Haemorrhoids

Question 1

Haemorrhoids

Answer 1

Enlarged anal vascular cushions

Question 2

Anal cushions

Answer 2

Specialised submucosal tissue that contains connections between arteries and veins

Supported by smooth muscle and connective tissue

Help control anal continence

Located at 3, 7 and 11 o’clock (12 towards genitals, 6 towards back)

Question 3

Clinical features

Answer 3

Painless rectal bleeding

Pruritis

Pain (usually not significant unless piles are thrombosed)

Soiling may occur with third or forth degree piles

Question 4

External heamorrhoids

Answer 4

Below the dentate line

Prone to thrombosis, may be painful

Question 5

Internal haemorrhoids

Answer 5

Originate above dentate line

Do not generally cause pain

Question 6

Grading of internal

Answer 6

1- do not prolapse

2- prolapse on defecation but reduce spontaneously

3- can be manually reduced

4- cannot be reduced

Question 7

Topical treatments

Answer 7

Anusol (contains chemicals to shrink haemorrhoids)

Anusol HC (also contains hydrocortisone)

Germoloids cream (contains lidocaine)

Procosedyl ointment (contains cinchocaine and hydrocortisone)

Question 8

Prevention and treatment of constipation

Answer 8

Increase fibre in diet

Maintain good fluid intake

Using laxative where required

Consciously avoid straining

Question 9

Outpatient treatments

Answer 9

Rubber band ligation is superior

Injection sclerotherapy

Infra-red coagulation

Question 10

Surgical options

Answer 10

Haemorrhoidal artery ligation

Haemorrhoidectomy (may result in faecal incontinence)

Stapled haemorhoidectomy

Question 11

Thrombosed haemorrhoids

Answer 11

Caused by strangulation at base

Can be very painful

Appear purplish, tender, swollen lumps around anus

Resolve with time (can take several weeks)

Consider admission if present within 72 hours- may benefit from surgical treatment