Haemorrhoids Flashcards
What are haemorrhoids
Disrupted and dilated anal cushions
Why do haemorrhoids commonly bleed
They are vulnerable to trauma (i.e. from hard stools) and bleed readily from capillaries of underlying lamina propria
Why is bleeding in haemorrhoids bright red
because bleeding is from capillaries
Why are they normally painless
There are no sensory fibres above the dentate line
When may they become painful
If they thrombose when they protrude and are gripped by the anal sphincter
Causes blocked venous return
Symptoms and signs
Bright red rectal bleeding Mucous discharge Pruritus ani Anaemia Sensation of lump at anus
Site
Internal - origin above dentate line
External - origin below dentate line
Mixed - origin both above and below dentate line
Classification of haemorrhoids
1st - remain in rectum
2nd - prolapse through anus on defecation but spontaneously reduce
3rd - as for 2nd but require digital reduction
4th - remain persistently prolapsed
Medical therapy for 1st degree
Increased fibre and fluid
Topical analgesics and stool softeners
Non-operative treatment for 2nd, 3rd and 1st which doesn’t respond to medical therapy
Rubber band ligation
Surgical Treatment
Usually needed for 3rd and 4th
Excisional Haemorrhoidectomy (most effective)
Stapled Anopexy
What is stapled anopexy and what is it used for
Removes inner portion / lining of the bowel
For prolapsing haemorrhoids
