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Hemorrhoids

What Are Hemorrhoids?
 Alternative Names
 Piles

 Definition:
 Dilated

or enlarged hemorrhoidal veins in the lower portion of the rectum or anus.

Prolapse and reduce spontaneously III.Require replacement !V.occurring outside the external sphincter Grades: I.Permanently Prolapsed .  Two Types:   Internal.Cont.Hemorrhoids only bleed II.occurring above the internal sphincter External.

.Cont.

Four classifications of prolapsed hemorrhoids .

this force damage the muscles.  Blood flow through the veins of the hemorrhoidal plexus is impaired.Etiology  Hemorrhoids develop as a result of shearing forces during defecation. .  This is the most common reason for bleeding with defecation.  Intravascular clot in the venule results in a thrombosed external hemorrhoid.

Clinical Manifestations  Rectal Bleeding  Bright red blood in stool  Pain during bowel movements  Anal Itching  Rectal Prolapse  Thrombus .

Causes  Constipation  Diarrhea  Sitting time  Obesity  Heavy Lifting  Pregnancy or standing for long periods of .

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Diagnostic Tests  Rectal Examination  Visual  Digital  Tests  Stool Guaiac (FOBT)  Sigmoidoscopy  Anoscopy  Proctoscopy .

 Severe bleeding can occur causing iron deficiency anemia.Complications  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. .

Treatment Non-surgical  Mild cases are controlled by:  Preventing constipation  Increased Fluid intake  High-fiber diet  Stool softeners .

 Apply and OTC cream or suppository containing hydrocortisone (should only lasts for 1 week because this can cause dermatitis and muscle atropy)  Keep anal area clean  Hot sitz bath bath .Cont.

.an anascope is inserted so the hemorrhoid can be identified and then ligated with a rubber band.Non surgical approach for Internal Hemorrhoids  Rubber band ligation.

 Infrared coagulation- used to treat bleeding internal hemorrhoids .

 Cryotherapy. .involves rapid freezing of the hemorrhoid.

This may be done by a cautery. . This is done when there is prolapsed.Hemorrhoid Surgery Hemorrhoidectomy  Surgical excision of hemorrhoids. or excision  The area is to be leaved open so that healing takes place by secondary intention. clamp. excessive pain. In other approach the tissue is sutured and wound healing takes place by primary intention. bleeding and or large hemorrhoids.

Prevention/ Nursing Management  Avoid long periods of standing or sitting  Don’t Strain  Go as soon as you feel the urge  Proper use of OTC drugs  Sitz Bath for 15-20 mins for 2-3 times each day for 7 days  Opiods is given for pain  Topical nitroglycerin preparations may be used to decrease pain .

this should be removed on the first or second post op day. ( Colace) .Nursing Management  Patient should not be left alone  Packing may be inserted to the rectum to absorb     drainage. Assess for rectal bleeding Provide for privacy Pain meds given before bowel movement to reduce discomfort Stool softener is given for the first few post op days.

 Regular check ups are important in the prevention of any further problems because this may reccur. If patient has not yet defecate for two Days after operation an oil – retention enema is given. .