ASUHAN

KEPERAWATAN
PADA PASIEN
HEMOROID
KELOMPOK 5
Nikolaus Johanis Tumun
Reski Maulana
Indra Prasetiyawan
Nurulita Viranti Rahmana
Novalina Sarce Yerisetow
HEMOROID
1. Pengertian
Hemoroid adalah pelebaran varices satu segmen atau lebih vena-vena hemoroidalis (Mansjoer, 2000).
Hemoroid atau ”wasir (ambeien)” merupakan vena varikosa pada kanalisani. Hemoroid timbul akibat kongesti vena
yang disebabkan oleh gangguan aliran balik dari vena hemoroidalis.
Hemoroid sering dijumpai dan terjadi pada sekitar 35% penduduk berusia lebih dari 25 tahun. Walaupun keadaan ini
tidak mengancam jiwa, namun dapat menimbulkan perasaan yang sangat tidak nyaman (Price dan Wilson, 2006).
Penyakit hemoroid sering menyerang usia diatas 50 tahun. Hemoroid seringkali dihubungkan dengan konstipasi
kronis dan kehamilan. Terkadang dihubungkan dengan diare,sering mengejan, pembesaran prostat, fibroid uteri, dan
tumor rectum. Komplikasi dapatmenyebabkan nyeri hebat, gatal dan perdarahan rectal (Chandrasoma, 2006; Price
danWilson, 2006).
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 4. Keturunan atau hereditas.
1. Mengejan pada waktu defekasi.

2. Konstipasi yang menahun yang tanpa

pengobatan.
2. Etiologi 5. Kelemahan dinding structural dari
dinding pembuluh darah.

3. Pembesaran prostat. 6. Aktivitas fisik berat

7. Peningkatan tekanan intra
abdomen (seperti: Kehamilan,
berdiri dan duduk terlalu lama
dan konstipasi).
3. Tanda dan Gejala
 Tanda
a. Perdarahan
Umumnya merupakan tanda pertama hemoroid interna trauma oleh feces yang keras.Darah yang keluar
berwarna merah segar dan tidak bercampur dengan feces.Walaupun berasal dari vena, darah yang keluar
berwarna merah segar karena kaya akan zat asam, jumlahnya bervariasi.
b. Nyeri
Nyeri yang hebat jarang sekali ada hubungannya dengan hemoroid interna dan hanya timbul pada
hemoroid eksterna yang mengalami trombosis dan radang.
 Gejala
a. Anemia dapat terjadi karena perdarahan hemoroid yang berulang.
b. Jika hemoroid bertambah besar dapat terjadi prolap awalnya dapat tereduksi spontan. Pada tahap
lanjut pasien harus memasukkan sendiri setelah defekasi dan akhirnya sampai pada suatu keadaan
dimana tidak dapat dimasukkan.
c. Keluarnya mucus dan terdapatnya feces pada pakaian dalam merupakan ciri hemoroid yang
mengalami prolap menetap.
d. Rasa gatal karena iritasi perianal dikenal sehingga pruritis anus rangsangan mucus.
 4. Klasifikasi
0 Hemoroid Interna
1
Hemoroid interna terbagi menjadi 4 derajat:
a. Stadium I
Hemoroid interna dengan perdarahan segar tanpa nyeri pada waktu deteksi
b. Stadium II
Hemoroid interna yang menyebabkan perdarahan dan mengalami
prolaps pada saat mengedan ringan, tetapi dapat masuk kembali
secara spontan.
c. Stadium III
Hemoroid interna yang mengalami perdarahan dan disertai prolapsdan diperlukan intervensi manual
memasukkan ke dalam kanalis.
d. Stadium IV
Hemoroid interna yang yang tidak kembali ke dalam atau berada terus-menerus di luar.
 LANJUTAN..
02 Hemoroid Eksterna
hemoroid eksterna dapat di klasifikasikan menjadi 2 yaitu:
a. Akut
berupa pembengkakan bulat kebiruan pada pinggir anus dan sebenarnya adalah hematom.
b. Kronik
terdiri atas satu lipatan atau lebih dari kulit anus yang berupa jaringan penyambung dan sedikit
pembuluh darah.
 5. Patofisiologi
Dalam keadaan normal sirkulasi darah yang melalui vena hemoroidalis mengalir dengan lancar sedangkan pada
keadaan hemoroid terjadi gangguan aliran darah balik yang melalui vena hemoroidalis. Gangguan aliran darah ini
antara lain dapat disebabkan oleh peningkatan tekanan intra abdominalPeningkatan tekanan intra abdominal
menyebabkan peningkatan vena portal dan vena sistemik dimana tekanan ini disalurkan ke vena anorektal. Arteriola
regio anorectal menyalurkan darah dan peningkatan tekanan langsung ke pembesaran (varices) vena anorektal.
Dengan berulangnya peningkatan tekanan dari peningkatan tekanan intraabdominal dan aliran darah dari arteriola,
pembesaran vena (varices) akhirnya terpisah dari otot halus yang mengelilinginya ini menghasilkan prolap pembuluh
darah hemoroidalis.Hemoroid interna terjadi pada bagian dalam sfingter anal, dapat berupa terjepitnya pembuluh darah
dan nyeri, ini biasanya sering menyebabkan pendarahan dalam feces, jumlah darah yang hilang sedikit tetapi bila
dalam waktu yang lama bisa menyebabkan anemia defisiensi besi
6. Pathway
Tumor,Obesitas,tidak ada katub di sytem Sering mengejan, berjalan, berdiri duduk Faktor congenital
portal,penyakit hati kronik, hipertensi lama, prostate membesar, saluran
portar, diare, konstipasi,konggesti pelvis kencing sempit, batuk lama Dinding pembuluh
darah yang lemah

