Haemorrhoids

Question 1

What are haemorrhoids?

Answer 1

Enlarged anal vascular cushions

Question 2

What are the risk factors for haemorrhoids?

Answer 2

Straining
Constipation
Pregnancy
Obesity
Increased age
Increased intra-abdominal pressure

Question 3

What is an anal cushion?

Answer 3

Submucosal tissue in the anus that contains connections between arteries and veins, making it very vascular

Question 4

What is the classification of haemorrhoids?

Answer 4

Class 1 - no prolapse
Class 2 - prolapse on straining and return on relaxation
Class 3 - prolapse on straining with no return on relaxation, but that can be pushed back
Class 4 - prolapsed permenantly

Question 5

What is the presentation of haemorrhoids?

Answer 5

Bright red bleeding upon wiping or after opening bowels
Blood not mixed with stool
Sore/itchy anus
Intermittent protrusion

Question 6

What are the differentials of haemorrhoids?

Answer 6

Anal fissure
Crohn’s disease
Ulcerative colitis
Bowel cancer
Anal fistula
Diverticulosis

Question 7

What is the first line investigation of haemorrhoids?

Answer 7

Inspection and PR exam

Question 8

What other investigations may be performed in the diagnosis of haemorrhoids?

Answer 8

FBC
Colonoscopy (to exclude other conditions)

Question 9

What is the management of haemorrhoids?

Answer 9

Topical treatments - anusol
Rubber band ligation
Sclerotherapy
Surgical treatment - haemorrhoidal artery ligation or haemorrhoidectomy

Question 10

What is a thrombosed haemorrhoid?

Answer 10

Where there is strangulation at the base of the haemorrhoid which causes thrombosis in the haemorrhoid

Question 11

What lifestyle advice should be given to someone with haemorrhoids?

Answer 11

More dietary fibre
Good fluid intake
Using laxatives where required
Avoid straining