A patient with a history of hemorrhoids presents complaining of acute rectal pain for two days. The patient reported an acute sensation of the need to defecate, s followed by pain and the development of edematous anal tissue. She denied adequate intake of dietary fiber. 

On physical examination a 2 inch diameter, ping pong ball-sized thrombosed hemorrhoid was observed on the patient’s rectum. She was unable to sit comfortably, very anxious and concerned about the potential for a cancer diagnosis.

Thrombosed hemorrhoid treatment aims to reduce the edema and improve pain. Patients who present within 72 hours of symptom development may benefit form surgical intervention and hemorrhoidectomy. In most cases, conservative treatment includes stool softeners, sitz baths and topical analgesics to improve pain until self-resolution occurs. Some research has shown that topical nitroglycerin or nifedipine can be used to reduce spasm and promote dilation. 

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Patients often underestimate dietary fiber health benefits.  Adequate dietary fiber intake can lower cholesterol and help control blood sugar. It is invaluable to gastrointestinal health, improving constipation symptoms and preventing hemorrhoids. It has been hypothesized that fiber decreases the risk for colon cancer because it decreases  the amount of time potential toxins come in contact with the colon by increasing the speed at which the stool moves through and is excreted.

Recommended daily values for fiber are 20g to 35 g a day.  Many patients are aware of the need for fruits and vegetables in their diet as sources of fiber, but many do not include them in their diet.  These patients are challenging for health-care providers, who must recommend alternative food sources that are rich in fiber. Nuts, such as almonds and peanuts, and legumes, like lentils, are excellent fiber sources. In addition, many breakfast cereals, including oatmeal, are rich in fiber. 

Increasing patient awareness about the importance of dietary fiber is an important component of prevention education. Adequate dietary fiber intake can improve a patient’s quality of life by improving colon health and preventing disease.

Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.