2. DEFINITION
• HAEMORRHOIDS are swellings in the upper anal canal and lower rectum due
to engorgement of veins.
• Alternative definition, Pathological term for a downward
displacement of the anal cushions, which produces dilatation of
the venules.”
• Anal cushions:(3 in number)
4. HAEMORRHOIDS
Classification and nomenclature:
External hemorrhoids- below the dentate line covered with ano-derm
Internal hemorrhoids- above the dentate line covered with sub-mucosa
Mixed hemorrhoids
Classification of internal hemorrhoids
Grade I- don’t prolapse
Grade II- prolapse on defecation but reduce spontaneously
Grade III- prolapse on defecation but can be reduced manually
Grade IV- prolapse on defecation but cant be reduced
Other s
Skin tags, strangulated or gangrenous Haemorrhoids.
5. CLINICAL MANIFESTATION
Symptoms and Signs:
Bleeding
o Painless
o After defecation
o Intermittent over a long period
Mucous discharge
o Due to engorged mm
o Causes pruritus ani
Prolapse
Pain
o Rare
o Indicates a complication
Anemia
6. MANAGEMENT
Evaluation:
History
Examination
General
Abdominal
DRE- Hemorrhoids are not palpable unless they are thrombosed
Proctoscopy
Investigation – General and Specific
Differential Diagnosis:
1. Rectal mucosal prolapse
2. Hypertrophied anal papillae
3. Rectal polyps
4. Anal carcinoma
5. Inter-sphincteric abscess
6. Melanoma
7. Perianal endometrioma
8. Symptomatic Rx :
1. Diet ie rich in fibre
2. Bulk forming agents
3. Creams and Suppositories eg anusol and pilorect
4. Analgesia
5. Warm Sitz baths
Complications of Hemorrhoidectomy :
1. Pain
2. Reactionary hemorrhage
3. Retention of urine
4. Anal stricture(Late)
9. HAEMORRHOIDS
Anal cushions:(3 in number)
Location
o Lt lateral
o Lt posteral lateral
o Rt posteral lateral
o Run from dentate line to ano-rectal ring.
Contents
o Bld vessels
o Smooth muscles fibers(Treitz muscle)
o Elastic CTx
Function ? Anal continence.
