissue, strangulation, ulceration and thrombosis.
Haemorrhoids are collections of submucosal, fibrovascular, arteriovenous sinusoids that are part of the normal anorectum. The purpose of these ‘vascular cushions′ is incompletely understood, but they appear to be important for sensing fullness and pressure and for perceiving anal contents. In addition, they may support anal closure, facilitate continence, and help protect the anal sphincter from injury during defecation.
Haemorrhoidal complexes are normally collected in the left lateral, right anterolateral, and right posterolateral regions of the anal canal but may be found in other locations. Hydrocortisone reduces the swelling, itching, and redness that can occur in these types of conditions. This medication is a mild corticosteroid used to treat minor pain, itching, swelling, and discomfort caused by haemorrhoids and other problems of the anal area (eg, anal fissures, itching). Hydrocortisone is a corticosteroid that reduces redness, itching, and swelling.
A 1% hydrocortisone cream on the skin outside the anus (not inside) can relieve itching, too. This product is usually used two to four times daily, or after each bowel movement. Dosage is based on medical condition and response to therapy. Patients should use this medication regularly.
KEY CLINICAL POINTS
- Patients who present with any symptoms related to the anorectum need to be carefully evaluated to determine the cause.
- Many patients who are found to have low-grade internal hemorrhoidal disease have a response to conservative medical management, which should include attention to local hygiene and bowel regulation through adequate fibre and water intake and the avoidance of straining.
- Most patients who do not have a response to medical management can be offered an in-office procedure, most commonly rubber-band ligation. This procedure, in concert with bowel regulation, can be highly effective.
Excisional therapies are more appropriate for patients in whom rubber-band ligation should not be performed or has failed and for those with grade IV disease or complications.