Haemorrhoids and Piles

Do you suffer from Haemorrhoids and Piles?

Yes

No

Can you relate to any of the following?

Your hair loss started recently, and you've lost a lot of hair in less than four weeks.

Hair loss has occurred in irregular spots on your head.

Your scalp is itchy or inflamed.

You've lost your hair as a result of your pharmacological treatment.

You're completely bald or have lost all of your body hair.

Yes

No

Can you relate to any of the following?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Do you have a history of using Perinal to treat haemorrhoids or piles?
If so, how successful was it?

Yes

No

Did you know that?
If your condition does not improve after four weeks, you should consult a doctor.
You must not use Enstilar on broken skin or beneath a bandage.
You cannot use Enstilar aound the eyes or on the eyelids.

Yes

No

Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Your doctor has ever told you that your kidney function is less than 100 percent.
You have previously suffered a terrible reaction to aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You want to use Ibuprofen Gel on skin that is fractured, injured, diseased, or infected.

Yes

No

Do you have a history of using Proctosedyl to treat haemorrhoids or piles?
If so, how successful was it?

Yes

No

Did you know that:
A healthcare practitioner should assess any acute injuries.
You should see your doctor about chronic pain at least once a year.

Yes

No

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

Do you have a history of using Scheriproct to treat haemorrhoids or piles?
If so, how successful was it?

Yes

No

Do you have a history of using Uniroid to treat haemorrhoids or piles?
If so, how successful was it?

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Please explain why you require this treatment if you are not already suffering from piles.

Has a certified medical practitioner ever examined you with haemorrhoids and piles?
If do, when was the last time you saw your doctor to discuss your condition?

If you don't how do you know if you have haemorrhoids?

Yes

No

Have your symptoms remained the same since your previous examination?

Yes

No

Kindly identify some of the symptoms you may be experiencing
You can select more than one option

Bottom itch

Outside the anus there was a bulge (which may need to be pushed back in after passing a stool)

After passing a stool a mucus discharge occurs

When wiping the bottom there are small amounts of bright red blood

Soreness

Swelling and redness around your anus

Did you know that that persons over the age of 55 should get their bowels screened by the NHS?
More information can be found on the link below:
https://www.nhs.uk/conditions/bowel-cancer-screening/#when-its-offered

Yes

No

Did you know that Constipation is a common cause of piles?
Constipation can cause piles, so avoid it. You may learn more about constipation treatment and prevention at https://www.nhs.uk/conditions/constipation/.

Yes

No

Are you experiencing any of the following signs and symptoms:
Over 40 years old and experiencing symptoms for the first time
Weight loss that was unexpected
Rectal hemorrhage that hasn't been explained (specifically if the blood is darker in colour)
Stools or vomit containing blood (may appear dark or sticky)
A lack of iron (anaemia)
Swallowing problems
Consistent pain in the stomach or intestines
Ulcers in the stomach or esophagus
A bulge or enlargement in your stomach or lower abdomen
Fatigue and a lack of energy

Yes

No

Are you willing to visit your doctor if:
Your symptoms are becoming more severe.
After seven days of medication, the symptoms have not improved.
Continuous rectal bleeding, dark or sticky feces, stomach pain, or sudden weight loss are all symptoms you're experiencing.

Yes

No

Kindly provide more details of the change in symptoms

Do you have a history of using Xyloproct to treat haemorrhoids or piles?
If so, how successful was it?

Yes

No

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