Haemorrhoids Counselling

PC3102 Week 2 Workshop 2 Poomitta Sivachandran

HAEMORRHOIDS W- WHO IS THE PATIENT? Hello my name is Poomitta, and Im the pharmacist today. Is there anything that I can assist you with? L- LOCATION Does the haemorrhoid protrude from the anus?

I- INTENSITY On defecation, is the pain a dull aching type? If painless, it is usually an internal haemorrhoid
If pain is severe, possibly grade 4 as this severe pain is due to spasm of the sphincter complex around the haemorrhoid. Stabbing pain- anal fissure?

N- NATURE

Can only treat if mild in nature, otherwise REFER. Soiling can occur with grade 3 and 4 due to impaired continence or mucus discharge, causing irritation and itching. Sensation of fullness and feeling of incomplete evacuation= prolapsed.

D- DURATION How long have your haemorrhoids been present for? O- ONSET Have you had haemorrhoids before? All initial cases need to be REFERED. If greater than three weeks- REFER.

C- CESSATION How often do you get haemorrhoids?

A- AGGRAVATION

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Haemorrhoids Counselling
PC3102 Week 2 Workshop 2 Poomitta Sivachandran

Is there anything that seems to worsen any of the symptoms you are experiencing? Pain in haemorrhoids often increases in severity when the patient defecates or is sitting down for prolonged periods of time.

R- RELIEF Has there been anything that seems to give you a bit of relief from the symptoms?

R- RADIATION Do you have any other symptoms? Should include bright red blood, pain and perianal itching.
Blood which is mixed into stool (due to GI system) = REFERAL

Large volumes of blood from anus, even when not defecating needs to be referred to eliminate carcinoma. Other symptoms such as nausea, vomiting, loss of appetite and altered bowel habit should be viewed with caution.

OTHER CONDITIONS TO ELIMINATE

Dermatitis- Itching is the only symptom. There is NO bleeding or prolapsed Anal Fissure- pain is INTENSE on defecation with bright red blood. REFER and tell patient to include more fibre into their diet and water Ulcerative Colitis and Crohns Disease- In addition to bloody stools, the stools are watery, the patient ALSO has abdominal pain and fever. Patients may also feel unwell and have urgency, nocturnal diarrhoea and early morning rushes. Upper GI bleeding- Stool is often tarry or black Colorectal Cancer- Change in bowel habit, middle aged patient, rectal bleeding is PERSISTENT and STEADY, may be tarry or bright red, depending on location.
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Haemorrhoids Counselling
PC3102 Week 2 Workshop 2 Poomitta Sivachandran

HAVE YOU TRIED ANYTHING YET? M- MEDICATIONS/ALLERGIES Are you taking any medications or do you have any medical conditions? Allergies? Haemorrhoid creams or ointments, suppositories dont interact with any other medications and can be used in pregnancy. CONFIRM DRUG OR DISEASE/PROBLEM These symptoms are indicative of .

ASK ABOUT THE PAST USE OF MEDICATIONS FOR THE CURRENT PROBLEM? Have you used anything in the past to treat this? How did that go for you?

INFORMATION OF WHY A COURSE IS RECOMMENDED. EXPLAIN THIS IN TERMS OF TREATMENT OF DISEASE AND BENEFITS

Today I will be recommending a product that contains a local anaesthetic and a local steroid. This product will provide you the best treatment over the counter as there is evidence to suggest that these products work best and will provide you with relief. They will temporarily reduce the pain and itching (anaesthetic) and reduce inflammation and swelling (hydrocortisone). This product is called Proctosedyl and is available in an ointment or suppository.

INFORMATION OF ANY MEDICATIONS OR TREATMENTS RECOMMENDED AND HOW TO USE IT INCLUDING DOSE, TIMING AND DURATION, WHETHER TO TAKE WITH FOOD OR WITHOUT AND HOW TO STORE THE DRUG Apply to the affected area twice daily and also apply after each bowel movement for up to 7 days. The action of the product will be quite short lived.

SPECIAL INSTRUCTIONS- TIME TILL EFFECT, TIME TILL FOLLOW UP If the symptoms are still present or have worsened within 1 week, make an appointment to see your doctor as it may require medical management.

SIDE EFFECTS AND RISKS- COMMON AND CATASTROPHIC

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Haemorrhoids Counselling
PC3102 Week 2 Workshop 2 Poomitta Sivachandran

1. Sensitisation of perianal skin making the symptoms worse after using the product (local anaesthetic) 2. Exacerbation of local infection and skin atrophy (topical corticosteroids) LIFESTYLE ADVICE Avoid sitting for long periods of time. Avoid vigorous straining, including lifting heavy items or when defecating. Chronic constipation and diarrhoea may also cause haemorrhoids, so make sure you treat this, if this is the case. To further relieve your symptoms, have a warm bath before going to the toilet, use warm water and nappy wipes after going and also dab rather than rub the area, when using the bathroom. (Pregnancy- pelvic floor exercises may be beneficial). I will just hand you a fact card to show you what you can do to prevent the reoccurrence of haemorrhoids)

SUMMARY AND QUESTIONS

Again, just apply this cream twice daily and after defecation. Avoid straining and lifting heavy loads. If the haemorrhoids are still present within 7 days make an appointment to see your doctor. Is there any questions that you have for me?

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