# Symptomatic Haemorrhoids - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ASCRS Clinical Practice Guidelines for Management of Hemorrhoids 2018 · Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) · Internal Hemorrhoid - StatPearls NBK537182, disease-level clinical article (haemorrhoids-symptomatic-full.txt). StatPearls has no combined haemorrhoids chapter; external haemorrhoids appear only in this article's differential - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract - Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) ## Treatment metadata - Diosmin + Hesperidin — 500 mg — oral.solid - Cinchocaine + Hydrocortisone — topical - Lactulose — oral.liquid ## Complete treatment card ```text SYMPTOMATIC HAEMORRHOIDS Sources: ASCRS Clinical Practice Guidelines for Management of Hemorrhoids 2018 · Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) · Internal Hemorrhoid - StatPearls NBK537182, disease-level clinical article (haemorrhoids- symptomatic-full.txt). StatPearls has no combined haemorrhoids chapter; external haemorrhoids appear only in this article's differential Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (10) - The label is over-used - fissures, fistulas and abscesses get called piles by patients and by doctors alike [fistula · haemorrhoids] - The complaints are itching, bleeding, pain, burning, prolapse, mucus, wetness, swelling, or trouble keeping clean [bleeding · itching] - Some describe it as sitting on something that is not there - An internal pile arises above the dentate line and by rights should not hurt at all - So when the complaint is pain, look for a fissure or an excoriated perineum before settling on piles [haemorrhoids] - Severe pain means it has clotted off or strangulated - The bleeding is bright red and comes at the end of the motion; blood mixed through the stool, or black stool, is a different problem [bleeding] - A prolapsing pile gives fullness, an urge to go, or the sense of not having finished - Once it prolapses fully there is a lump, and soiling or wetness with it [faecal incontinence] - Ask what is driving it - constipation, diarrhoea, heavy lifting, a chronic cough, too little fibre and water [constipation · cough · diarrhoea] SIGNS - what you find (5) - Look for the cause on general examination: liver disease, chronic lung disease, a distended abdomen or a loaded rectum [abdominal distension] - Prone jackknife gives the best view of the perineum; left lateral or lithotomy will also do - Inspect first and name what is there - external piles, skin tags, a prolapsing internal pile, a fissure, a fistula, an abscess [abscess · fistula · haemorrhoids] - Then feel: a mass, hardening of the tissue, tenderness - The digital examination finishes it - sphincter tone, any mass, pain, an abscess [abscess] TESTS (7) - Anyone you think has piles needs an anoscopy - the article allows no exception - A side-viewing scope is best: the pile drops into the slot and you can judge its bulk - A clear disposable one shows the whole anal canal in a single look - Ask the patient to bear down during the examination, or the prolapse will be under-graded - In some patients only straining while seated on the toilet shows how far it comes down - Add proctoscopy, and do it without fail where there is bleeding, weight loss, a change in bowel habit or anaemia - With any of those red flags consider a full colonoscopy - finding piles does not excuse you from excluding a cancer IF NOT THIS - what else fits (5) - External haemorrhoids, which sit below the dentate line and do hurt - An abscess beside the anus - Fistula disease - Cancer of the anus or rectum - the reason the red flags above are not optional - An anal fissure, which is the usual answer when the complaint is pain Source StatPearls "Internal Hemorrhoid" - disease-level clinical article Status traced to the source above Rx: Main treatment | Local relief | Stool softening MAIN TREATMENT 1. DIOSMIN + HESPERIDIN [1st line] Adult Acute attack: 2 tablets 3 times daily for 4 days, then 2 tablets twice daily for 3 days; Chronic: 1 tablet twice daily x 7 days (acute) or 4-8 weeks (chronic) Peds Not recommended in children Source Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract Why Micronized purified flavonoid fraction (Daflon) widely prescribed and available in Egypt as phlebotonic Caution This is the first-line phlebotonic for acute haemorrhoidal bleeding and swelling. Take with food. Discontinue if severe stomach discomfort occurs. Egypt DIOSMIN PLUS 500 MG 30 F.C.TABS. MARCYRL PHARM... 111.00 EGP (3.70/unit) VASCUREST 500MG 30 F.C.TABS. D B K PHARMA ... 147.00 EGP (4.90/unit) DAFLON 500 MG 30 F.C. TABS. SERVIER 236.00 EGP (7.87/unit) LOCAL RELIEF - give alongside 2. CINCHOCAINE + HYDROCORTISONE [add-on - not a substitute] Adult Apply ointment or insert 1 suppository rectally twice daily (morning and night) and after defecation x 7 days maximum; if the piles are no better by then, review rather than repeat Peds Not recommended in children under 12 years Source Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) Why Combined local anaesthetic and topical corticosteroid that numbs the area and reduces perianal inflammation and itch; added to dietary and stool-softening measures for symptom relief, not a treatment for the underlying haemorrhoidal disease, and limited to a short course to avoid mucosal thinning. Caution LIMIT TO 7 DAYS MAX: prolonged rectal corticosteroid use causes mucosal atrophy and systemic absorption. Rule out colorectal malignancy if rectal bleeding persists or is accompanied by altered bowel habit. Seven days and no longer. Past that the steroid thins perianal skin and can suppress the adrenal axis - which happens here without any dressing, because the rectum absorbs freely. Not onto anal thrush, tuberculous lesions, or herpes simplex and other viral lesions. A steroid on candidal perianal skin makes it spread. Cinchocaine sensitises on repeated use - a rash that appears after a few courses is often the anaesthetic, not the piles. Not under 12 years without a doctor's decision. Egypt SEDIPROCT TOPICAL CREAM 20 GM MUP 42.00 EGP STOOL SOFTENING - give alongside 3. LACTULOSE [add-on - not a substitute] Adult 15-30 mL once or twice daily, adjusted according to stool consistency x 2-4 weeks as needed Peds Under 1 year: Up to 5 mL daily 1 to 6 years: 5 to 10 mL daily 7 to 14 years: 15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea. (Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) Why Osmotic laxative that softens stool and eases passage, added to reduce the straining that aggravates haemorrhoids; it addresses a contributing factor rather than the haemorrhoids themselves. Caution Prevents straining which exacerbates haemorrhoids. May cause flatulence and abdominal cramps initially. Egypt FARCOLAC 667GM/L SYRUP 120 ML PHARCO 7.50 EGP LACTOLINE 50% SYRUP 200ML ALEXANDRIA 9.25 EGP LAEVOLAC 67GM/100ML SYRUP 120 ML SIGMA > FRESE... 12.00 EGP SEDALAC 3.35GM/5ML SYRUP 120ML SEDICO 20.00 EGP LAXOLAC 3.35GM/5ML SYRUP 300ML MUP 40.00 EGP LAXOLAC 3.35GM/5ML SYRUP 120ML MUP 50.00 EGP DUPHALAC 667GM/L SYRUP 200ML ABBOTT LABORA... 143.00 EGP LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML AUG PHARMA 170.00 EGP VILLAPURG 67% SYRUP 120 ML AL ESRAA PHAR... 12.00 EGP -> ? strength differs, ? different route - not oral liquid VILLAPURG 67% SYRUP 200 ML AL ESRAA PHAR... 17.75 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)