Hemorrhoids
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ScribdTranslationsHemorrhoids
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ScribdTranslationsHemorrhoids (piles)
definition
Hemorrhoids are dilated portions of veins in the anal canal. They
are very common. By the age of 50, about 50% of people have
Hemorrhoids occur when there is an increase in pressure in the veins, often from increased intra-
abdominal pressure.
TYPES
1, INTERNAL HEMORRHOIDS
• 2. EXTERNAL HEMORRHOIDS Internal hemorrhoids occur above the internal sphincter, and.
Most hemorrhoids are caused by straining during bowel movements. They are common during
pregnancy. Prolonged sitting or standing, obesity, and chronic constipation also contribute to
Hemorrhoids. Portal hypertension related to liver disease may also be a factor.
• Internal hemorrhoids are usually not painful unless they prolapse. They may bleed during bowel.
movements.
• External hemorrhoids occur below the external sphincter. External hemorrhoids are associated.
with severe pain from the inflammation and edema caused by thrombosis (i.e., clotting of blood)
Within the hemorrhoid. Inflammation and edema occur with thrombosis, causing severe pain.
and possibly infarction of the skin and mucosa over the hemorrhoid.
Causes and risk factor
• Ageing
• Heredity
• Pregnancy and childbirth
• Chronic constipation
• Anal infection
• Overuse of laxatives or enemas
• Prolonged sitting and standing
• Foods that are lacking fiber
• Irritable bowel syndrome
DEGREES OF SEVERITY
• LEVEL 1–Level 1 may bleed but they do not prolapse
• LEVEL 2 - In level 2, they have prolapsed, but they can push back into the anal wall with or without any.
accompanied bleeding
• LEVEL 3–IT cannot retract back into anal cavity and must be put back into their original
position, it will bleed
• LEVEL 4- LEVEL 4 have all other condition present, but they also may have blood clots. This type
A clotted hemorrhoid is called a thrombosed hemorrhoid.
• Clinical manifestation
• Painless bleeding during bowel movement
• Bright red blood on stool
• Itching or irritation in anal region
• Anal pain while sitting
• Swelling around anus
• Leakage of feces
• Diagnostic evaluation
• Cbc
• Digital rectal examination
• Colonoscopy
• Barium enema x ray
• Proctoscopy or rectoscope – used to examine the anal cavity, rectum, or sigmoid colon. It is short.
straight, rigid, hollow metal tube and usually has a small light bulb mounted at the end
Medical management
• Sitz baths increase circulation to the area and aid in comfort and healing.
• Stool softeners can be used to reduce the need for straining.
• anti-inflammatory medications such as steroid creams or suppositories.
• Alternating ice and heat helps relieve edema and pain with thrombosed hemorrhoids.
• Analgesic ointment
• If hemorrhoids are prolapsed and are no longer reduced by palliative measures, more aggressive
measures may be used.
• Sclerotherapy involves the injection of a sclerosing agent into the tissues around the
hemorrhoids, causing them to shrink.
• Rubber band ligation The hemorrhoid is visualized through the anoscope, and its proximal
portion above the mucocutaneous lines is grasped with an instrument. A small rubber band is
then slipped over the hemorrhoid. Tissue distal to the rubber band becomes necrotic after
several days and sloughs off.
• Cryosurgery uses cold to freeze the hemorrhoid tissue.
• 2 to 3 L of fluid a day to promote regular bowel movements.
• The effects and side effects, proper dosage, and frequency of local or topical treatments should be considered.
be explained.
• If the patient has surgery, analgesics should be given as needed because of the many nerves.
Endings in the anal canal can cause severe pain.
• Comfort measures such as a side-lying position and fresh ice packs should also be used to relieve.
pain.
• After the first postoperative day, sitz baths may be ordered.
• a side effect of opioid analgesics is constipation, which needs to be avoided, especially in the
immediate postoperative period. Because the first bowel movement can be painful and anxiety
provoking
• Stool softeners are given and analgesics administered before the first bowel movement.
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ANAL FISSURE
definition
• An anal fissure is a longitudinal tear or ulceration in the lining of the anal canal
• An anal fissure may be acute or chronic. A chronic fissure often has a small lump associated with the tear.
called sentinel pile or skin tag
Causes
• Fissures are usually caused by the
• trauma of passing a large,
• Hard stool or from persistent tightening of the anal canal because of stress and anxiety (leading
to constipation).
• Other causes include childbirth, trauma, and overuse of laxatives.
Clinical manifestation
• painful defecation, burning, and bleeding characterize fissures.
• Bright red anal bleeding
• Itching
• Visible crack skin around anus
• small lump
Diagnostic evaluation
Diagnosis can be made by inspection
colonoscopy
Management
• Most of these fissures heal if treated by conservative measures, which include stool softeners.
and bulk agents, an increase in water intake, sitz baths, and emollient suppositories. A
A suppository combining an anesthetic with a corticosteroid helps relieve the discomfort.
• Anal dilation under anesthesia may be required.
• nonopioid analgesics may be ordered for comfort. If conservative measures are not helpful,
surgery required
Surgical management
lateral internal sphincterotomy – this is usually achieved by cutting a small portion of the inner muscle
around the anus
