External Hemorrhoid

Pt with h/o constipation/straining presents with rectal bleeding. Hemorrhoid visible on exam.

• Refer for colonoscopy due to [FOBT+, iron deficiency anemia on CBC]

• Age>50 and no colonoscopy within the past 10 years: refer for colonoscopy

• Age>40 and no colonoscopy within the past 10 years with one 1st degree relative diagnosed with colorectal CA prior to age 60: refer for colonoscopy

• Age>40 and no colonoscopy within the past 5 years with more than one 1st degree relative diagnosed with colorectal CA prior to age 60: refer for colonoscopy

• Topical nifedipine/lidocaine for pain relief

• Stool softener, fiber supplementation

• Discussed importance of adequate fluid intake

• Refer to surgery: Concern for thrombosis due to acute onset of severe pain