Haemorrhoids Flashcards
What are haemorrhoids?
Enlarged anal vascular cushions
What are haemorrhoids associated with?
Constipation and straining
Pregnancy
Obesity
Increased age
Increased intra-abdominal pressure
Why do haemorrhoids often occur in pregnancy?
Constipation and pressure from baby in the pelvis and the effects of hormones that relax connective tissues
What are anal cushions?
Submucosal tissue that contain connections between arteries and veins making them very vascular
They help control anal continence
Blood supply from rectal arteries
How is pathology of haemorrhoids described?
12 O’clock- anterior to genitals
6 O’clock- posterior to the back
Most common at 11,7 and 3 o’clock
How are haemorrhoids classified?
1st degree
No prolapse
2nd degree
Prolapse when straining and return on relaxing
3rd degree
Prolapse when straining, do not return on relaxing, can be pushed back
4th degree
Prolapsed permanently
How do haemorrhoids commonly present?
Painless, bright red bleeding
Blood is not mixed with stool
Sore/itchy anus
Lump around or inside anus
What is present on examination of haemorrhoids?
External haemorrhoids
Visible on inspection as swellings covered in mucosa
Internal haemorrhoids
May be felt on PR (difficult)
What is proctoscopy used for?
Proper visualisation and inspection, hollow tube into anal cavity to visualise mucosa
What differentials are there for rectal bleeding?
Anal fissures
Diverticulosis
IBD
Colorectal cancer
Haemorrhoids
What topical treatments can be given for relief of haemorrhoids?
Anusol
Astringents- shrinks the haemorrhoid
Anusol HC
Anusol + Hydrocortisone
Germoloids cream
Contains lidocaine
Proctosedyl ointment
Cinchocaine + hydrocortisone
How can constipation be prevented and treated?
Increasing fibre
Good fluid intake
Laxatives where required
Consciously avoiding straining when opening bowels
What non-surgical treatments are available for haemorrhoids?
Rubber band ligation
Tight rubber band, cuts off blood supply to haemorrhoid
Injection sclerotherapy
Phenol oil injection, causes sclerosis and atrophy
Infra-red coagulation
Infra-red light damaged blood supply
Bipolar diathermy
Current destroys the haemorrhoid
What surgical options are available for haemorrhoids?
Haemorrhoidal artery ligation
Proctoscope to identify blood vessel supply haemorrhoid and suturing it to cut off supply
Haemorrhoidectomy
Excision of the haemorrhoid- may result in faecal incontinence as anal cushion removed
Stapled haemorrhoidectomy
Tool used to excise a ring of haemorrhoid tissue while adding staples at the same time
What are thrombosed haemorrhoids caused by?
Strangulation
