Haemorrhoids Flashcards
Definition
Enlarged and symptomatic anal vascular cushions (AKA Piles)
- Can be internal or external
Types
Internal:
- Above the dentate line
- Epithelium: Columnar
- Venous drainage: Superior rectal vein
- Nerve supply: Inferior hypogastric plexus
- Symptoms: Painless
External: Below the dentate line
- Epithelium: Stratified squamous
- Venous drainage: Middle/Inferior rectal veins
- Nerve supply: Inferior rectal nerves
- Symptoms: Painful
Risk factors
Contipation
Heavy lifting
Chronic cough: COPD
Raised intra-abdominal pressure: pregnancy, or childbirth
Signs on DRE
- Internal haemorrhoids: Not palpable unless prolapsed
- External haemorrhoids: Visible, swollen and appear as pink swelling of the mucosa
- Acutely thrombosed external haemorrhoid : tense, swollen, and acutely painful mass in the rectum (purple-blue colour)
Symptoms
Rectal bleeding: bright red, painless rectal bleeding
Rectal pain:
- Internal: painless unless prolapsed and become strangulated
- External: painful, particularly if thrombosed
- Anal itching or irritation: MC with external
Diagnosis
Clinical diagnosis
Consider:
- Proctoscopy: appear as pink swellings of mucosa
- FBC
Treatment
FIRST LINE:
- Conservative management:
= Ensure Px is not constipated (increase dietary fibre and fluid)
= Avoid itching around the anus to promote healing
= Topical haemorrhoidal preparations can be considered e.g. Anusol
SECOND LINE:
- Rubber band ligation
- Injection sclerotherapy
- Photocoagulation
- Diathermy
- Surgical intervention
Thrombosed external haemorrhoid treatment
- Presentation within 72 hours: consider admitting them to the hospital for reduction or excision
- After 72 hours: they can usually be managed with stool softeners, ice packs, and analgesia and often settle within 10 days
Complications
- Perianal thrombosis
- Ulceration
- Incarceration of prolapsed haemorrhoids tissue
- Anal stenosis
- Anaemia from excessive bleeding
