Haemorrhoids

Question 1

Where do the mucosal vascular cushions occur in the anal canal?

Answer 1

Left lateral (3 oclock)

Right Anterior (7 O’clock)

Right posterior (11 o’clock)

Question 2

What are the difference between internal and external haemorrhoids?

Answer 2

Internal haemorrhoids - originate above the dentate line and do not cause pain.

External haemorrhoids - originate below the dentate line and do cause pain.

Question 3

Desribe the grading of haemorrhoids.

Answer 3

Grade I- Do not prolapse out of the anal canal

Grade II- Prolapse on defecation but reduce spontaneously

Grade III- Can be manually reduced

Grade IV- Cannot be reduced

Question 4

What is your management pathway for haemorrhoids?

Answer 4

• Soften stools: increase dietary fibre and fluid intake
• Topical local anaesthetics and steroids may be used to help symptoms
• Outpatient treatments: rubber band ligation is superior to injection sclerotherapy
• Surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
• Newer treatments: Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy

NOTE: Fibre supplementation has been shown to be as effective as injection sclerotherapy in some studies

Question 5

What are the clinical features of haemorrhoids?

Answer 5

• Painless rectal bleeding is the most common symptom
• Pruritus
• Pain: usually not significant unless piles are thrombosed
• Soiling may occur with third or fourth degree piles