Hemorrhoids: The Daily PANCE Blueprint
A 56-year-old patient with a history of constipation and obesity presents to your clinic with anal discomfort and pain. On physical exam, you note a few small external hemorrhoids in the anal region. Which of the following is the most appropriate intervention?
A. Inject a sclerosing agent
B. Hemorrhoidectomy
C. Increased dietary fiber and Sitz baths
D. Rubber band ligation
E. Topical steroids only
Answer and topic summary
The answer is C. Increased dietary fiber and Sitz baths
Hemorrhoids are basically varicose veins of the anus and rectum. Risk factors include constipation, pregnancy obesity, prolonged sitting, and anal intercourse. There are two main types: external and internal. General treatment includes Sitz baths, stool softeners, a high-fiber diet, and topical steroids. Rubber band ligation can be done for internal hemorrhoids. Hemorrhoidectomy is indicated for patients who do not respond to normal management.
Here is the differences between external vs internal:
INTERNAL: not painful, above the dentate line, presents as bright red blood per rectum
EXTERNAL: painful, distal to the dentate line, not usually bloody, itching around the anus or rectal area
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
Also covered on the Emergency Medicine EOR, Family Medicine EOR, Internal Medicine EOR, and General Surgery EOR topic list
