Haemorrhoids

Question 1

What are risk factors?

Answer 1

Constipation
Straining
Pregnancy
Obesity
increasing age
Increased intra-abdominal pressure

Question 2

How are they classified?

Answer 2

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

Question 3

How do they present?

Answer 3

Painless bright red bleeding
Sore itchy anus
Lump around or inside the anus

Question 4

How can haemorrhoids be properly visualised?

Answer 4

Proctoscopy

Question 5

What topical treatments can be given?

Answer 5

Anusol
Anusol HC - contains hydrocortisone
Germoloids cream
Proctosedyl

Question 6

What would you advise patients for prevention?

Answer 6

Increase fibre
Good fluids intake
Laxatives when required
Avoid straining

Question 7

What are non-surgical treatments?

Answer 7

Rubber band ligation
Injection sclerotherapy
Infra-red coagulation
Bipolar diathermy

Question 8

What are surgical options?

Answer 8

Haemorrhoidal artery ligation - cut off blood supply
Haemorrhoidectomy
Stapled haemorrhoidectomy

Question 9

What are thrombosed haemorrhoids

Answer 9

Strangulation of the base of the haemorrhoi

Question 10

How do thromboses haemorrhoids present?

Answer 10

Purplish tender swollen lumps around the anus
Cannot PR easily due to pain

Question 11

What is management of thromboses haemorrhoids?

Answer 11

Usually resolve with time (can take several weeks)
Consider admission if extremely painful as can have surgical intervention