1. HEMORRHOIDS Factors associated with development of zGenetic zIncreased venous pressure from various causes zRectal tumors & causes for incomplete evacuation of stool from the rectum

2. HISTORY zBleeding & rectal pain most common complaint zDietary consumption of roughage zCharacteristics & degree of pain, itching, burning zCharacteristics & severity of bleeding - on toilet paper, in bowl, mixed with stool

3. PHYSICAL EXAM zInternal hemorrhoids - one or more intrarectal masses, usually soft & tender zBleeding of hemorrhoids coats stool whereas stool itself is negative for blood zInternal hemorrhoids may be large & prolapse through anus zThrombose hemorrhoids - firm & tender

4. TREATMENT zProper bowel & eating habits best preventative measures zCold packs 1st few hours, hot sitz bath bid for 20-30 minutes zUse of bulk laxatives or a high fiber diet, stool softeners & lubricants zMedications - astringent OTC in creams & suppository forms

5. FOLLOW-UP zRefer to GI if no improvement in symptoms in 4-7 days or have severe bleeding, unrelieved constipation zMinimize recurrence by reviewing preventative measures