Haemorrhoids Flashcards
What are haemorrhoids?
Haemorrhoids = enlarged dilated vascular structures within the anal canal which can protrude outside the anal canal
Haemorrhoidal cushions are normal, vascular, mucosal anatomical structures
Usually occupy the left lateral, right anterior and right posterior positions
Normally function to maintain anal continence
What is the aetiology of Haemorrhoids?
Primarily due to excessive straining – due to either chronic constipation/diarrhoea
Causes downward stress on the cushions, leading to disruption of the supporting tissue elements
Can also be due to increased intra-abdominal pressure
Pregnancy, ascites, pelvic space occupying lesions, obesity?
Generally, symptoms are caused when the cushions become enlarged, inflamed, thrombosed or prolapsed
Vicious circle, as the more the cushions protrude, the more congested and hypertrophies they become
Painless unless strangulated
What are the risk factors for haemorrhoids?
45-65 y/o
Constipation
Pregnancy/space-occupying pelvic lesion
Ascites
What is the epidemiology of haemorrhoids?
Very common – prevalence of 4%
More common in white patients
Presentation peaks at age 45-65
What are the symptoms of haemorrhoids?
External If thrombosed Perianal pain Perianal swelling – resolves to a skin tag Tenesmus Pruritus
Internal Rectal bleeding = most common symptom Bright red Covers the stool/drips Perianal pain/discomfort Anal pruritus Faecal incontinence Mucous discharge
What are the signs of haemorrhoids?
External If thrombosed Perianal pain Perianal swelling – resolves to a skin tag Tenesmus Pruritus
Internal Rectal bleeding = most common symptom Bright red Covers the stool/drips Perianal pain/discomfort Anal pruritus Faecal incontinence Mucous discharge
What are the appropriate investigations for haemorrhoids?
Abdo exam/history
DRE
Cannot palpate internal haemorrhoids
Done to exclude other pathology
Anoscopic examination (rigid endoscopy) Flexible sigmoidoscopy - to exclude IBD Bloods - FBC: Anaemia
What is the management for haemorrhoids?
Dietary and lifestyle modification
Discourage straining and excessive time at stool
Improved hygiene
Constipation treatment = adding fibre and fluid to diet
Grade 1 = remain in rectum ->Topical corticosteroids
Grade 2 = prolapse through anus on straining, but spontaneously reduce - > Rubber band ligation, sclerotherapy, infrared photocoagulation
Grade 3 = prolapse through anus on straining, but can be reduced manually -> Rubber band ligation
Grade 4 = persistently prolapsed, and cannot be reduced = surgical -> Surgical haemorrhoidectomy
What are the possible consequences of haemorrhoids?
Anaemia
Thrombosis
Manifests as sudden onset of perianal pain and appearance of tender perianal nodule
Faecal incontinence
Following surgery, 52% report flatus and 40% report liquid stool incontinence
Incarceration
What is the prognosis of haemorrhoids?
Treatment generally very effective
Less than 20% reoccurrence with surgical haemorrhoidectomy
Symptoms resolve or improve in most patients with treatment
Untreated, can predispose to anal SCC due to chronic inflammation
