Case scenario

Mary, 34 years old, is seeking your assistance with ‘something embarrassing’. After waking up, she noticed some pain and itchiness around her anus, and upon inspection, a sore, discoloured bulge that ‘definitely wasn’t there last week’.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

  • Describe the causes and symptoms associated with haemorrhoids and anal fissures
  • Summarise over-the-counter treatment options for haemorrhoids and anal fissures
  • Discuss potential interactions, adverse effects and precautions of treatment options
  • Recognise when referral to a doctor is required

Competency standards addressed (2016): 1.1, 2.1, 2.2, 2.3, 2.4, 3.1, 3.5

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What are haemorrhoids?

Symptomatic haemorrhoids, also known as ‘piles’, are characterised by enlargement, swelling, prolapse and/or thrombosis of swollen blood vessels.1

Haemorrhoids are a normal part of the rectal anatomy, being vascular cushions in the distal (lower) rectal mucosa. They provide a significant proportion of resting anal pressure, around 15–20% , contributing to the complete closure of the anal canal.1 Haemorrhoids a

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