What are the discharge instructions for patients with external hemorrhoids?

From the Guidelines

Discharge instructions for patients with external hemorrhoids should prioritize non-operative management, focusing on dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits, as recommended by the most recent guidelines 1. To manage symptoms, patients can take over-the-counter pain relievers like acetaminophen or ibuprofen as needed for discomfort.

• Apply topical treatments such as witch hazel pads, hydrocortisone cream (0.5-1%), or lidocaine ointment to reduce pain and swelling; these can be used 2-4 times daily for up to one week.
• Sitz baths (warm water soaks) for 10-15 minutes, 2-3 times daily, help relieve symptoms and keep the area clean.
• Prevent constipation by drinking 6-8 glasses of water daily, consuming high-fiber foods (25-30g daily), and using a stool softener like docusate sodium if needed. After bowel movements, clean gently with unscented, alcohol-free wipes or warm water and pat dry.
• Avoid straining during bowel movements, sitting for prolonged periods, and using scented toilet paper or harsh soaps on the affected area. Most external hemorrhoids improve within 1-2 weeks with these measures. Seek medical attention if you experience severe pain, bleeding that doesn't stop, fever, or if symptoms worsen despite treatment, as suggested by the guidelines 1. These instructions help reduce inflammation, prevent further irritation, and promote healing of the swollen blood vessels that form hemorrhoids, ultimately improving morbidity, mortality, and quality of life outcomes.

From the Research

Discharge Instructions for External Hemorrhoids

• The management of external hemorrhoids typically involves conservative measures, such as dietary changes, stool softeners, and local hydrocortisone creams 2.
• In cases of acutely thrombosed external hemorrhoids, excision of the entire hemorrhoidal mass and the overlying skin may be necessary to alleviate pain 2, 3.
• Patients with external hemorrhoids should be advised to:
  • Increase fiber intake to soften stool and reduce straining during bowel movements
  • Use stool softeners and topical creams as prescribed
  • Avoid prolonged sitting or straining during bowel movements
  • Take sitz baths to reduce discomfort and promote healing
• For patients with persistent or severe symptoms, further evaluation and treatment by a healthcare professional may be necessary 4, 5, 3.

Post-Procedure Care

• After excision of a thrombosed external hemorrhoid, patients should be instructed to:
  • Apply ice packs to reduce swelling and pain
  • Take pain medication as prescribed
  • Keep the area clean and dry to promote healing
  • Follow up with their healthcare provider for further evaluation and treatment 3, 6.

Follow-Up Care

• Patients with external hemorrhoids should be advised to follow up with their healthcare provider for further evaluation and treatment if symptoms persist or worsen 4, 5, 3.
• Regular follow-up appointments can help monitor the progression of the disease and adjust treatment plans as needed 2, 6.