3. DEFINATION
◦ Haemorrhoids Are the dilated portion of haemorrhoidal
veins in the anal canal.
◦ It may be :
INTERNAL – occur above
the internal sphincter.
EXTERNAL – occur
outside the external
sphincter.
5. 1 Stage: Hemorrhoid Nodes Are Slightly Enlarged, But Not
Exposed To The Anus. Patients Usually Complain Of Tingling
And Itching In The Area Of The Anus, And Also Bleed.
2 Stage: Hemorrhoid Nodules Are Significantly Increased,
Dark Blue In Color And Very Painful. When Strain And
Performance Of Defecating.
3 Stage: Hemorrhoid Nodules Are Constantly Visible. With
Slight Hand Pressure, They Can Return To Its Former
Position.
4 Stage : All Other Condition Are Present. Have Blood Clot.
Thrombosed Hemorrhoid Are Formed.
6. Causes Of Haemorrhoid's
◦ Weaken supportive tissue.
◦ Straining during defecation
◦ Prolonged sitting & standing.
◦ Obesity
◦ Pregnancy
◦ Heavy lifting
◦ Portal hypertension
◦ Constipation
7. PATHOPHYSIOLOGY
Due To Shearing Force Damages Of Supporting Muscles.
Weaken Supportive Tissue In The Anal Canal.
Venules Become Dilated
Impaired Hemorroidal Plexus Intravascular Clot In The Venules
Leading Rectal Bleeding.
8. CLINICAL MANIFESTATION
◦ Bright red bleeding, pruritis, prolapse & pain.
◦ Internal hemorrhoids may be asymtomatic but when internal
hemorroid become constricted or enlarge bleeding & prolapse
occur, patient will report chronic dull pain.
◦ Blood on toilet paper or out side of stool after defecation.
◦ External hemorrhoids reddish, blue seldom bleed,
pain on palpation, itching, burning,
intermitten pain.
9. DIAGNOSTIC EVALVATION
History & Physical
Examination
CBC
Digital Rectal
Examination
Proctoscopy &
Anoscopy
Colonoscopy Or
Sigmoidoscopy
Barium Enema X
Ray
10. Management
◦ High fiber diet & increase fluid intake
◦ Hydrophillic bulk forming agent. Mucilloid may be help
◦ Anti inflammatory agent or astringent, suppositories &
anesthetic may be used to shrink the mucous membranes.
◦ Stool softener to keep stool soft
◦ Sitz bath& warm compress to relieve pain
◦ Exercise help to relieve constipation
◦ Natural fiber underwear
11. Non Surgical Treatment
◦ Rubber band ligation to remove necrotic tissue
◦ Infrared coagulation to stop bleeding
◦ Cryotherapy rapid freezing the haemorrhoids
◦ Laser treatment to affix the mucosa in the under
lying muscle.
◦ Sclero therapy: is the inserting the solution
directly to haemorrhoidal tissue.
12. SURGICAL MANAGEMENT
◦ Anal dilation :anal sphincter muscle is
stretched or dilated to reduce straining to
pass the stool
◦ Stapled hemorrhoidectomy: uses a
special device to internally staple &
excise internal hemorrhoidal tissue.
◦ Hemorrhoidectomy : is the surgical
excision of haemorrhoid when there is
prolapsed.
13.
14. NURSING MANAGEMENT
◦ Teaching measures to prevent constipation.
◦ Avoidance of prolonged standing or sitting
◦ Proper use of OTC drugs
◦ Need to seek medical care if symptom severe
◦ Sitz bath 2 to 3 times each day for 7 to 10 days.
◦ Keep anal area clean packing may be inserted into the rectum to absorb drainage.
◦ T-binder may hold the dressing in place.
◦ Assess for rectal bleeding
◦ Privacy should be provided
◦ Pain medication may be given before bowel movement.
◦ Regular check up is important.
