What are the recommended first-line treatments for patients with symptomatic haemorrhoids in primary care?

First-line treatments for patients with symptomatic haemorrhoids in primary care primarily focus on conservative management through lifestyle and dietary modifications, alongside symptomatic relief ¹.

• Dietary and Lifestyle Measures:
  • Advise patients to gradually increase their dietary fibre intake by consuming whole grains, fruits, and vegetables ¹.
  • Emphasise the importance of adequate fluid intake, especially when increasing fibre, to ensure stools remain soft and well-lubricated, preventing intestinal obstruction ¹.
  • Patients should be advised to ensure their stools are soft and easy to pass ¹.
  • Provide lifestyle advice to aid haemorrhoid healing, including maintaining correct anal hygiene by keeping the area clean and dry, and patting (rather than rubbing) the area dry ¹.
  • Advise against 'stool withholding' and undue straining during bowel movements, as these can worsen the condition ¹.
• Symptomatic Relief:
  • Offer simple analgesia, such as paracetamol, for pain relief ¹.
  • Avoid opioid analgesics (e.g., codeine) due to their potential to cause constipation ¹.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if rectal bleeding is present ¹.
  • Consider recommending a topical haemorrhoidal preparation for symptomatic relief ¹. However, it is important to note that over-the-counter haemorrhoidal preparations should no longer be routinely prescribed ¹. Topical preparations containing local anaesthetics and corticosteroids may provide symptomatic relief by reducing perianal inflammation, but they do not affect swelling, protrusion, or bleeding ¹.