DRUG INDEX
Hemorrhoids - Over-the-Counter Treatment
Diseases of the ano-rectal area--the rectum and anus (the opening of the rectum)--are annoying, uncomfortable, and sometimes distressing. Although they are potentially dangerous (they can bleed a lot), in most cases they disappear on their own and can be managed without prescription medications.
The peri-anal area, which is very sensitive to pain, includes the skin and buttocks surrounding the anus. The anal canal is a 2-inch channel connecting the last part of the gastrointestinal tract (the rectum) with the outside of the body. The anal canal is sensitive to pain as well as to pressure. The anal canal contains two muscles that control the elimination of stool. One muscle is under conscious (voluntary) control; the other is under unconscious (involuntary) control. The rectum, which is above the muscles and the anal canal, is not sensitive to pain but it is sensitive to pressure.
What are hemorrhoids ?
Like all parts of the body, the ano-rectal area is supplied by blood vessels. The arteries deliver the blood and the veins drain the blood away from the area. The most prominent blood vessels in the ano- rectal area are the hemorrhoidal arteries and veins. Hemorrhoids (also called "piles") are abnormally large, bulging, hemorrhoidal blood vessels, together with their surrounding tissue.
Hemorrhoids occur in one of every 25 persons, most often between the ages of 20 and 50. Factors thought to be involved in producing hemorrhoids include heredity (i.e. genetics), prolonged standing or sitting, pregnancy, lack of dietary fiber , heavy lifting with straining, constipation , and diarrhea . The common mechanism of their formation is felt to be an obstruction to the flow of blood within the veins that causes blood to "back up" and the vessels to enlarge. Depending on how high they are in the anal canal, hemorrhoids are classified as "internal" (high) or "external" (low).
What are the symptoms of hemorrhoids ?
Hemorrhoids cause itching, burning, swelling, and/or pain. Bleeding, seepage (the involuntary passing of small amounts of feces), or protrusion (the projection of the hemorrhoid outside of the anus) also may occur. Itching may be due to swelling and irritation produced by the hemorrhoids. However, there are many other sources of anal itching , such as pinworm infection or moisture in the anal area. Additionally, sensitivity to fabrics, perfumes in toilet paper, detergents, or to local treatments (including treatments for hemorrhoids) can cause itching. Oral, broad-spectrum antibiotics may lead to overgrowth of certain bacteria or fungi, which in turn can induce anal itching. Taking mineral oil regularly also can produce itching.
Bleeding from the anus is more common with internal than external hemorrhoids. It can occur before, during, or after defecation, though painless bleeding during defecation is the most common type of bleeding. Anal bleeding also may be a symptom of a different, more serious problem, such as polyps or tumors of the rectum or colon. Therefore, care must be used in attributing all bleeding to hemorrhoids.
Protrusion or bulging of the hemorrhoids from the anus occurs frequently. This usually occurs after defecation, prolonged standing, or unusual physical exertion. Protrusion can be painful or painless.
What are the over-the-counter treatments for hemorrhoids and anal itching?
Non-drug measures
Cleaning the peri-anal area with mild, unscented soap and water -- available as wipes or pads -- after each bowel movement can reduce swelling and itching. It is important to pat or blot rather than rub the irritated area. Toilet paper, which should also be unscented, should be blotted or patted as well.
Local anesthetics
Local anesthetics temporarily relieve the pain, burning, and itching by numbing the nerve endings. The use of these products should be limited to the peri-anal area and lower anal canal. Local anesthetics can cause allergic reactions with burning and itching (similar to hemorrhoids themselves). Thus, if burning and itching increase with the application of anesthetics, they should be discontinued. Examples of local anesthetics include: - Benzocaine 5% to 20%
- Benzul alcohol 5% to 20%
- Dibucaine 0.25% to 1.0%
- Dyclonine 0.5% to 1.0%
- Lidocaine 2% to 5%
- Pramoxine 1.0%
- Tetracaine 0.5% to 1.0%
Vasoconstrictors
Vasoconstrictors are chemicals that resemble epinephrine, a naturally-occurring chemical. Applied to the anus, vasoconstrictors make the blood vessels become smaller, which reduces some of the swelling. They also may reduce pain and itching due to their mild anesthetic effect. Vasoconstrictors applied to the peri-anal area - unlike vasoconstrictors that are taken orally or by injection - have a low likelihood of causing serious side effects, such as high blood pressure, nervousness, tremor , sleeplessness, and aggravation of diabetes or hyperthyroidism . Examples of vasoconstrictors include: - Ephedrine sulfate 0.1% to 1.25%
- Epinephrine 0.005% to 0.01%
- Phenylephrine 0.25%
Protectants
Protectants prevent irritation of the peri-anal area by forming a physical barrier on the skin that prevents contact of the irritated skin with aggravating liquid or stool from the rectum. This barrier reduces irritation, itching, pain, and burning. There are many products that are themselves protectants or that contain a protectant in addition to other medications. Protectants include: - Aluminum hydroxide gel
- Cocoa butter
- Glycerin
- Kaolin
- Lanolin
- Mineral oil
- White petrolatum
- Starch
- Zinc oxide zinc or calamine (which contains zinc oxide) in concentrations of up to 25%
- Cod liver oil or shark liver oil if the amount of vitamin A is 10,000 USP units/day.
