Question 1

A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient's symptoms?

A) A high-fiber diet and increased fluid intake
B) Daily laxatives to prevent straining with stools
C) Infiltration of a local anesthetic into the hemorrhoid
D) Referral for possible surgical intervention

A

Accepted Answer

The patient's symptoms are consistent with external hemorrhoids, which are often caused by straining during bowel movements. Treatment should focus on reducing straining and promoting softer stools. A high-fiber diet and increased fluid intake can help achieve this by adding bulk to stools and decreasing constipation. Daily laxatives are not necessary and may cause dependence. Infiltration of a local anesthetic into the hemorrhoid may provide temporary relief of pain but does not address the underlying cause. Referral for surgical intervention may be considered if symptoms are severe or do not improve with conservative measures.

Question 2

What recommendations are appropriate for patients with chronic pruritus ani? (Select all that apply.)&#10;A) Application of a topical antihistamine&#10;B) Applying a of 1% hydrocortisone cream for several months&#10;C) Avoid tight-fitting or non-breathable clothing&#10;D) Avoiding perfumed soaps and toilet papers&#10;E) Using a hair dryer on the cool setting to control itching

Accepted Answer

Avoiding tight-fitting or non-breathable clothing, perfumed soaps, and toilet papers can help reduce irritation. Using a hair dryer on a cool setting can help keep the area dry and reduce itching. Long-term use of topical hydrocortisone is not recommended due to potential skin thinning, and topical antihistamines are not typically recommended for pruritus ani.

Deck 110: Anorectal Complaints