Haemorrhoids

Question 1

What is the definition of haemorrhoids

Answer 1

abnormal swelling or enlargement of the anal vascular cushions

Question 2

What is the function of the anal vascular cushions

Answer 2

The anal vascular cushions act to assist the anal sphincter in maintaining continence.

Question 3

How many vascular cushions are there in the anus and what are the positions of those

Answer 3

3 vascular cushions

3, 7, 11 o’clock

Question 4

How are haemorrhoids classified

Answer 4

According to their size

Question 5

What is a 1st degree haemorrhoid

Answer 5

Within the rectum

Question 6

What is a 2nd degree haemorrhoid

Answer 6

Prolapse through the anus on defecation but spontaneously reduce

Question 7

What is a 3rd degree haemorrhoid

Answer 7

Prolapse through the anus on defecation but require digital reduction

Question 8

What is a 4th degree haemorrhoid

Answer 8

Remains prolapsed

Question 9

What are the risk factors of haemorrhoids.

Answer 9

Excessive straining ( chronic constipation )

Increasing age

Raised intra-abdominal pressure ( pregnancy, ascites )

Question 10

How do patients present with haemorrhoids

Answer 10

Painless bright red rectal bleeding

Pruritus

Rectal fullness

Soiling

Large haemorrhoids can thrombose - these can be very painful and are a emergency

Question 11

What are the differential diagnoses to think about

Answer 11

Other causes of bleeding eg
Malignancy

IBD

Diverticular disease.

Perianal abscess

Question 12

What investigations would you carry out to investigate haemorrhoids

Answer 12

Proctoscopy

FBC - to see if there is anaemia

A sigmoidoscopy or colonoscopy may also be considered to exclude malignancy if suspected

Question 13

How would you manage haemorrhoids that are asymptomatic

Answer 13

Almost all haemorrhoids can be conservatively managed through lifestyle advise eg

Increase fibre

Increase fluid intake

Prescribe laxatives if necessary to relieve constipation

Question 14

What medications would you prescribe for painful haemorrhoids

Answer 14

Lignocaine gel

Avoid oral opioids as they cause constipation. => lead to more symptoms

Question 15

What are some non-surgical management therapies for haemorrhoids

Answer 15

1st and 2nd degree haemorrhoids can be treated with rubber band ligation

Question 16

What are complications of rubber band ligation

Answer 16

recurrence, pain (if the band is mistakenly placed below the dentate line), and bleeding

Question 17

When is the surgical management of haemorrhoidectomy indicated in patients

Answer 17

If patients are symptomatic even after conservative therapies/ or are not suitable for RBL as are degree 3/4.

Question 18

What are the two haemorrhoidectomy procedures available

Answer 18

stapled haemorrhoidectomy or Milligan Morgan haemorrhoidectomy

Question 19

what are the complications of haemorrhoidectomy

Answer 19

complications of a haemorrhoidectomy are bleeding, infection, constipation, stricture, anal fissures, or faecal incontinence

Question 20

What are the complications of haemorrhoids

Answer 20

thrombosis, ulceration or gangrene (secondary to thrombosis), skin tags, or perianal sepsis.