Astringents
Astringents cause coagulation (clumping) of proteins in the cells of the peri-anal skin or the lining of the anal canal. This action promotes dryness of the skin, which in turn helps relieve burning, itching, and pain. Examples of astringents include: - Calamine 5% to 25%
- Zinc oxide 5% to 25%
- Witch hazel 10% to 50%
Antiseptics
Antiseptics inhibit the growth of bacteria and other organisms. However, it is unclear whether antiseptics are any more effective than soap and water. Examples of antiseptics in over-the-counter products include: - Boric acid
- Hydratis
- Phenol
- Benzalkonium chloride
- Cetylpyridinium chloride
- Benzethoneum chloride
- Resorcinol
Keratolytics
Keratolytics are chemicals that cause the outer layers of skin or other tissues to disintegrate. The rationale for their use is that the disintegration allows medications that are applied to the anus and peri-anal area to penetrate into the deeper tissues. The two approved keratolytics used in hemorrhoidal products are: - Aluminum chlorhydroxy allantoinate (alcloxa) 0.2% to 2.0%
- Resorcinol 1% to 3%
Analgesics
Analgesic/anesthetic products relieve pain, discomfort, and burning by depressing receptors on nerves. Examples include: - Menthol 0.1% to 1.0% (greater than 1.0% is not recommended)
- Camphor 0.1% to 3% (greater than 3% is not recommended)
- Juniper tar 1% to 5%
Other agents
Anticholinergics are included in some hemorrhoidal products. Anticholinergics are chemicals that block transmission of some nerves, but they only work when given systemically (e.g. orally) and not when applied locally to hemorrhoids.
Wound healing agents speed the healing of inflamed tissues. There is controversy about the effectiveness of an extract of brewer's yeast found in some over the counter medications (also known as live yeast cell derivative or LYCD) as a wound-healing agent. LYCD has not been shown to improve healing. There are no wound healing products available OTC.
Corticosteroids relieve itching and pain, but no products containing corticosteroids are available for the treatment of hemorrhoids without a prescription.
How are treatments for hemorrhoids and anal itching used ?
Medications used for the treatment of hemorrhoids and anal itching are available as ointments, creams, gels, suppositories, and foams. Ointments, creams, and gels -- when used on the outside of the anal canal -- should be applied as a thin covering over the peri-anal area. When applied to the internal part of the anus, these products should be inserted with a finger or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
Because suppositories can travel up into the rectum and away from the anal canal, they are not preferred for the treatment of hemorrhoids. They also act slowly since they must melt in order to release their active ingredients.
Foam products have no proven advantage over ointments.
What precautions or instructions are there for using these products?
Pregnant or lactating women should only use products that are recommended for external use (outside of the anal canal) or protectants, which can be used internally (within the anus). For internal use in non-pregnant women or men, additional products that are effective include astringents, vasoconstrictors, and protectants. As a general rule, products containing the fewest number of ingredients are recommended. Scented and tinted products are best avoided.
For maximum benefit, hemorrhoidal products are best used after, not before, bowel movements. If possible, the peri-anal area should be cleaned with soap and water prior to the application of the products. If seepage, bleeding, black tarry stools or protrusion occurs, a physician should be consulted.
|
DISCLAIMER:
Information on this site is provided for informational
purposes and is not meant to substitute for the advice
provided by your own physician or other medical professional.
You should not use the information contained herein
for diagnosing or treating a health problem or disease,
or prescribing any medication. You should read carefully
all product packaging. Not all Canadian drugs, Canada
prescription and Canadian prescription medicine is available
at discount Canadian on line pharmacies. If you have
or suspect that you have a medical problem, promptly
contact your health care provider. Information and statements
regarding diet supplements have not been evaluated by
Health Canada and are not intended to diagnose, treat,
cure, or prevent any disease. All trade and service
marks mentioned on this site are recognized as belonging
to their respective owners.
|
|
|
|
