Excuse my naive experience in this area.
Lets assume we have a patient with 2nd degree hemorrhoids, and we want to apply topical product to reduce the swelling of hemorrhoids, do we apply the product on the hemorrhoids after it prolapse or we wait till it return to its position spontaneously then we apply using an applicator? I mean the proper timing for the application of the product.
Second scenario, we have a patient with third degree hemorrhoids, will we apply the product on the prolapsed hemorrhoids or we reduce it manually then we apply the product afterwards using the applicator?
Dr.Deepak, what will happen if I applied the product to the prolapsed hemorrhoids instead of waiting till it returns to its normal position?
Deepak Sethi
I never use topic ointments, either before or after reduction. I use oral drugs, instead. Third degree piles are an indication for surgical procedure, in my opinion and experience.
Hi
Really speaking
I am not believing in topical agents in curing haemorrhoids,neither prolapsed nor 3rd degree haemorrhoids...
Manual reduction is better for relieving the pain and discomfort...
Some drugs stop bleeding like DAFLON
Some cryo therapy may cure the problem like ANOCRYO
SURGERY is still the best,if it is associated with mild-moderate rectal prolapse....
Regards to all.
The efficacy of topical treatments of haemorrhoids is doubtful. The curative treatment in my view is Surgery or banding
According to my experience,there is no difference but the patient may be more comfortable when it is reduced
Benign anal conditions, e.g., fissure, hemmorrhoids, and even early anal fistula development, are due to functional bowel disorders and should be treated accordingly by tackling the Functional bowel problems besides some local minimal support unless there is some complication. Some local anesthetic creams for pain of fissure, sitz baths, etc. If a perianal hematoma is present, it can be evacjuated surgically. If bleeding in hemmorrhoids occur, local sclerosant injection, e.g., aethosclerol or STD solution locally in the agffected hemmorrhoid is very effective. Surgery should be reserved only in refractive cases or in complications.
Topical preparations for Haemorrhoids have a very limited role but for the prolapsed inflamed Haemorrhoids they have no role,other options should be considered.
My own feeling after long observation of hemorrhoids is that the whole concept about its etio-pathology and hence, management needs complete rethinking. Old concept of three primary hemorrhoids is hardly observed in patients and their occurrence along the three branches of rectal artery is already challenged to prolapse of cushion of pads of ano-rectal mucosaand the overlying mucosa contains spongy mucosa with vascual plexus of artero-venous plexus. One hardly ever see an artery during open hemorrhoidectomy.
Current hypothesis expounds that these hemorrhoids are more of prolapse of ano-rectal mucosa. Clinically also, often the hemorrhoids are seen away from the traditional teaching of 3,7,11 O'Clock positions. Further externasl or interno-external hemorrhoids hardlly confirm to the traditional description.
Sir, the timing of application would depend on the agent used and its mechanism of action, however for prolonged duration of action, introduction of the agent with an applicator after reduction of the hemorrhoids would be better, since topical application while the piles are external may not have sufficient contact time or may be wiped off/absorbed by clothing.
Analgesic and local anesthetic agents may be applied to the hemorrhoid while prolapsed, corticosteriod based applications too may be applied while prolapsed especially if perianal eczema is concomitantly being managed, where as flavinoids would ideally be applied once the hemorrhoids have returned/reduced to their native sites because of the hypothesised phlebotonic and remodelling effects.
Apply when the tissue is in the correct position so the contact with the substance is there for a period as long as possible.
Better let the patient be examined physically by a surgen. The surgen would decide the things.
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