• Reassure the patient that minor PR bleeding from haemorrhoids is common, especially with constipation.
• Optimize stool consistency to prevent straining:
  • Ensure adequate hydration.
  • Encourage a high-fibre diet (if tolerated) or consider a laxative eg. osmotic laxative like macrogol or lactulose
• Symptomatic relief:
  • Consider a topical haemorrhoidal preparation (e.g., hydrocortisone or lidocaine cream/suppositories).
  • Paracetamol for discomfort (avoid NSAIDs due to risk of GI bleeding).
• Discharge with GP follow-up for monitoring.
• Safety-netting:
  • Ask patient to monitor the rectal bleeding and assess for any worsening or new symptoms.
  • Advise the patient to seek medical attention if bleeding worsens, becomes persistent, or is associated with dizziness, fatigue, or abdominal pain.

Click here for NICE guidelines on haemorrhoids

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