Hemorhhoids Css

Alternative Names
Rectal Lump
Piles
Lump in the Rectum
Definition:
Dilated or enlarged veins in the

lower portion of the rectum or
anus.
10 million
Peak ages: 45-65
years
½
of adults
experience
hemorrhoids by age
50
Common amon pregnan
women g t

Right anterior, Right posterior and
Left lateral positions
Those originating above the dentate line

which are termed internal
Those originating below the dentate line

which are termed external
Internal Hemorrhoids Disease
Manifested by two main symptoms
- Painless Bleeding
- Protrusion
(Pain is rare as they originate above dentate
line)
Most popular etiologic theory states that
Hemorrhoids result from chronic straining
at defecation
 Continued straining engorgement
and bleeding, as well
causes hemorrhoidal
prolaps
as
e
Grades
I:. Hemorrhoids only bleed
II.Prolapse and reduce
spontaneously III- Require
replacement
IV- Permanently Prolapsed
Pressure
Constipation
Diarrhea
Sitting or standing for long periods of
time
Obesity
Heavy Lifting
Pregnancy
Rectal Bleeding
Bright red blood in
stool
Dripping in the toilet
On wiping after defecation
Pain during bowel movements
Anal Itching
Rectal Prolapse (while walking, lifting weights)
Thrombus
Extreme pain, bleeding and occasionally signs
of systemic illness in case of strangulation
 Asymptomatic
 except when secondary thrombosed
 Thrombosis may result from defecatory straining
or extreme physical activity or may be random
event
 Patient presents with constant anal pain of acute
onset
 Physical examination identifies external thrombosis as
purple mass at anal verge
Management
- Depends on patients symptoms
-In the first 24 – 72 hours after onset, pain increase
and excision is warranted
Rectal
Visual
Examination
Digital
Tests
Stool Guaiac
(FOBT)
Sigmoidoscopy
Anaoscopy
Proctoscopy
Patients should be examined in the
left lateral decubitus position (while
asking the patient to bear down)
any rashes, condylomata, or
eczematous lesions.
external sphincter function
Any abscesses, fissures or fistulae
lubricated finger should be gently inserted
into the anal canal
the resting tone of the anal canal should be
ascertained as well as the voluntary
contraction of the puborectalis and external
anal sphincter.
masses should be noted as well as any areas

of tenderness.
Gastroenterologists
Seek emergency care if :

large amounts of rectal
bleeding
Lightheadedness
Weakness
Rapid HR < 100 BPM
The blood in the enlarged veins may
form clots and the tissue
surrounding the hemorrhoids can
die (Necrosis)
This causes painful lumps in the anal
area.
Severe bleeding can occur causing
iron deficiency anemia.
Varies from simple reassurance
to operative hemorrhoidectomy.
Treatments are classified into

three
categories:
1)Dietary and lifestyle modification.
2) Non operative / office procedures.
3)Operative hemorrhoidectomy.
 The main goal of this treatment is to minimize
straining at stool.
 Achieved by increasing fluid and fiber in the diet,
recommending exercise, and perhaps adding
fiber agents to the diet such as psyllium.
 If necessary, stool softeners may be added.
"you don't defecate in the library

so you shouldn't read in the
bathroom".
Apply and OTC cream or
suppository containin
hydrocortisone g
Keep anal area clean
Soak in a warm bath

Apply ice packsorcompresses x
10min
If prolapses, gently push back into anal
canal
Use a sitz bath
with warm water
Use moist towelettes or wet toilet paper
instead of dry toilet paper.
 Grade I or Grade II hemorrhoids
and, in some circumstances,
Grade III hemorrhoids.
 Complications include
bleeding, pain, thrombosis and
life threatening perianal sepsis.
 Successful in two thirds to three
quarters of all individuals with
first and second degree
hemorrhoids.
Generates
infrared radiation
which coagulates
tissue protein and
evaporates water
from cells.
Most beneficial
in Grade I and
small Grade II
hemorrhoids.
Injectionof an irritating material into the
sub mucosa in order to decrease
vascularity and increase fibrosis.
Injectingagents have traditionally been

phenol in oil, sodium morrhuate, or
quinine urea.
Manual anal dilatation was first
described by Lord .
Cryotherapy was used in the past with

the belief that freezing the apex of the
anal canal could in decreased
vascularity result and of the
cushions. fibrosis anal
The triangular shaped hemorrhoid is
excised down to the underlying sphincter
muscle.
Wound can be closed or left open
Stapled hemorrhoidectomy has been

developed as an alternative to Standard
hemorrhoidectomy
Eat high fiber diet
Drink Plenty of Liquids
Fiber Supplements
Exercise
Avoid long periods of standing

or sitting
Don’t Strain

Hemorhhoids Css

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Alternative Names

Dilated or enlarged veins in the

Those originating above the dentate line

Those originating below the dentate line

masses should be noted as well as any areas

Seek emergency care if :

Treatments are classified into

"you don't defecate in the library

Soak in a warm bath

Injectingagents have traditionally been

Cryotherapy was used in the past with

Stapled hemorrhoidectomy has been

Avoid long periods of standing

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