A practical guide to hemorrhoid therapy

Pruritus ani is caused by leakage of highly alkaline mucoid material from the anus onto the perianal area. After a stool passes, a pool of this material remains above the sphincter. During the day, when the patient coughs or bends over, this residue leaks out. The single most effective measure is to have the patient give himself an immediate postevacuation enema with plain water, using an empty Fleet enema container, which he can recharge after each bowel movement. In the immediate postoperative course of anorectal surgery, the use of any kind of anal or rectal plug to control bleeding is categorically condemned. So is the use of a finger to dilate the anus. Both measures are completely unnecessary. If the patient is returned to a regular diet the day after his operation and given laxatives, his own bowel movements will provide adequate dilation. If you do an extensive resection, check the patient in about 3 wk, when it is not so painful, to make sure the rectum has not undergone stricture. If there is a tendency toward stenosis, dilate the patient's anus weekly and have him do it daily.