Kongesti vena hemoroidailis

Menyumbat pembuluh Gangguan aliaran balik

darah
Merangsang ujung saraf Pembekakan vena hemoroidailis
kulit
Hemoroid
Nyeri
Prolaps saat
Tindakan defeksi Ruptur
Suplai cairan
operasi pembuluh darah
dan elektrolit
menurun Mucus dan Suplai O2
Kerusakan Pendarahan
feses keluar menurun
jaringan kulit
Feses keras anal Inkonitinentia Anemis Metabolisme
anal menurun
Konstipasi Porte de
entre Kelembapan Resti Kelemahan
meningkat kekurangan
Gangguan
Resti volume cairan
pola eliminasi Pruritus
infeksi Intoleransi
aktivitas
Gangguan
integritas kulit
 7. Pemeriksaan Diagnostik
1. Pemeriksaaan Laboratorium
Pemeriksaan hitung darah lengkap untuk mendeteksi kadar hematokrit
dan adanya anemia.
2. Pemeriksaan Colok Dubur
Pada pemeriksaan colok dubur, hemoroid interna stadium awal tidak dapat diraba sebab tekanan vena di dalamnya tidak terlalu tinggi
dan biasanya tidak nyeri. Hemoroid dapat diraba apabila sangat besar. Apabila hemoroid sering prolaps, selaput lendir akan menebal.
Trombosis dan fibrosis pada perabaan terasa padat dengan dasar yang lebar. Pemeriksaan colok dubur ini untuk menyingkirkan
kemungkinan karsinoma rectum
3. Pemeriksaan Anoskopi
Dengan cara ini dapat dilihat hemoroid internus yang tidak menonjol keluar. Anoskop dimasukkan untuk mengamati keempat
kuadran. Penderita dalam posisi litotomi. Anoskop dan penyumbatnya dimasukkan dalam anus sedalam mungkin, penyumbat
diangkat dan penderita disuruh bernafas panjang. Hemoroid interna terlihat sebagai struktur vaskuler yang menonjol ke dalam lumen.
Apabila penderita diminta mengejan sedikit maka ukuran hemoroid akan membesar dan
penonjolan atau prolaps akan lebih nyata. Banyaknya benjolan, derajatnya, letak besarnya dan keadaan lain dalam anus seperti polip,
fissura ani dan tumor ganas harus diperhatikan.
 
