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Hemorrhoids
- 1. Dr. Angelo Smith M D WHPL
- 2. Alternative Names Rectal Lump Piles Lump in the Rectum Definition: Dilated or enlarged veins in the lower portion of the rectum or anus.
- 4. 10 million Peak ages: 45-65 years ½ of adults experience hemorrhoids by age 50 Common among pregnant women Temporary
- 5. Right anterior, Right posterior and Left lateral positions Those originating above the dentate line which are termed internal Those originating below the dentate line which are termed external
- 9. Internal Hemorrhoids Disease  Manifested by two main symptoms - Painless Bleeding - Protrusion (Pain is rare as they originate above dentate line)  Most popular etiologic theory states that Hemorrhoids result from chronic straining at defecation  Continued straining causes engorgement and bleeding, as well as hemorrhoidal prolapse
- 10. Grades: I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement IV- Permanently Prolapsed
- 12. Pressure  Constipation  Diarrhea  Sitting or standing for long periods of time  Obesity  Heavy Lifting  Pregnancy
- 14.  Rectal Bleeding  Bright red blood in stool  Dripping in the toilet  On wiping after defecation  Pain during bowel movements  Anal Itching  Rectal Prolapse (while walking, lifting weights)  Thrombus  Extreme pain, bleeding and occasionally signs of systemic illness in case of strangulation
- 15.  Asymptomatic  except when secondary thrombosed  Thrombosis may result from defecatory straining or extreme physical activity or may be random event  Patient presents with constant anal pain of acute onset  Physical examination identifies external thrombosis as purple mass at anal verge  Management - Depends on patients symptoms - In the first 24 – 72 hours after onset, pain increase and excision is warranted - After 72 hours, pain generally diminishes
- 16. Rectal Examination  Visual  Digital Tests  Stool Guaiac (FOBT)  Sigmoidoscopy  Anaoscopy  Proctoscopy
- 17. Patients should be examined in the left lateral decubitus position (while asking the patient to bear down)  any rashes, condylomata, or eczematous lesions.  external sphincter function  Any abscesses, fissures or fistulae
- 18.  lubricated finger should be gently inserted into the anal canal  the resting tone of the anal canal should be ascertained as well as the voluntary contraction of the puborectalis and external anal sphincter.  masses should be noted as well as any areas of tenderness.
- 19.  Gastroenterologists  Seek emergency care if :  large amounts of rectal bleeding  Lightheadedness  Weakness  Rapid HR < 100 BPM
- 20. 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.
- 22. Varies from simple reassurance to operative hemorrhoidectomy. Treatments are classified into three categories: 1) Dietary and lifestyle modification. 2) Non operative / office procedures. 3) Operative hemorrhoidectomy.
- 23.  The main goal of this treatment is to minimize straining at stool.  Achieved by increasing fluid and fiber in the diet, recommending exercise, and perhaps adding fiber agents to the diet such as psyllium.  If necessary, stool softeners may be added. "you don't defecate in the library so you shouldn't read in the bathroom".
- 24. Apply and OTC cream or suppository containing hydrocortisone Keep anal area clean Soak in a warm bath Apply ice packs or compresses x 10min
- 25. If prolapses, gently push back into anal canal Use a sitz bath with warm water Use moist towelettes or wet toilet paper instead of dry toilet paper.
- 26.  Grade I or Grade II hemorrhoids and, in some circumstances, Grade III hemorrhoids.  Complications include bleeding, pain, thrombosis and life threatening perianal sepsis.  Successful in two thirds to three quarters of all individuals with first and second degree hemorrhoids.
- 27. Generates infrared radiation which coagulates tissue protein and evaporates water from cells. Most beneficial in Grade I and small Grade II hemorrhoids.
- 28. Injection of an irritating material into the sub mucosa in order to decrease vascularity and increase fibrosis. Injecting agents have traditionally been phenol in oil, sodium morrhuate, or quinine urea.
- 29. Manual anal dilatation was first described by Lord . Cryotherapy was used in the past with the belief that freezing the apex of the anal canal could result in decreased vascularity and fibrosis of the anal cushions.
- 30. The triangular shaped hemorrhoid is excised down to the underlying sphincter muscle. Wound can be closed or left open Stapled hemorrhoidectomy has been developed as an alternative to Standard hemorrhoidectomy
- 31. Eat high fiber diet Drink Plenty of Liquids Fiber Supplements Exercise Avoid long periods of standing or sitting Don’t Strain Go as soon as you feel the urge