Haemorrhoids

Question 1

1) What are haemorrhoids?
2) What are anal cushions?

Answer 1

1) Enlarged and swollen anal vascular cushions
2) Specialised submucosal tissue that contain connections between the arteries and veins, making them very vascular

Question 2

Name 2 risk factors for developing hemorrhoids

Answer 2

• Obesity
• Pregnancy
• Older age
• Increased intra-abdominal pressure i.e. weightlifting

Question 3

1) What 2 things are haemorrhoids often associated with?
2) Name 2 ways haemorrhoids may present

Answer 3

1) Constipation and straining
2) Painless, bright red bleeding that is not mixed with stool, sore or itchy anys and feeling a lump around or inside the anus

Question 4

Name 2 aspects of the medical management of haemorrhoids

Answer 4

• Topical analgesics
• Laxatives
• Topical steroids for short periods only

Question 5

Name a non-surgical treatment of haemorrhoids

Answer 5

• Rubber band ligation (fitting a tight rubber band around the base of the haemorrhoid to cut off the blood supply)
• Injection sclerotherapy (injection of phenol oil into the haemorrhoid to cause sclerosis and atrophy)
• Infrared coagulation (infrared light is applied to damage the blood supply)
• Bipolar diathermy (electrical current applied directly to the haemorrhoid to destroy it)

Question 6

Name a surgical treatment of haemorrhoids

Answer 6

• Haemorrhoidal artery ligation involves using a proctoscope to identify the blood vessel that supplies the haemorrhoids and suturing it to cut off the blood supply.
• Haemorrhoidectomy involves excising the haemorrhoid. Removing the anal cushions may result in faecal incontinence.
• Stapled haemorrhoidectomy involves using a special device that excises a ring of hemorrhoidal tissue at the same time as adding a circle of staples in the anal canal. The staples remain in place long-term.

Question 7

What causes thrombosed haemorrhoids?

Answer 7

Strangulation at the base of the haemorrhoid that can become very painful