Hemorrhoids definition, etiology,stages,types, causes,clinical feautes,diagnosis,medical management,surgical treatment,prevention.

1. HEMORRHOIDS
Presented by: S.MUTHUKUMARAN
6th year 3rd Group
Yerevan Haybusak University

2. SYNOPSIS
• Definition
• Anatomy and pathophysiology
• Etiology
• Types
• Stages
• Clinical features
• Causes
• Diagnosis
• Treatment
• Complication
• Prevention

3. NORMAL ANAL CANAL

4. DEFINITION
• Hemorrhoids also called piles.(Swollen veins in
your Anus and lower rectum similar to varicose
veins).
• It is due to dilation of rectal venous plexus
consists of internal and external components , its
very frequent disease
• The exact cause is unknown because there is a
number of cause for hemorrhoids.

5. ETIOLOGY
• Constipation
• straining at stool
• Increased pelvic pressure during pregnancy
• By hereditary (weakness of the vein walls)

6. ANATOMY & PHYSIOLOGY
HEMORRHOID CUSHION:
The hemorrhoid cushion contains venules ,
arterioles and smooth muscle fiber that are
located in the anal canal.
• These cushion are useful in diagnosing of
hemorrhoid , inspection at 3 , 7, 11’o clock in
lithotomy position.

7. There are 3 main hemorrhoid complexes or
hemorrhoid cushion of anal canal known as
1:LEFT LATERAL(3’o clock)
2:RIGHT ANTERIOR(11’o clock)
3:RIGHT POSTERIOR(7’o clock)
When the anatomic support system of the
hemorrhoidal complexes weakens due to
straining causes exposing the tissue into the
anal canal causes hemorrhoids.

9. STAGES
• STAGE 1
occasional bleeding only
• STAGE 2
Protrusion with spontaneous reduction
• STAGE 3
Protrusion requiring manual reduction
• STAGE 4
Irreducible protrusion with inflammation

11. TYPES OF HEMORRHOIDS:
Depends on Location
Internal hemorrhoids
External hemorrhoids
Thrombosed hemorrhoids

12. • Inside the rectum ( internal Hemorrhoids )
• Under the skin around the Anus ( External
hemorrhoids)
• ¾ Adults will have hemorrhoids.
• Sometime they don’t cause any symptoms but
cause
• Itching
• Discomfort
• Bleeding

13. INTERNAL HEMORRHOIDS
• Lie inside the Rectum
• Usually we can’t see/feel these hemorrhoids
• Straining/irritation when passing the stool can
damage a hemorrhoid’s surface &cause
bleeding.
• Straining can push internal hemorrhoids
through anal opening.
• This is known as protruding/ prolapsed causes
pain and irritation.

15. EXTERNAL HEMORRHOIDS
• These are under the skin around your perianal
region.
• When hemorrhoids gets irritated it causes
itching & bleeding.

16. THROMBORED HEMORROIDS
• It is an outcome of external hemorrhoid.
• Sometimes blood may pull out in an external
hemorrhoid and form clot.(thrombus)
 Causes severe pain
 Don’t cause bleeding(coz it forms as clot)
 Swelling
 Inflammation
 Hard lump near your Anus

18. CAUSES:
Straining during Bowel movements
Sitting for long periods of time on Toilet
Chronic diarrhea/constipation
Obesity
Pregnancy
Anal intercourse
Low-fiber diet

19. CLINICAL FEATURES:
• Painless Bleeding during bowel movements
(you may notice some small amount of Blood
in feces)
• Itching / irritation in Anal region
• Pain /discomfort
• Swelling
• A lump near the Anus ( Sensitive and painful)

20. DIAGNOSIS:
• Digital examination
(We can see unusual growth in the Rectum)
• Visual inspection
(Examine the lower portion of your colon and Rectum
with Anoscope, Proctoscope or Sigmoidoscope)
• Colonoscopy

21. TREATMENT:
CONSERVATIVE
 Eat high-Fiber foods
 Use hydrocortisone
 Soak regularly in a warm bath
 Keep the anal area clean
 Don’t use dry toilet paper
 Take oral pain relievers
Ex : Acetaminophen , Aspirin /Ibuprofen

22. SURGICAL
• Hemorrhoid Removal (Hemorrhoidectomy)
(Remove excessive tissue that causes Bleeding)
• Hemorrhoid Stapling.
• Rubber band ligation

25. COMPLICATION
Anemia
Due to chronic Blood loss
Strangulated hemorrhoids
causes extreme pain

26. PREVENTION
Eat high-Fiber foods
Drink plenty of fluids
Consider Fiber supplements
Don’t strain
Defecate as soon as you feel the urge
Exercise
Avoid long periods of sitting

29. Thank you