Haemorrhoids

Question 1

What are they?

Answer 1

Haemorrhoidal tissue is part of the normal anatomy which contributes to anal continence.

mucosal vascular cushions

Question 2

where are they found?

Answer 2

found in the left lateral, right posterior and right anterior portions of the anal canal (3 o’clock, 7’o’clock and 11 o’clock respectively).

Question 3

when do haemorrhoids exist?

Answer 3

when they become enlarged, congested and symptomatic

Question 4

clinical features

Answer 4

painless rectal bleeding is the most common symptom

pruritus

pain: usually not significant unless piles are thrombosed

soiling may occur with third or forth degree piles

Question 5

types of haemorrhoids

Answer 5

1. external
2. internal

Question 6

what are external haemorrhoids?

Answer 6

originate below the dentate line
prone to thrombosis, may be painful

Question 7

what are internal haemorrhoids?

Answer 7

originate above the dentate line

do not generally cause pain

Question 8

grade I internal haemorrhoids

Answer 8

Do not prolapse out of the anal canal

Question 9

grade II internal haemorrhoids

Answer 9

Prolapse on defecation but reduce spontaneously

Question 10

grade III internal haemorrhoids

Answer 10

Can be manually reduced

Question 11

grade IV internal haemorrhoids

Answer 11

Cannot be reduced

Question 12

Mx

Answer 12

1. soften stools
2. topical local anaesthetics and steroids
3. outpatient treatment - rubber band ligation
4. surgery

Question 13

newer treatment

Answer 13

Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy

Question 14

presentation of acute thromboses external haemorrhoids

Answer 14

typically present with significant pain
examination reveals a purplish, oedematous, tender subcutaneous perianal mass

if patient presents within 72 hours then referral should be considered for excision.

Otherwise patients can usually be managed with stool softeners, ice packs and analgesia.

Symptoms usually settle within 10 days