Haemorrhoids

Question 1

What are haemorrhoids

Answer 1

Enlarged anal vascular cushions, usually associated with constipation and straining

Question 2

Haemorrhoids risk factors

Answer 2

Pregnancy
Obesity
Increased age
Increased intra-abdominal pressure - weightlifting, chronic coughing…

Question 3

What are anal cushions

Answer 3

Specialised submucosal tissue that contain connections between arteries and veins (anastomoses) = very vascular
Blood supply from rectal arteries
Located at 3, 7 and 11 o’clock
Supported by smooth muscle and connective tissue
Help to control continence along with internal and external sphincters

Question 4

Haemorrhoid classification

Answer 4

1st degree - no prolapse
2nd degree - prolapse when straining and return on relaxing
3rd degree - prolapse when straining, does not return on relaxing but can be pushed back
4th degree - prolapse permanently

Question 5

Haemorrhoid symptoms

Answer 5

Can be asymptomatic
Painless, bright red bleeding usually after opening bowels - blood isn’t mixed with stool
Sore/itchy anus
Lump around or inside anus

Question 6

Haemorrhoid initial management

Answer 6

Increase fibre and fluid intake
Use laxatives when required
Avoid straining when opening bowels
Topical treatments for symptomatic relief:
Anusol (contains astringents to shrink haemorrhoid)
Anusol HC - also contains hydrocortisone cream (short term use only)
Germoloids cream - contains lidocaine as local anaesthetic

Question 7

Haemorrhoid non-surgical treatment

Answer 7

Rubber band ligation (to cut off blood supply)
Injection sclerotherapy (injection of phenol oil into haemorrhoid to cause sclerosis and atrophy)
Infra-red coagulation (to damage blood supply)
Bipolar diathermy (electric current applied to destroy haemorrhoid)

Question 8

Haemorrhoid surgical management

Answer 8

Haemorrhoid artery ligation (proctoscope to identify blood vessel that supplies - suture to cut it off)
Haemorrhoidectomy - excising (removing anal cushions can cause faecal incontinence)
Stapled haemorrhoidectomy

Question 9

What is a thrombosed haemorrhoid

Answer 9

Strangulation at the base of the haemorrhoid resulting in thrombosis (clot) in the haemorrhoid
Very painful - PR unlikely
Can appear purplish, very tender, swollen lumps
Resolve with time but can take weeks
Admit if within 72hr - may benefit from surgical management