Hemorrhoids

What Are Hemorrhoids?

Alternative Names
Piles

Definition:
Dilated

or enlarged hemorrhoidal veins in the lower portion of the rectum or anus.

Cont.
Two Types:

Internal- occurring above the internal sphincter External- occurring outside the external sphincter

Grades:
I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement !V- Permanently Prolapsed

Cont.

Four classifications of prolapsed hemorrhoids

Etiology
Hemorrhoids develop as a result of shearing forces

during defecation, this force damage the muscles. Blood flow through the veins of the hemorrhoidal plexus is impaired. Intravascular clot in the venule results in a thrombosed external hemorrhoid. This is the most common reason for bleeding with defecation.

Clinical Manifestations
Rectal Bleeding Bright red blood in stool Pain during bowel movements

Anal Itching
Rectal Prolapse Thrombus

Causes
Constipation Diarrhea Sitting

time Obesity Heavy Lifting Pregnancy

or standing for long periods of

Diagnostic Tests
Rectal Examination
Visual Digital

Tests
Stool

Guaiac (FOBT) Sigmoidoscopy Anoscopy Proctoscopy

Complications
The blood in the enlarged veins may form clots and

the tissue surrounding the hemorrhoids can die (Necrosis) This causes painful lumps in the anal area. Severe bleeding can occur causing iron deficiency anemia.

Treatment Non-surgical
Mild cases are controlled by:
Preventing

constipation Increased Fluid intake High-fiber diet Stool softeners

Cont.
Apply and OTC cream or suppository containing

hydrocortisone (should only lasts for 1 week because this can cause dermatitis and muscle atropy) Keep anal area clean Hot sitz bath bath

Non surgical approach for Internal Hemorrhoids

Rubber band ligation- an anascope is inserted so the hemorrhoid can be identified and then ligated with a rubber band.

 Infrared coagulation-

used to treat bleeding internal hemorrhoids

 Cryotherapy- involves

rapid freezing of the hemorrhoid.

Hemorrhoid Surgery
Hemorrhoidectomy
Surgical excision of hemorrhoids. This is done when

there is prolapsed, excessive pain, bleeding and or large hemorrhoids. This may be done by a cautery, clamp, or excision

The area is to be leaved open so that healing takes

place by secondary intention. In other approach the tissue is sutured and wound healing takes place by primary intention.

Prevention/ Nursing Management

Avoid long periods of standing or sitting Dont Strain Go as soon as you feel the urge

Proper use of OTC drugs

Sitz Bath for 15-20 mins for 2-3 times each day for 7

days Opiods is given for pain Topical nitroglycerin preparations may be used to decrease pain

Nursing Management
Patient should not be left alone Packing may be inserted to the rectum to absorb

drainage, this should be removed on the first or second post op day. Assess for rectal bleeding Provide for privacy Pain meds given before bowel movement to reduce discomfort Stool softener is given for the first few post op days. ( Colace)

 If patient has not yet defecate for two Days after

operation an oil retention enema is given. Regular check ups are important in the prevention of any further problems because this may reccur.