This document discusses hemorrhoids including defining them as vascular masses in the lower rectum or anus. It lists the learning objectives as defining hemorrhoids, discussing their etiology and risk factors, clinical manifestations, diagnostic evaluation, and management. The document covers the sites of hemorrhoids, predisposing factors, clinical manifestations, diagnostic tests, medical management including lifestyle changes and procedures, surgical management options, potential complications, and the nursing role in post-operative care and patient education.

1. MEDICAL SURGICAL NURSING
DEPARTMENT
SRMMCON

2. At the end of this lecture the students should be
able to—
1. Define hemorrhoids.
2. Enlist the etiology and risk factors of
hemorrhoids.
3. Discuss the clinical manifestation of hemorrhoids.
4. List down the diagnostic evaluation of
hemorrhoids.
5. Explain the management of hemorrhoids.
LEARNING OBJECTIVES

3. Hemorrhoids are vascular masses in the lower
rectum or anus.

4. External hemorrhoids-- appear outside the
external sphincter.
Internal hemorrhoids-- appear above the
internal sphincter.
Thrombosed hemorrhoids--When blood within
the hemorrhoids becomes clotted due to
obstruction, the hemorrhoids are referred to as
thrombosed.
SITES OF HEMORRHOIDS

5. Abnormal dilatation of veins of internal
hemorrhoidal venous plexus.
Abnormal distension of the arteriovenous
anastomoses.
Downward displacement or prolapse of anal
cushions.
Destruction of the anchoring connective
tissue system.

6. Pregnancy, prolonged sitting/standing.
Straining at stool, chronic
constipation/diarrhea.
Anal infection, rectal surgery, or
episiotomy.
PREDISPOSING FACTORS

7. Hereditary factor.
Exercise.
Coughing, sneezing, vomiting.
Loss of muscle tone due to age.
Anal intercourse.
CT-PREDISPOSING FACTORS

8. CT-PREDISPOSING FACTORS
Increased intra-abdominal pressure causes
engorgement in the vascular tissue lining the
anal canal.
Loosening of vessels from surrounding
connective tissue occurs with protrusion or
prolapse into anal canal.

9. 1.Bleeding during or after defecation, bright red blood
on stool due to injury of mucosa covering
hemorrhoid.
2.Visible (if external) and palpable mass.
3.Constipation, anal itching.
CLINICAL MANIFESTATIONS

10. 4.Sensation of incomplete fecal evacuation.
5.Infection or ulceration, mucus discharge.
6.Pain noted more in external hemorrhoids.
7.Sudden rectal pain due to thrombosis in external
hemorrhoids.
Ct---Clinical Manifestations

11. 1.History
2.Anoscopy or Proctosigmoidoscopy.
2.Barium enema or colonoscopy to rule out more
serious colonic lesions causing rectal bleeding.

12. 1.Regulated Bowel habits .
2.Nonirritating stool softeners and
3.High-fiber diet to keep stools soft.
4.Frequent, warm sitz baths to ease pain and combat
swelling.
5.Analgesics as needed.
MEDICAL MANAGEMENT

13. 6.Topical creams, lotions, and suppositories to
provide comfort (Tucks pads, Anusol
cream/suppositories, Balneol lotion,
ProctoFoam,).
7.Control of itching by improved anal hygiene
measures and control of moisture.
8.Avoid prolonged use of topical anesthetics.
CT--MEDICAL MANAGEMENT

14. 1.Manual reduction of external hemorrhoids if
prolapsed.
2.Injection of sclerosing solutions (phenol 5%) to
produce scar tissue and decrease prolapse.
CT--MEDICAL MANAGEMENT

15.  3.Cryodestruction (cryosurgery)—freezing of
hemorrhoids.
1. Profuse drainage and swelling occurs.
2. Foul-smelling discharge may last for 7 to 10
days after cryosurgery.

16. INDICATIONS FOR SURGERY :----
1. Prolonged bleeding
2. Disabling pain
3. Intolerable itching
4. Prolapse

17. 1.Rubber ring ligation.
2.Dilatation of the anal canal and lower rectum
under general anesthesia.
3. Incision and removal of clot from acutely
thrombosed hemorrhoid.
4.Hemorrhoidectomy—excision of
internal/external hemorrhoids.
CT--SURGICAL MANAGEMENT

18. 1.Hemorrhage, anemia
2.Incontinence
3.Prolapse and strangulation
Complications

19. 1.After thrombosis or surgery, assist with frequent
positioning, using pillow support for comfort.
2.Provide analgesics, warm sitz baths, or warm
compresses to reduce pain and inflammation.
3.Apply anal pads, creams.
Nursing Management

20. 4.Observe anal area postoperatively for drainage and
bleeding; report if excessive.
5. Administer stool softener/laxative to assist with
bowel movements soon after surgery, to reduce
risk of stricture.
Ct--Nursing Management

21. 6.Encourage regular exercise, high-fiber diet, and
adequate fluid intake (8 to 10 glasses per day) to
avoid straining and constipation.
7.Discourage regular use of laxatives—firm, soft
stools dilate the anal canal, decreasing stricture
formation.
Ct--Nursing Management

22. SUMMARY
In this class we discussed
Definition hemorrhoids.
Etiology and risk factors of hemorrhoids.
Clinical manifestation of hemorrhoids.
Diagnostic evaluation of hemorrhoids.
Management of hemorrhoids.
• Medical
• Surgical
• Nursing

23. Lippincott “Medical surgical nursing” 10th
edition
Joyce M Black ” Medical surgical nursing”
Brunner And Suddharth “Medical surgical
nursing”

24. THANK YOU