Haemorrhoids Flashcards
What are risk factors?
Constipation
Straining
Pregnancy
Obesity
increasing age
Increased intra-abdominal pressure
How are they classified?
1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently
How do they present?
Painless bright red bleeding
Sore itchy anus
Lump around or inside the anus
How can haemorrhoids be properly visualised?
Proctoscopy
What topical treatments can be given?
Anusol
Anusol HC - contains hydrocortisone
Germoloids cream
Proctosedyl
What would you advise patients for prevention?
Increase fibre
Good fluids intake
Laxatives when required
Avoid straining
What are non-surgical treatments?
Rubber band ligation
Injection sclerotherapy
Infra-red coagulation
Bipolar diathermy
What are surgical options?
Haemorrhoidal artery ligation - cut off blood supply
Haemorrhoidectomy
Stapled haemorrhoidectomy
What are thrombosed haemorrhoids
Strangulation of the base of the haemorrhoi
How do thromboses haemorrhoids present?
Purplish tender swollen lumps around the anus
Cannot PR easily due to pain
What is management of thromboses haemorrhoids?
Usually resolve with time (can take several weeks)
Consider admission if extremely painful as can have surgical intervention