Non Medical Management Also Can Be Done in The Form of Improvement of Diet and Drink To

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 4

Non Medical Treatment

1. Educating the patient about their illness, and the action to be taken to treat the patient's
illness, and also advising the patient on things to avoid that can worsen the disease and the
condition of the their illness.
2. Non medical management also can be done in the form of improvement of diet and drink to
improve patient's defecation way, that is;
 Improving the way defecation, is an always-present treatment in every form and degree of
hemorrhoids where this improvement is called the Bowel Management Program (BMP)
consisting of patient's diet, fluids, dietary fiber, and behavioral patterns of defecation.
 To correct the defecation way, is recommended to use squatting position during defecation.
In a squatting position only a lighter effort is needed to push the stool down or out the
rectum. Straining and constipation will increase the pressure of hemorrhoid vein and will
aggravate the occurrence of hemorrhoids. By using squatting position, there will be less
straining.
 Along with the above BMP program, patient's also need to perform local hygiene measures
by soaking the anus into warm water for 10-15 minutes 2-4 times a day. With this immersion,
the sticky stool that can cause irritation and itching can be cleaned.
 Patients should not have too much sitting or sleeping, and recommended to do some
exercise and walking so the pattern of defecation becomes better.
 Patients are required to drink a lot of 30-40 ml / KgBB / water a day to soften the stool.
 Patients should eat a lot of food with high fiber like fruits, vegetables, ceral, and refrain
from eating too much meat.

Medical Treatment
Medical treatment by using pharmacologic drugs for hemorrhoids can be divided into four namely
to repair defecation, relieve complaints, stop bleeding, suppress or prevent complaints and
symptoms
1. Drugs to help the defecation
There are two drugs included in the BMP and that is fiber supplement and laxative.
Commonly used commercial fiber supplements like pylium or isphagula husk that derived
from plantago ovate seed shell that dried and ground into powder. In the gastrointestinal
tract the powder can be water-absorbing and functionate as laxative blot that works to
increase stool volume and increase peristalsis. Side effects include flatus, bloating, and
cosntipation. To prevent constipation or obstruction, it is recommended to drink plenty of
water.
2. Symptomatic drugs
This treatment aims is to eliminate or reduce complaints of itching or pain because of skin
damage in the area of the anus. Symptom-reducing drugs are often mixed with lubricants,
vasoconstrictors, and weak antiseptic. To decrease or eliminate the pain, drugs that
contained local anesthesia can be use. Provision of local anesthesia is done as short as
possible to avoid sensitivity and anal skin irritation. These drugs can be in the market in the
form of ointment or suppository. If necessary, use a preparation containing corticosteroid to
reduce inflammation of the hemorrhoids or anus. Suppository forms of preparation are used
for internal hemorrhoids, while ointment / cream preparations are used for external
hemorrhoids.
3. Drugs to stop bleeding
Administration of commercial fibers eg psyllium in the study after 2 weeks of
administration was able to reduce hemorrhoidal bleeding that occurred. Giving citrus
bioflavonoids that derived from lemon and paprika in patients with bleeding hemorrhoids
can improve the permeability of blood vessel walls, bioflavonoids that derived from lemon
are diosmin, heperidin, routine, naringin, tangretin, diosmetin, neohesperidin, quercetin.
Bioflvonoids derived drugs that are often used for the treatment of bleeding hemorrhoids are
mixtures of diosmin (90%) and hesperidin (10%), in micronized form.
4. Healing and prevention medicine for hemorrhoids
Diosminthesperidine provides recovery and improvement in symptoms of inflammation,
congestion, edema, and prolapse.
Management of hemorrhoids by degrees or levels:
1. Grade I
 Can be done by eliminating the causal factors, such as obstipation by giving diet advice.
Patients are required to drink water 30-40ml / kgBB / day to soften the stool. Patients should
eat a lot of high fiber food like fruits, vegetables, cereals, and commercial fiber
supplementation when there is lack of fiber in the diet, and eat less meat. All spicy foods are
not recommended.
 Oral antibiotics are given when there is inflammation.
 Commonly used commercial fiber supplements include psyllium or isphagula husk.
 When there is pain, corticosteroid suppositories can be use.
 To smooth the defecation, Parrafin liqudium or laxadin can be use.
 If the above treatment does not provide improvement, try with sclerotherapy by injecting 5%
Sodium Morrhuate, Phenol or 1-3% aetoksisklerol between lining membranes and varicose
veins, in the hope of fibrosis and deflection of internal hemorrhoids in the area of
hemorrhoids.
2. Grade II
 Commonly used commercial fiber supplements include psyllium or isphagula husk.
 If there is pain, corticosteroid suppository may be given
 Sclerotherapy and if it does not help then surgery.

