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1. • Subject: Adult Health Nursing
• Topic: Hemorrhoids

2. Objectives
• At the end of this presentation the student will be
able to:
• Define hemorrhoids.
• Describe Pathophysiology of hemorrhoids.
• Identify types of hemorrhoids.
• Enlist signs, symptoms and causes of hemorrhoids.
• Explain medical diagnosis and treatment.
• Discuss nursing diagnosis and nursing intervention
for hemorrhoids.

3. Hemorrhoids
• Hemorrhoids
Hemorrhoids are
painful, swollen veins
in the lower portion
of the rectum or
anus.

4. Pathophysiology
• Hemorrhoid cushions are a part of normal human
anatomy and only become a pathological disease
when they experience abnormal changes.
• There are three cushions present in the normal
anal canal.
• They are important for continence, contributing
to at rest 15-20% of anal closure pressure and act
to protect the anal sphincter muscles during the
passage of stool.

5. Causes
Hemorrhoids may be cause by:
• Straining during bowel movements
• Constipation
• Sitting for long periods of time
• Anal infections
• Pregnancy
• Certain diseases such as liver cirrhosis
• Obesity
• Genetics
• Low fiber diet

6. Types
• There are two types of
hemorrhoids i.e.
• Internal hemorrhoids
occur just inside the
anus, at the beginning of
the rectum
• External hemorrhoids
occur at the anal opening
and may hang outside
the anus

7. Sign and symptoms
• Anal itching
• Rectal pain
• One or more hard tender lumps near the anus
• Bleeding

8. Diagnosis
• Visual examination
• Anoscopy
• Endoscopic image
• Sigmoidoscopy

9. Treatment
 Conservative Treatment
• Increase dietary fiber
• Oral fluids
• NSAID
• Sitz bath
• Rest
• Steroids ointments or creams

10. Conti…
 Fixative Procedures
The goal of nonsurgical procedures
used to treat hemorrhoids is called fixative procedures.
It include tying off the hemorrhoids
• with a rubber band
• using heat
• Lasers
• electric current
 Hemorrhoidectomy
Surgical removal of hemorrhoid is
called hemorrhoidectomy.

11. Prevention
• Drink plenty of water, at least eight glasses
per day
• Eat high fiber diet of fruits, vegetables, and
whole grains
• Empty bowels as soon as possible after the
urge occurs
• Regular exercise

12. Nursing Diagnosis for Hemorrhoids
• Pain (acute or chronic) related to rectal
swelling
• Constipation related to ignore the urge to
defecate due to pain during defecation
• Anxiety related to plan surgery
• Impaired Urinary Elimination related to the
fear of postoperative pain.

13. Conti….
• Risk for infection related to inadequate
primary defenses.
• Deficient knowledge related to the lack of
information about home care.

14. Nursing Intervention for
Hemorrhoids
• As needed, provide warm sitz baths to reduce
local pain and swelling
• Check for signs and symptoms of anal
infection, such as increases pain and foul
smelling anal drainage.
• Teach the patient about hemorrhoidal
development, predisposing factors, and tests.

15. Conti…
• Emphasize the need for good anal hygiene.
• Encourage the use of toilet paper without
dyes or perfumes.
• Provide the patient with high fiber diet and
encourage adequate fluid intake and exercise
to prevent constipation.

16. Conti….
• Prepare the patient for surgery if necessary
• Monitor the patient’s pain level and the
effectiveness of the prescribed medications.

17. References
• Dozois EJ, Pemberton JH (2006). Hemorrhoids and
other anorectal disorders. In MM Wolfe et al.,
eds., Therapy of Digestive Disorders, 2nd ed., pp.
945-958. Philadelphia: Saunders Elsevier.
• Hull TL (2006). Hemorrhoids section of Diseases of
the anorectum. In M Feldman et al., eds., Sleisenger
and Fordtran's Gastrointestinal and Liver Disease,
8th ed., vol. 2, pp. 2833-2852. Philadelphia: Saunders
Elsevier.