Appendix F — Patient Education Pages

One page per topic. Short sentences, no jargon, and a clear “seek urgent care now” section. Photocopy, print, or publish on your website.

F.1 Haemorrhoids (piles)

Haemorrhoids are swollen cushions inside or just outside the back passage. They are very common. They can bleed bright red blood, itch, or come out when you open your bowels.

• Eat more fibre (fruit, vegetables, wholegrains) and drink enough water.

• Go when you feel the urge. Do not strain or sit on the toilet for long — leave your phone outside.

• Use creams only as your doctor advises; steroid creams no longer than 2 weeks.

• Sitting in warm water may soothe.

Important: bleeding can have other causes. Your doctor may need to check your bowel, especially if you are over 45–50, have lost weight, have anaemia, or your bowel habit has changed.

🚨 Seek urgent care now if: Heavy bleeding or clots, or feeling faint; severe pain with a hard swollen lump; temperature above 38.0 °C.

F.2 Anal fissure

A fissure is a small tear in the skin of the back passage. It causes sharp pain when you open your bowels, sometimes a little bright red blood on the paper, and an ache afterwards.

• Keep stools soft: fibre, water, and a stool softener if prescribed.

• Sit in warm water for 10–15 minutes.

• Use the prescribed ointment exactly as advised, usually twice a day for 6–8 weeks — keep going even when the pain improves.

• If you use GTN ointment: do not take sildenafil (Viagra), tadalafil (Cialis), or similar medicines, and expect some headache at first.

See your doctor if the fissure has not healed after 6–8 weeks.

🚨 Seek urgent care now if: Temperature above 38.0 °C, swelling, or throbbing pain that keeps getting worse; heavy bleeding.

F.3 Perianal abscess and fistula

An abscess is a collection of pus next to the back passage. It causes constant throbbing pain, swelling, and sometimes fever. It needs to be drained — antibiotics alone do not cure it.

• After drainage: shower or sit in warm water 2–3 times a day and after bowel movements.

• Wear a pad, take painkillers, and keep stools soft. Daily packing of the wound is usually not needed.

• Some people later develop a small tunnel (fistula) with discharge. This is not a failure of the operation — see your surgeon if discharge or swelling returns.

🚨 Seek urgent care now if: Temperature above 38.0 °C or shivering; pain or redness spreading; skin turning dark; you cannot pass urine; you have diabetes and feel very unwell.

F.4 Itching around the back passage (pruritus ani)

Itching around the back passage is common. It is usually caused by irritation, moisture, or small amounts of leakage — not by poor hygiene.

• Wash with plain water only — no soap, wet wipes, perfumes, or antiseptics such as Dettol. Pat dry gently and do not scratch.

• Wear loose cotton underwear and use a barrier cream (zinc oxide).

• Try avoiding coffee, tea, cola, chocolate, citrus fruit, and spicy food for 2 weeks.

• Use steroid creams only as advised, for no more than 2 weeks.

See your doctor if itching lasts more than 4–6 weeks, or if you notice a skin patch that looks different, a lump, an ulcer, or bleeding — a small skin sample (biopsy) may be needed. Children in the house who itch at night may have threadworms.

🚨 Seek urgent care now if: Bleeding, a painful lump with fever, or a sore that does not heal.

F.5 Pilonidal disease

A pilonidal sinus is a small channel in the skin at the top of the buttock crease, often containing hairs. It can become infected and form an abscess.

• After drainage: shower daily, change dressings as advised, and keep the area dry.

• Avoid sitting for long periods on hard surfaces.

• After healing, keeping the area free of hair (for example laser hair removal, if advised) may reduce recurrence.

• Your surgeon may recommend a planned operation later.

🚨 Seek urgent care now if: Temperature above 38.0 °C, spreading redness, increasing pain or swelling, or foul-smelling discharge.

F.6 Constipation and faecal impaction

Constipation means hard, infrequent, or difficult stools. When hard stool gets stuck (impaction), watery stool can leak around it and look like diarrhoea.

• Eat fibre (fruit, vegetables, wholegrains, or a fibre supplement) with plenty of water, and stay active.

• Use the toilet at a regular time after meals, with a small footstool under your feet.

• Take laxatives as prescribed, and ask your doctor to review medicines that cause constipation (for example strong painkillers, iron, some antidepressants).

• Do not take anti-diarrhoea medicines for leakage unless a doctor has examined you.

🚨 Seek urgent care now if: Severe tummy pain, a swollen tummy, vomiting, fever, blood in the stool, or no stool or wind for several days.

F.7 Rectal bleeding — when to seek urgent care

Bleeding from the back passage is often caused by piles or a small tear, but it can also come from higher up in the bowel. “It looks like piles” is not a full diagnosis.

See your doctor soon (within days to weeks) if:

• you are over 45–50, or the bleeding keeps happening;

• the blood is dark or mixed with stool, or your bowel habit has changed;

• you have lost weight, feel tired or pale (anaemia), or a relative had bowel cancer.

🚨 Seek urgent care now if: You pass a lot of blood or clots; you feel faint, dizzy, short of breath, or your heart is racing; you have severe tummy pain; you take blood thinners and the bleeding will not stop.

F.8 Anal cancer warning signs

Anal cancer is uncommon and is often treatable when found early. It can look like piles or a tear. See a doctor promptly if you have:

• a lump in or near the back passage that is hard or growing;

• a sore or ulcer that has not healed after 4–6 weeks;

• bleeding that continues, or itching or a skin patch that does not go away;

• lumps in the groin, or pain or a change in bowel habit that does not settle.

You may be at higher risk if you have HIV or a weak immune system (for example after an organ transplant), have had HPV-related disease of the cervix, vulva, or vagina, or smoke. Ask about HPV vaccination and screening.

🚨 Seek urgent care now if: Heavy bleeding, severe pain with fever, or you cannot open your bowels.