Haemorrhoids

Question 1

HAEMORRHOIDS:
What is it?

What are risk factors?

Answer 1

Internal haemorrhoids arise in the upper anal canal and lower rectum from the internal venous haemorrhoids plexus. It becomes a disease state when they enlarge. It can be internal or external.

Bleeding is coming and rarely severe usually bright red
painful and uncomfortable
mucus discharge can irritate perineum

pregnancy, diarrhoea, constipation, prolonged straining and hereditary factors

Question 2

HAEMORRHOIDS:
What are red flag symptoms?

Answer 2

excessive bleeding which patient is worried about
Aged 40 and over with rectal bleeding which persist for longer than 3 weeks

Aged 60 and over refer if longer than 3 weeks

blood mixed with stools rather than surface of stool

Question 3

HAEMORRHOIDS:
What are practical tips?

Answer 3

avoid straining due to constipation by ensuring diet contains lots of fibre-rich foods and plenty fluid
keep anal area clean and free of irritant faecal matter
cold compress may help shrink

Question 4

HAEMORRHOIDS:

What are differential diagnose?

Answer 4

rectal bleeding
local dermatitis or irritation
threadroom

Question 5

HAEMORRHOIDS:
What are treatment options?

Answer 5

dependent on classification and severity of symptoms

soothing creams- zinc oxide, balsam of Peru, allantoin

Local anaesthetics: lidocaine, benzocaine
can alleviate pain, burning and itching but may cause sensitisation of peri-anal skin- use for 3-4 days

topical corticosteroids: hydrocortisone- 7days use only

Question 6

HAEMORRHOIDS in pregnancy:

Why are pregnant women at higher risk?

Answer 6

Due to increased pressure on the haemorrhoidal vessels due to the gravid uterus and the increase incidence of constipation in pregnancy.

Same treatment options in pregnant women.