Benign, External:
Patient’s history and exam most consistent with hemorrhoid as an etiology for their pain.

Exam not consistent with thrombosed hemorrhoid.
Patient’s symptoms and exam not typical for other emergent causes of rectal pain such as, but not limited to, anorectal abscess, rectal foreign body, anal fissure, anal fistula, proctitis, rectal prolapse.

Rx: Bowel regimen, topical lidocaine, sitz bath 15min TID and after each bowel movement

Disposition: 
Patient will be discharged with strict return precautions and follow up with primary MD within 24-48 hours for further evaluation.


HPI
Pain described as itching, burning pain.
Pain Does not subside between bowel movements.
Denies blood mixing in stool. Denies melena.
Denies history of immunosuppression/HIV.
Denies anal-receptive intercourse.
Denies fever, vomiting, diarrhea.

Treatments (mainly for the likely underlying constipation)
– Stool softeners (psyllium), high-fiber diet, topical analgesics
– Avoid laxatives causing liquid stool (can lead to cryptitis and anal sepsis)
– Sitz bath (decreases sphincter pressure)
– Hydrocortisone Acetate Suppository
Emollients
– Docusate (colace) 100mg daily
Stimulants
– Senna 2 tabs daily
Hyperosmolar
– Miralax (polyethylene glycol) 17gm
– Lactulose 30ml daily or BID