Haemorrhoids

Question 1

What is the aetiology of haemorrhoids?

Answer 1

Excessive straining (chronic constipation or diarrhoea) -> downward stress on vascular haemorrhoidal cushions with disruption of supports > enlargement of haemorrhoids.

Question 2

How are haemorrhoids classified?

Answer 2

External: located in distal anal canal, distal to dentate line.
Internal: (Grade 1 - 4) originate proximal to dentate line. Covered by insensate transitional epithelium.

Question 3

How can haemorrhoids be prevented?

Answer 3

Fibre in diet (RI 25-30g).

Adequate hydration.

Question 4

What are the key diagnostic factors for haemorrhoids?

Answer 4

• Presence of risk factors
• Rectal bleeding
• Perianal discomfort

Question 5

What are the risk factors for haemorrhoids?

Answer 5

• Age 45-65
• Constipation
• Pregnancy or space occupying pelvic lesion

Question 6

DDx for haemorrhoids?

Answer 6

Anal fissure, IBD (UC/CD).

Question 7

Ix in suspected haemorrhoids?

Answer 7

Anoscopic examination, colonscopy, FBC, faecal occult blood.

Question 8

Rx of haemorrhoids?

Answer 8

• Dietary fibre
• Rubber band ligation (Grade 2-3 internal)
• Surgical haemorrhoidectomy (grade 4)

Question 9

What are the risks of haemorrhoidectomy?

Answer 9

• Bleeding
• Infection
• Recurrence
• Damage to internal anal spincter

Question 10

Operative options in haemorrhoid removal?

Answer 10

-Standard: Milligan Morgan Excision Ligation
-New: Stapled haemorrhoidectomy OR
Doppler guided Haemorrhoidal artery ligation