HAEMORRHOIDS

Brittany Jordan
Medical-Surgical Nursing
 OBJECTIVES
 Define Haemorrhoids
 Classification of Haemorrhoids
 Aetiology of Haemorrhoids
 Risk Factors
 Signs & Symptoms
 Medical Management of Haemorrhoids
 Nursing Management: Assessment, Diagnosis, Interventions &
Evaluation
 WHAT ARE HAEMORRHOIDS?

Haemorrhoids are swollen and inflamed blood vessels in the rectum

and anus.

Haemorrhoids can be internal or external

CLASSIFICATION OF HAEMORRHOIDS
 Haemorrhoids are classified as external or internal depending on their location in regard
to the pectinate line.
CLASSIFICATION CNTD: EXTERNAL
CLASSIFICATION CNTD : INTERNAL

 N
AETIOLOGY: WHAT CAUSES HAEMORRHOIDS?

 Haemorrhoids develop due to increased pressure in the rectum.

RISK FACTORS

 Aging
 Pregnancy
 Irregular bowel habits e.g. Frequent constipation
 Obesity
 Low Fibre Diet
 Frequent heavy lifting
 Frequent anal sex can exacerbate existing haemorrhoids
SIGNS & SYMPTOMS

 Pain
 Swelling
 Itching
 Rectal bleeding
 Faecal incontinence
 Perineal Mass (in the case of prolapsed haemorrhoids)
MEDICAL MANAGEMENT

 Creams & Ointments

 Sclerotherapy
 Rubber band Ligation
 Surgery : Hemorrhoidectomy
NURSING MANAGEMENT: ASSESSMENT

 Dietary History
 Medical History
 Medications
 Physical Exam
 Pain Assessment
NURSING MNGMT: NURSING DIAGNOSIS
 Acute pain related to thrombosed or prolapsed haemorrhoids possibly evidenced by
verbalised pain/fever/facial grimacing/tachycardia
 Impaired skin integrity related to thrombosed or prolapsed haemorrhoids possibly
evidenced by swelling/drainage/bleeding/breaks in the skin.
 Impaired bowel continence related to impaired anal sphincter function, secondary to
haemorrhoids possibly evidenced by patients’ inability to control passage of
stool/faecal leakage.
 Deficient knowledge related to lack of information resources as possibly evidenced
by limited knowledge on disease prevention and nutrition.
 Risk for situational low self-esteem related to shame felt due to the condition.
NURSING MNGMT: INTERVENTIONS
Acute Pain
 Assist with warm sit baths – To decrease discomfort, soothe haemorrhoids and reduce
pain.
 Encourage stool softeners as prescribed – To reduce instances of straining and reduce
pressure during bowel movements. To avoid the pain of passing hardened stool.
 Encourage fluids – To facilitate hydration and smoother bowel movements and reduce
pain.
 Ensure analgesics are administered as prescribed – To reduce pain.
 Monitor vital signs – To assess against baseline as indication of pain.
NURSING MNGMT: INTERVENTIONS
Impaired Skin Integrity
 Ensure topical medication is administered as prescribed – To reduce pain, swelling
and itching.

 Provide donut cushion for patient to sit on – To remove pressure from haemorrhoids,
promote comfort and tissue repair.

 Assist with haemorrhoid treatment procedures – To reduce or remove haemorrhoids

NURSING MNGMT: INTERVENTIONS
Impaired Bowel Continence
 Provide bedside commode – To ensure prompt access to toilet and reduce likelihood
of accidents.
 Encourage a high fibre diet – To add bulk to stools and reduce straining and pressure
on haemorrhoids.  
 Ensure fibre supplements are taken as ordered – To provide bulk to stool and aid in
bowel movement.
 Assist with the creation and maintenance of a bowel program/schedule – To regulate
bowel movement.
NURSING MNGMT: EVALUATION
At the end of shift:
 Acute Pain - Client is pain free based on a 0/10 rating on the pain scale and stable
vital signs.
 Impaired Skin Integrity - Client shows no sign of rectal bleeding as determined by
physical examination.
 Impaired Bowel Continence - Client has established or returned to a normal pattern
of bowel function.
 Deficient Knowledge – Client verbalizes understanding of good anal hygiene,
haemorrhoid prevention and good dietary habits.
 Risk for Situational Low Self-Esteem – Client verbalizes feeling in control and
empowered.
THE END