Introduction

Proctology focuses on the diagnosis and treatment of conditions related to the anus and rectum. These conditions can often cause significant discomfort and pain, which can interfere with daily activities. Many available treatments, both topical and systemic, may not always provide sufficient relief. Fortunately, your pharmacist can prepare customized medications to help manage these conditions and alleviate the discomfort associated with them.

Hemorrhoids

Hemorrhoids (also known as piles) are swollen veins in the lining of the anal canal or lower rectum. They can either be internal, located inside the anus, or external, under the skin around the anus. Internal hemorrhoids often cause little discomfort, but external hemorrhoids are typically painful and may bleed when irritated.

While hemorrhoids are often associated with aging, pregnancy, chronic constipation or diarrhea, and prolonged sitting, they can also develop due to straining during bowel movements. These conditions disrupt blood flow in the area, leading to pooling and enlargement of the vessels.

Symptoms of hemorrhoids include bleeding, anal itching, and pain, though some people may have no symptoms at all and only discover their condition during routine physical exams or colonoscopy screenings. In most cases, symptoms resolve within a few days. Simple self-care and over-the-counter treatments can relieve pain and promote healing. Increasing fluid and fiber intake can soften stools, making them easier to pass.

Over-the-counter topical treatments like Tucks (witch hazel pads) and Preparation H (soothing creams with lidocaine, hydrocortisone, or phenylephrine) can offer relief. For more severe or thrombosed hemorrhoids, compounded prescription preparations may be necessary.

Anal Fissures

An anal fissure is a tear in the skin around the anus, often caused by hard stools, constipation, chronic diarrhea, or conditions such as pregnancy, childbirth, Crohn's disease, or anal herpes infections.

Fissures cause sharp, stinging pain, which intensifies during and after a bowel movement. This pain is often accompanied by bleeding. Most anal fissures heal quickly, but some can become chronic due to repeated injury during bowel movements. Increased pressure in the anal canal from muscle spasms of the internal anal sphincter can impede blood flow to the area, slowing healing.

Effective treatments for anal fissures focus on improving blood flow and relaxing the anal muscles to reduce spasms. Compounded topical medications like nitroglycerin, nifedipine, and diltiazem can be customized to help dilate blood vessels and relax the anal sphincter, promoting faster healing.

How Compounding Can Help

Your compounding pharmacist can prepare customized medications in various formulations to treat and manage conditions like hemorrhoids, anal fissures, idiopathic proctodynia (pain syndrome in the perianal region), and inflammatory bowel diseases like Crohn’s disease.

Additionally, your pharmacist can provide medications for managing pain after a hemorrhoidectomy (surgical removal of hemorrhoids). For patients receiving radiation therapy for pelvic malignancies, which can lead to radiation proctitis, your pharmacist can create a tailored treatment plan to address this complication.

If you think compounded treatments might be beneficial for you or a loved one, consult your healthcare provider. If so, your provider can contact us directly to discuss appropriate treatments.