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Hemorrhoids
OHHHH it Burns
Mike Parenteau
Soooo Angry
Pathophysiology
Hemorrhoids are varicosities (dilated
veins) that may occur outside the
anal sphincter.
Can be external or internal
Most common health problem in
humans. Seen in ages 20 to 50 years
old
Etiology Factors
Straining at with increased
intraabdominal and hemrorrhoidal
venous pressures. With repeated
increased pressure and obstructed
blood flow, permanent dilation occurs
Stuff that causes it
Constipation
Diarrhea
Pregnancy
CHF
Portal hypertension
Prolonged sitting or standing
Internal
Internal hemorrhoids are those that
occur inside the rectum. As this area lacks
pain receptors, internal hemorrhoids are
usually not painful and most people are
not aware that they have them. Internal
hemorrhoids, however, may bleed when
irritated.
Untreated internal hemorrhoids can lead
to two severe forms of hemorrhoids:
prolapsed and strangulated hemorrhoids.
Internal
Prolapsed hemorrhoids are internal
hemorrhoids that are so distended that
they are pushed outside of the anus.
If the anal sphincter muscle goes into
spasm and traps a prolapsed hemorrhoid
outside of the anal opening, the supply of
blood is cut off, and the hemorrhoid
becomes a strangulated hemorrhoid.
External
External hemorrhoids are those that
occur outside of the anal verge (the distal
end of the anal canal). They are
sometimes painful, and can be
accompanied by swelling and irritation.
Itching, although often thought to be a
symptom from external hemorrhoids, is
more commonly due to skin irritation.
If the vein ruptures and a blood clot
develops, the hemorrhoid becomes a
thrombosed hemorrhoid.
Clinical Manifestations
The most common symptoms
associated with enlarged, abnormal
hemorrhoids are prolapsed and
bleeding. The bright red bleeding and
prolepses usually occur at time of
defecation
Subjective Assessment
Complaints of constipation
Pruritus
Severe pain when dilated vain
becomes thrombosed
Bleeding from the rectum that is not
mixed with feces (poop).
Rectum darn near killed them
Objective Assessment
Observing external hemorrhoids and
palpating internal hemorrhoids on
examination
Bleeding and constipation are signs
of cancer of the rectum, all patients
with these symptoms should have a
thorough examination to rule out
cancer
Medical Management
There is no medicine that will cure hemorrhoids,
but local treatments such as warm sitz baths,
using a bidet, extendable showerhead, cold
compress, or topical analgesic (such as
Nupercainal), can provide temporary relief.
Consistent use of medicated creams (such as
Anusol) during the early stages of a hemorrhoid
flare-up will also provide relief and may stave off
further development and irritation. Keep the area
clean and dry, with some lubrication provided by
hemorrhoidal creams. Suppositories are of little
help since all of the symptoms come from the
external tissues and not in the rectum where the
suppository is placed.
Medical Management
Rubber band ligation: elastic bands are applied
onto an internal hemorrhoid to cut off its blood
supply. Within several days, the withered
hemorrhoid is sloughed off during normal bowel
movement.
Hemorrhoidolysis/Galvanic Electrotherapy:
desiccation of the hemorrhoid by electrical
current.
Sclerotherapy (injection therapy): sclerosant
or hardening agent is injected into hemorrhoids.
This causes the vein walls to collapse and the
hemorrhoids to shrivel up.
Medical Management
Cryosurgery: a frozen tip of a cryoprobe
is used to destroy hemorrhoidal tissues.
Rarely used anymore because of side
effects
Laser, infrared or BICAP coagulation:
laser, infrared beam, or electricity is used
to cauterize the affected tissues. Lasers
are now much less popular.
Hemorrhoidectomy: a true surgical
procedure to excise and remove
hemorrhoids.
Medical Management
Stapled Hemorrhoidectomy: Also called the procedure
for prolapse and hemorrhoids, it is designed to resect soft
tissue proximal to the dentate line, which disrupts the blood
flow to the hemorrhoids. It is generally less painful than
complete removal of hemorrhoids and also allows for faster
recovery times. It's meant for hemorrhoids that fall out or
bleed and is not helpful for painful outside conditions.
Enema: This Practice is only used to clean the rectum in
some cases and only done by an M.D. Water is injected into
the rectum and then flushed out cleaning the area.
Doppler Guided Hemorrhoidal Artery Ligation : The
only evidence based surgery for all grades of hemorrhoids.
It does not involve cutting tissues or even a stay at the
hospital; patients are usually back to work on the same
day. Best treatment for bleeding piles, as the bleeding
stops immediately.
Rubber band ligation
Stapled Hemorrhoidectomy
Diseases with similar symptoms
Symptoms associated with rectal
cancer, anal fissure, anal abscess,
anal fistula, and other diseases may
be similar to those produced by
hemorrhoids and may be reduced by
the topical analgesic, so it is
important to have the Doctor
examine the patient.