2. o They are symptomatic downward displacement of normal anal
cushions causing venous dilation.
o It is also called as piles
o They are swollen veins in the anus and lower rectum similar to
varicose veins.
o Anal region composed of tuft of vascular tissue like arterioles and
venules along with smooth muscles and connective tissue lined by
epithelium.
3.
4. Types / Classification:
It is classified into 2 types.
1) Internal Hemorrhoids : These are above internal sphincter.
2) External Hemorrhoids : They appear outside the external sphincter.
Internal Hemorrhoids are classified by degree of prolapse.
o First Degree: They do not prolapse & protrude into anal canal.
o Second Degree: prolapse outside the anal canal during defecation but
reduce spontaneously.
o Third Degree: prolapsed to the extent that they require manual
reduction.
o Fourth Degree: prolapsed to the extent that they may not be reduced.
7. Pathophysiology
Straining during defecation
Reduced venous return from anal canal
Weakening of the supportive structures
Displacement of normal anal blood vessels
Enlargement of anal vessels
Clinical manifestations
8. Clinical Manifestations :
- Internal Hemorrhoids may be asymptomatic
- Perianal Itching
- Pain
- Bright red Bleeding after passing the stool
- Patient show discomfort
- External Hemorrhoids is associated with severe pain
- Edema caused by thrombosis (clotting of blood within Hemorrhoids)
- Ischemia of the area & Necrosis
- Burning sensation & bleeding associated with defecation.
10. Management :
General :
- Maintain good personal hygiene.
- Avoid excessive straining during defecation.
- Provide high fiber diet, fruits and bran along with plenty of fluids.
- Ointments like Nupercainal, creams, suppositories & impregnated
pads that contain anti inflammatory agents.
- Stool softners can be adviced to keep stool soft.
- Sitz bath ordered to relieve pain.
- Application of ice packs for a few hours followed by warm packs
used for external hemorrhoids.
11. Non Surgical / Conservative treatment :
- Infra red photocoagulation (infra red or electrical current waves
are used)
- Cryotherapy (involves rapid freezing)
- Laser Therapy (most expensive procedure)
- Sclerotherapy : injection of sclerosing agents (5% phenol in saline)
into the base of hemorrhoids.
- Rubber band ligation procedure (hemorrhoid is visualized &
identified through anoscope, ligatetd using rubber band). Distal part
becomes necrotic after several days and sloughs off.
12. Surgical Treatment :
- Hemorrhoidectomy ,is surgical excision of hemorrhoids (It is
indicated when there is prolapse , excessive bleeding or large
hemorrhoids).
- Stapled Hemorrhoidopexy (use surgical staples to treart
prolapse).
13. Nursing management:
- Teach about measures to prevent constipation, avoidance of
prolonged standing or sitting.
- Sitz bath two to three times per day (15 to 20 minutes).
- Topical Nitroglycerin preparations are used to decrease pain.
- Anal packing is inserted into rectum to absorb drainage.
- T- Binder is placed in position.
- Monitor the patient for bleeding.
- Stool softners are adviced in the first 2-3 days after surgery.
- Teach the patient about diet and anal area hygiene.
