Compounding for proctology is the preparation of customized medication for conditions related to the anus and rectum. Conditions that involve the anus or rectum typically will cause one discomfort and pain. In addition, many available topical and systemic treatments may simply be inadequate in treating the condition. Fortunately, your pharmacist can prepare customized medications to manage your condition, and in turn, help to manage your discomfort and pain.

Hemorrhoids

Hemorrhoids (also called piles) are swollen, engorged veins within the lining of the anal canal or lower rectum. They are either inside the anus or under the skin around the anus. Internal hemorrhoids normally don’t cause much discomfort. External hemorrhoids, on the other hand, are typically painful. Both types of hemorrhoids can bleed when they are irritated.

Traditionally, hemorrhoids are associated with aging, pregnancy, chronic constipation or diarrhea, straining during bowel movements, and prolonged sitting on the toilet. These conditions interfere with blood flow to and from the area, causing it to pool and enlarge the vessels.

While bleeding, anal itching and pain are common symptoms, some people with hemorrhoids have none of these symptoms and only learn of their hemorrhoids during routine physical examinations or colonoscopy screenings. Symptoms, when they do occur, usually go away within a few days.

Simple, self-help and over-the-counter measures can ease pain and promote healing. Increased fluid and fiber intake, either by eating plenty of fruits and vegetables, or with fiber supplementation, draws water into stools, making them softer and easier to pass.

Over-the-counter topical therapies such as pads infused with witch hazel (Tucks), as well as soothing creams that contain lidocaine, hydrocortisone, or other ingredients like phenylephrine (Preparation H) are available to help you find relief. Compounded prescription preparations are sometimes necessary for more severe or thrombosed hemorrhoids.

Anal Fissures

An anal fissure is a tear in the anus. Passing hard stools, constipation, and chronic diarrhea can cause stretching and tearing of the anus. Other factors include pregnancy, childbirth and complications of Crohn's disease, ulcerative colitis or a sexually transmitted infection such as anal herpes infection.

Anal fissures cause sharp, stinging pain that can be severe and tends to worsen when you pass a bowel movement and for an hour or so after. The pain is often accompanied by bleeding during bowel movements. In most people, this skin damage will heal quickly without any problems. However, fissures sometimes become chronic because after the first tear, bowel movements reinjure the area. Some people seem to have a higher than normal pressure in the anal canal from muscle spasms of the internal anal sphincter (the muscle around the anus). Increased anal canal tone and sphincter spasm is believed to decrease blood flow to the anal region and slow the healing process. For this reason, the most effective medications for anal fissures work by increasing blood flow to the region and relaxing muscles to reduce spasms.

Compounded topical treatments such as nitroglycerin, nifedipine, and diltiazem can be prepared by your compounding pharmacist. These medications work by dilating the blood vessels around the anus, and/or by causing relaxation of the internal anal sphincter. Blood is able to flow to the area more easily to promote faster healing.

How can compounds help?

Your compounding pharmacist can prepare medications in a variety of formulations to treat and manage conditions like hemorrhoids, anal fissures, idiopathic proctodynia (pain syndrome affecting the perianal region), and/or inflammatory bowel disease such as Crohn’s disease.

In addition, your compounding pharmacist can prepare medications to manage pain post hemorrhoidectomy, which is a surgery to remove internal or external hemorrhoids. If you are receiving radiation therapy for pelvic malignancy, you may experience radiation proctitis, which is a known complication. If this is the case, your compounding pharmacist can formulate a customized treatment for you.

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