Hemorrhoids Flashcards
Differentiate between internal and external hemorrhoids.
internal:
-inside the anal tract
-can be asymptomatic
-when it falls, people feel a bulge (can be pushed up)
external:
-on anal rim
-more painful
-vessels have lost structure + value and are pushing into
undesired areas
What are the symptoms of hemorrhoids?
bleeding
itching
swelling
feeling of fullness in colon
seepage
pain
Which type of hemorrhoids can thrombose?
both external and internal
very painful as blood clots are there
can burst and pain will be gone
Which type of hemorrhoids can prolapse?
internal hemorrhoids
hemorroid prolapses off internal walls into anal sphincter and stays there
True or false: of all hemorrhoid complaints seen at MD office, 95% were actually hemorrhoids
false
50% were something else
What are the main characteristics of colorectal cancer?
BLEEDING
PAIN
more common with age
change in bowel habits (constipation or diarrhea)
stools narrower than usual
GI discomfort (bloating, cramps)
unexplained weight loss
very tired
more likely as you age
Which colour of blood in stool is more indicative of colorectal cancer?
bright red (acute)
very dark stool means there is likely a bleed further up the GI tract
Can we figure out if someone has an anal polyp? What is usually done when one is discovered?
we will not be able to figure out (found only via scope)
removed
What are anal fissures?
small tears on the anal canal
common (even in kids)
seen in ~20% of hemorrhoid sufferers
What is anal itch caused by?
commonly via hemorrhoids
seepage
poor hygiene
some skin conditions
irritation via diarrhea (often seen with IBS)
What is the second most common anal symptom?
anal itch
True or false: anal fissure concurrently seen with hemorrhoids are indistinguishable from eachother
false
100% distinct
What is proctitis?
inflammation of the rectal region
What are the symptoms of proctitis?
severe pain and cramps
severe bleeding
mucous/discharge
What are the causes of proctitis?
infections
trauma
What are the risk factors for hemorrhoids?
low fiber/straining
pregnancy
prolonged standing
chronic diarrhea or constipation
heredity
What happened to a patient who was experiencing severe pain from hemorrhoids and then suddenly, the pain is gone?
the hemorrhoid burst
How long does it take for hemorrhoids to heal on their own?
~4 days
most hemorrhoids heal on their own
What is a full stop for us during a hemorrhoids consult?
presence of blood
we cannot afford to make mistakes
PLAY BY THE BOOK
When hearing “presence of blood”, what are the three things we need to know?
amount (ex: on TP? on underwear? in toilet?)
frequency
other symptoms
True or false: most hemorrhoids heal on their own
true
How long does it take untreated thrombosed external hemorrhoids to heal?
2-3 days
What are some things that can be done post-BM to improve cleanliness to try prevent hemorrhoids?
timing of shower (after #2)
dry skin lotion PRN
commercial preps
True or false: sitz baths are needed for most hemorrhoid sufferers
false
When are sitz baths commonly used?
post-surgery
Aside from cleanliness, what is another strategy to try relieve pain from hemorrhoids?
taking pressure off area PRN by laying on stomach
What can you attempt to do for a prolapsed tissue?
push it back in
dont try push in an external one
What is the go to product for hemorrhoids?
Anusol (zinc sulfate in base)
What dosage forms does Anusol come as?
suppository
ointment (internal or external)
both are lubricating
let the patient decide
What is the extra ingredient found in AnusolPlus? Would you recommend this product?
pramoxine
probably wont recommend because we have little faith that it will anesthetize
let patient decide
What are the directions of use for Anusol suppositories? What about the ointment?
suppositories: insert BID (am and hs) + post-BM
ointment: apply Q4h (esp post-BM)
-overkill is fine, wont do any damage
Why do we not recommend Preparation H for hemorrhoids?
it claims wound healing and shrinking of tissue
-none of the ingredients are designed to do this
What do we make of the Preparation H gel product that contains phenylephrine and hamamelis water?
gel not desired (faster dissipating, less TLC in anal area)
PE wont do anything for the swelling
Is the addition of hydrocortisone 0.5% to Anusol a valuable addition?
no
the plain products are good enough
HC 0.5% is the weakest of the weak
we have to prescribe
What do we make of an oral agent like Hemovel or Venixxa for treating hemorrhoids?
dont recommend
highly unlikely that an oral agent can hit the anal area
What is Proctofoam and when is it used?
foam that is inserted rectally, pushes against hemorrhoid and delivers reasonably potent steroid
for post-surgery
What is Proctosedyl?
a hemorrhoid agent that contains lots, overkill
-HC 0.5%
-framycetin (antibiotic)
-cinchocaine (anesthetic)
-esculin 1% (emollient)
THE VAST MAJORITY OF HEMORRHOIDS DONT NEED ANTIBIOTICS
Which topical analgesic should never be used for hemorrhoids?
A535 (it will irritate)
True or false: while constipation may be evident with hemorrhoids, laxatives will provide acute relief
false
True or false: it is not unusual to develop hemorrhoids during pregnancy
true
Anusol is a good option
How common are hemorrhoid recurrences?
reasonably common
How long does it take for hemorrhoids to get better?
3-4 days
7 days max, worry after this
When do we refer for hemorrhoids?
WHEN WE ARE UNSURE
blood in stool
unintentional weight loss
persistent change in bowel habit
first time
How common is hemorrhoids in pregnancy?
up to 50% of women develop hemorrhoids during pregnancy
When do we refer for hemorrhoids in pregnancy?
presence of blood
Do all hemorrhoid sufferers experience symptoms?
no
What is fecal ocult bleeding?
GI bleeding that is not apparent/visible to the patient
-very dark stool