3. Grade III
 Commonly used commercial fiber supplements include psyllium or isphagula husk.
 If there is pain, corticosteroid suppository may be given
 Galvanized generator, to damaged the hemorrhoidal tissue by direct electric current coming
from a chemical battery. This method is most effective for internal hemorrhoids.
 Laser haemorrhoidectomy, this method is similar to infrared. It's just has the advantage in
the ability to cut. However, the cost is expensive. This procedure can be done only with
outpatient, not much blood, not a lot of injuries and with minimal pain.
 Doppler ultrasound guided haemorrhoid artery ligation. This method becomes the main
choice during bleeding because it can know the exact location of the hemorrhoidal artery to
be sewn.
 Hemorrhoidectomy, an excision technique that is only performed on completely redundant
tissue. A minimal excision as possible on the anoderm and normal skin by not disturbing the
anal sphincter.
 Stapled Hemorrhoidopexy, this technique is used for prolapsed hemorrhoids. Circular
stapling gun is used to excise the anal canal mucosa over 2-3cm above the dentate line. This
technique is used for internal hemorrhoid that does not respond to non-surgical therapy. Less
pain relief and healing faster than hemorrhoidectomy.
 Milligan Morgan technique, this technique is used for hemorrhoids bulge in 3 main places.
This technique was developed in England by Milligan and Morgan in 1973. The hemoroid
mass base just above the mucocutaneous line was clamped with hemostat and retracted from
the rectum. Then a proximate catgut transfiction suture is installed to the hemorrhoidal
plexus. It is important to prevent the installation of stitches through the internal sphincter
muscles. The second hemostat is placed distally against external hemorrhoids. An elliptical
incision is made by scalpel through the skin and the mucosal tunica around the internal and
external hemoroidal plexus, which is released from the underlying tissue. Hemorrhoids are
excised entirely. When the dissection reaches the transfiction stitch of the cat gut, the
external hemorrhoids under the skin are excised. After securing hemostasis, the mucosa and
anal skin are closed longitudinally with simple bast stitches. Usually no more than three
groups of hemorrhoids are removed at one time. Rectal stricture may be a complication of
too much rectal mucosal tunica excision. So it's better to take too little than taking up too
much tissue.

 Whitehead technique, the surgical technique used for circular hemorrhoids by stripping the
entire hemorrhoids to freeing the mucosa from submucosa and conducting circular resection
of the mucosa of the area. Then seek mucosal continuity again.
 Langenbeck technique, on Langenbeck technique, internal hemoroid clamped radier with
clamp. Perform a bleeding suture under the clamp with chromic no 2/0 paint gut. Then
excise the tissue above the clamp. After that, the clamps are removed and the baste clamps
under the clamps are tied. This technique is more often used because it is easy and does not
contain the risk of formation of secondary scar tissue that usually cause stenosis.

4. Grade IV
 Commonly used commercial fiber supplements include psyllium or isphagula husk.
 If there is pain, corticosteroid suppository may be given
 Usually there are inflammation and tongs, which is usually reassured with antibiotics and
zitbaden, new operative measures taken.
 External hemorrhoids, treatment is always operative, whether excision or incision of the
thrombus there almost no different about the outcome.
 Complaints can be reduced by sitting soak using a warm solution, an analgesic-containing
ointment to reduce pain or friction on walking, and sedation. Bed rest can help speed up
swelling healing. Patients who arrive before 48 hours can be helped and healed faster either
by removing the thrombus immediately or complete excision by hemorrhoidectomy with
local anesthesia. When the thrombus has been removed, the skin is made elliptical in order
to prevent skin bending and the re-formation of the underlying thrombus. Pain disappears
immediately after the action and the wound will heal in a short time because the wound is in
an area rich in blood.
 Hemorrhoidectomy.
 Stapled Hemorrhoidopexy.
 Milligan Morgan Technique.
 Whitehead Technique.
 Langenbeck Technique.
 Post surgery treatments are attempted so that patients can defecate the next day to prevent
the narrowing of the anal canal. If there is a narrowing, then dilated must be done again.

You might also like