Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
First-line treatments for patients with symptomatic haemorrhoids in primary care primarily focus on conservative management through lifestyle and dietary modifications, alongside symptomatic relief NICE CKS.
- Dietary and Lifestyle Measures:
- Advise patients to gradually increase their dietary fibre intake by consuming whole grains, fruits, and vegetables NICE CKS.
- Emphasise the importance of adequate fluid intake, especially when increasing fibre, to ensure stools remain soft and well-lubricated, preventing intestinal obstruction NICE CKS.
- Patients should be advised to ensure their stools are soft and easy to pass NICE CKS.
- Provide lifestyle advice to aid haemorrhoid healing, including maintaining correct anal hygiene by keeping the area clean and dry, and patting (rather than rubbing) the area dry NICE CKS.
- Advise against 'stool withholding' and undue straining during bowel movements, as these can worsen the condition NICE CKS.
- Symptomatic Relief:
- Offer simple analgesia, such as paracetamol, for pain relief NICE CKS.
- Avoid opioid analgesics (e.g., codeine) due to their potential to cause constipation NICE CKS.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if rectal bleeding is present NICE CKS.
- Consider recommending a topical haemorrhoidal preparation for symptomatic relief NICE CKS. However, it is important to note that over-the-counter haemorrhoidal preparations should no longer be routinely prescribed NICE CKS. Topical preparations containing local anaesthetics and corticosteroids may provide symptomatic relief by reducing perianal inflammation, but they do not affect swelling, protrusion, or bleeding NICE CKS.