Did you hear about the proctologist and the psychiatrist who opened a practice together? They called it “Odds and Ends”.  All joking aside, I’d like to discuss a couple of common, sometimes embarrassing, problems most people will have the pleasure of experiencing in their lifetimes: hemorrhoids and anal fissures. Joy!

 Hemorrhoids are swollen veins in the lowest part of your rectum and anus while anal fissures are small tears in the thin, moist tissue (mucosa) that lines the anus. The symptoms for each condition are similar and may include pain and sometimes bleeding during and after a bowel movement (BM), itching, swelling, and sometimes spasms in the anal sphincter (for anal fissures). Always consult a physician in the case of rectal bleeding!  The cause of these conditions vary and may include large/hard stools, constipation, straining, chronic diarrhea, childbirth, and could be associated with other diseases and conditions. Home treatment and prevention for each of these could consist of warm water sitz-baths 2 to 3 times daily, witch hazel pads, OTC hemorrhoid creams (external only), cold packs, increasing fiber in diet, drinking lots of water, and regular exercise to keep blood and bowels moving. Limiting your time on “the throne” and going right away can help prevent problems as well. If symptoms do not improve after 5 to 7 days of home-care, you may need to seek medical care. A doctor has a few options for treatment of severe hemorrhoids or anal fissures. Surgery, injection, or prescription medications may be prescribed.1,2.

Compounding pharmacies offer unique options for hemorrhoids and anal fissures.  Nifedipine 0.2% compounded into a cream or ointment can be applied to anal fissures up to 3 times daily.  Nifedipine is traditionally used as a blood-pressure medication, but when applied topically it may be helpful in alleviating pain by reducing the internal anal sphincter pressure and increasing blood flow to promote healing. Lidocaine and hydrocortisone can also be placed into a rectal suppository called a rectal rocket. This is a specialized suppository designed for use in internal and external hemorrhoids simultaneously. It is inserted at bedtime and is typically only needed for 3 to 4 nights to relieve pain and help heal hemorrhoids.

  1. What Are Hemorrhoids?  https://www.webmd.com/digestive-disorders/understanding-hemorrhoids-basics#1
  2. Anal Fissure.  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424



April Heitmeier Pharm.D.

Solutions Pharmacy
5517 Little Debbie Pkwy
Ooltewah, TN 37363