Case scenario

Sarah, a 42-year-old woman, presents to the pharmacy reporting a small lump near the anus, occasional bright red bleeding on toilet paper after bowel movements, anal itching and discomfort. She mentions feeling embarrassed to seek advice and has been self-managing with sitz baths. She reports a history of chronic constipation with frequent training during defecation. She is not taking any regular medicines and requests an over-the-counter product to relieve her symptoms. You take the time to explore Sarah’s symptoms in more detail, to help identify any red flags that would require immediate referral. You ask about the duration, severity and other symptoms such as fatigue, unintentional weight loss and changes in bowel habits, all of which she denies.

Learning objectives

After reading this article, pharmacists should be able to:

  • Describe the classification and causes of anal fissures and haemorrhoids
  • Identify the clinical features of anal fissures and haemorrhoids
  • Discuss management strategies for anal fissures and haemorrhoids
  • Describe the pharmacist’s role in supporting individuals with anal fissures and haemorrhoids.

Competency (2016) standards addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5

Accreditation code: PSAAP2604HQ

Accreditation expiry: 31/03/2028

Accreditation points: Up to 1 Group 2 CPD

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Epidemiology

Anal fissures and haemorrhoids are commonly encountered, but their epidemiology is not well documented. Haemorrhoids represent th

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