HAEMORRHOIDS
Haemorrhoids are varicose veins in the anal canal.
Internal haemorrhoids occur above the interior sphincter
External haemorrhoids - occur outside the exterior sphincter
Etiology
Predisposing-factors-
a. Pregnancy, prolonged sitting/standing.
b. Straining at stool, chronic constipation diarrhoea. c. Anal infection, rectal surgery or episiotomy
d. Hereditary factor, alcoholism.
e. Portal hypertension (cirrhosis)
f. Coughing, sneezing, vomiting.
g. Loss of muscle tone due to old age
h. Anal intercourse.
Pathophysiology
Predisposing factors
↓
increased intra-abdominal pressure
↓
Engorgement in the vascular tissue lining the anal canal.
↓
Loosening of vessels from surrounding connective tissue.
↓
Protrusion or prolapse of vessels into the anal canal.
Clinical Manifestations
1. Sensation of incomplete faecal evacuation.
2. Visible (if ext.) and palpable mass.
3. Constipation and anal itching (result of poor anal hygiene)
4. Bleeding during defecation, bright red blood on stool due to injury of mucosa covering haemorrhoid.
5. Infection or ulceration, mucus discharge.
6. Pain noted more in ext. haemorrhoids
7. Sudden rectal pain due to thrombosis in external haemorrhoids.
Diagnostic Evaluation
1. History and visualization y proctoscope external examination and the use of an anoscope or
2 Barium enema or sigmoidoscopy (to rule out more serious colonic lesions causing rectal bleeding)
Management
Asymptomatic haemorrhoids require no treatment
Medical Management
1. Bowels habits should be regulated with non-irritating stool softeners and high-fibre
2. Frequent, warm sitz baths to ease pain and combat swelling.
3. Insertion of soothing anal suppository 2-3 times a day.
4. Application of witch hazel compresses for comfort.
5. Control of itching by improved anal hygiene measures and control of moisture.
6. Do not use topical anaesthetics chronically on haemorrhoids or fissures, because they often produce hypersensitive (allergic) perianal skin rashes with severe itching.
7. Manual reduction of external haemorrhoids if prolapsed.
8. Injection of sclerosing solutions to produce, scar tissue and decrease prolapse.
Cryosurgery uses a probe to freeze the H, causing necrosis (Less painful). Some patients have a foul-smelling discharge for about a week to 10 days after cryosurgery.
Surgical Management
1. Ligation with a rubber band (treatment of choice).
A large anoscope is used, the apex of the interior H is grasped and drawn through a double-sleeved cylinder.
An elastic band is loaded on the inner cylinder and released by a trigger device so the band encircles the base of the haemorrhoids.
After a period of time, the H sloughs away.
2. Dilatation of the anal canal and lower rectum under G/A is another treatment.
Not recommended for aging patients with weak sphincters
3. Incision and removal of clot from acutely thrombosed H.
4. Haemorrhoidectomy excision of internal/external haemorrhoids. The haemorrhoids is removed through cauterization or excision.
Complications
1. Haemorrhage, anaemia
2. Incontinence.
3. Prolapse and strangulation.
4. Local infection.
Nursing Interventions
1. After surgery, assist with frequent positioning, using pillow support for comfort.
2. Provide analgesics, warm sitz baths or warm compresses to reduce pain and inflammation.
3. Check the dressing regularly and immediately report any excessive bleeding or drainage.
4. Administer stool softener/laxative to assist with bowel movements soon after surgery.
5. Clean the perianal area with warm water and a mild soap to prevent infection and irritation, then gently pat the area dry. After spreading petroleum jelly on the wound site to prevent skin irritation, apply wet dressing (a 1:1 solution of cold water and witch hazel) to the perianal area.
6. Encourage regular exercise, high-fibre diet, and adequate fluid intake (8-10 glasses/day) to avoid training and constipation.
7. Encourage the patient to eat a high fibre diet to promote regular bowel movements
8. Discourage regular use of laxatives firm, soft stools dilate the anal canal, decreasing stricture formation
9. Instruct the patient to watch for and report increased rectal bleeding purulent drainage, fever, constipation or rectal spasm