4. Pemeriksaan Proktosigmoidoskopi
Proktosigmoidoskopi perlu dikerjakan untuk memastikan keluhan bukan disebabkan oleh proses radang atau proses keganasan di
tingkat tinggi, karena hemoroid merupakan keadaan fisiologik saja atau tanda yang menyertai. Faeces harus diperiksa terhadap
adanya darah samar.
 8. Terapi
1. Non-Farmakologi
Bertujuan untuk mencegah perburukan penyakit dengan memperbaiki cara
defekasi. Pelaksanaan berupa perbaikan pola hidup, perbaikan pola makan dan
minum, perbaikan pola atau cara defekasi. Perbaikan defekasi disebut Bowel
Management Program (BMP) yang terdiri atas diet, cairan, serat tambahan, pelicin
feses, dan perubahan perilaku defekasi (defekasi dalam posisi jongkok/squatting).
Makanan berserat akan menyebabkan gumpalan isi usus besar namun lunak
sehingga mempermudah defekasi dan mengurangi keharusan mengedan secara
berlebihan..
lakukan tindakan kebersihan lokal dengan cara merendam anus dalam
air selama 10-15 menit, 2-4 kali sehari dengan larutan kalium
permanganat (PK) 1:10.000 (1 gram bubuk PK dilarutkan dalam 10 liter
air).
 a) Obat yang memperbaiki defekasi
Terdapat dua macam obat yaitu suplement serat (fiber suplement) dan pelicin tinja
2. Farmakologi (stool softener). Suplemen serat komersial yang banyak dipakai antara lain psylium
atau isphaluga Husk (ex.:Vegeta, Mulax, Metamucil, Mucofalk).Obat ini bekerja
dengan cara membesarkan volume tinja dan meningkatkan peristaltik usus. Efek
samping antara lain kentut dan kembung. Obat kedua adalah laxant atau
pencahar (ex.: laxadine,dulcolax, dll).

b. Obat simtomatik
Bertujuan untuk menghilangkan atau mengurangi keluhan rasa gatal, nyeri, atau
kerusakan kulit di daerah anus. Jenis sediaan misalnya Anusol, Boraginol N/S
dan Faktu. Sediaan yang mengandung kortikosteroid digunakan untuk
mengurangi radang daerah hemoroid atau anus. Contoh obat misalnya
Ultraproct,Anusol HC, Scheriproct.
.
c. Obat penghenti pendarahan
Perdarahan menandakan adanya luka pada dinding anus atau pecahnya vena
hemoroid yang dindingnya tipis. Psyllium, citrus bioflavanoida yang berasal dari
jeruk lemon dan paprika berfungsi memperbaiki permeabilitas dinding pembuluh
darah.
d. Obat penyembuh dan pencegah serangan
Menggunakan Ardium 500 mg dan plasebo 3×2 tablet selama 4 hari, lalu
2×2 tablet selama 3 hari. Pengobatan ini dapat memberikan perbaikan
terhadap gejala inflamasi, kongesti, edema,dan prolaps.
9. Komplikasi
Menurut Haryono (2012)

a. Perdarahan, dapat sampai dengan anemia

b. Trombosis (pembekuan darah dalam hemoroid)

c. Hemoroidal strangulasi adalah hemoroid yang

prolaps dengan suplai darah dihalangi oleh
sfingterani
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 Infographic Style
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Get a modern PowerPoint You can simply impress your audience
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VISION MISSION
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CONTENTS

VALUE VALUE VALUE

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Fully Editable Shapes
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Insert Your Image

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 Fully Editable Icon Sets: C

You can Resize without

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You can Change Fill
Color &
Line Color

FREE
PPT
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www.allppt.com