May 28, 2022

1400H - 1500H
Empowerment Via Zoom
Health Disorder
Course– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management of the MEDICAL
HEMORRHOIDS MANAGEMENT of
HEMORRHOIDS.
 Empowerment ROJoson PEP Talk
Health Disorder
Course– objective - for
laypeople to have an I have a Patient
Fundamentals Empowerment
and understanding of the
Program in which I
Generalities in FUNDAMENTALS like to empower the
Medical and GENERALITIES in lay people or
Management of the MEDICAL patients to take
HEMORRHOIDS MANAGEMENT of control in the
HEMORRHOIDS. management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 My PEP TALK today
is entitled:
Empowerment
Health Disorder Fundamentals and
Course– objective - for
Generalities in
Fundamentals laypeople to have an Medical
and understanding of the Management of
Generalities in FUNDAMENTALS HEMORRHOIDS. This
Medical and GENERALITIES in is part of the Health
Management of the MEDICAL Disorder Course.
HEMORRHOIDS MANAGEMENT of
HEMORRHOIDS.
 Contents of PEP TALK on HEMORRHOIDS
Fundamentals
• What are hemorrhoids?
and Generalities
• What are the different types of hemorrhoids?
in Medical
• What are the causes of hemorrhoids?
Management of
• How common are hemorrhoids?
HEMORRHOIDS
• Clinical diagnosis of hemorrhoids
• Paraclinical diagnostic procedures for
hemorrhoids
• Basic treatment modalities for hemorrhoids
• Clinical course of hemorrhoids
• Prevention of hemorrhoids
• Myths and facts on hemorrhoids
 Definition of Terms in Title AND Delimitation of
Fundamentals
Coverage of Talk:
and Generalities
in Medical
Fundamentals – simplest and essential facts and
Management of
theories which can serve as a basis or foundation
HEMORRHOIDS
and support for advanced information

Generalities – general statements of info, not

covering specifics and details

Medical Management – diagnosis and treatment

by physicians
 • What are hemorrhoids?
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • What are hemorrhoids?
Fundamentals
and Generalities A hemorrhoid is a swollen and at times, inflamed
in Medical vein around the anus or in the lower rectum,
Management of similar to a varicose vein on the legs.
HEMORRHOIDS
There are usually multiple. That’s why,
hemorrhoids.
Hemorrhoids are swollen and inflamed veins
around the anus or in the lower rectum, similar to
varicose veins on the legs.
 • What are the different types of hemorrhoids?
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • What are the different types of hemorrhoids?
Fundamentals
and Generalities Two types of hemorrhoids are:
in Medical
• External hemorrhoids, which form
Management of
HEMORRHOIDS under the skin around the anus
(below dentate line)
• Internal hemorrhoids, which form in
the lining of the lower rectum
(above dentate line)
 
Mixed hemorrhoids – combination of
internal and external hemorrhoids
 • What are the causes of hemorrhoids?
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • What are the causes of hemorrhoids?
Fundamentals
and Generalities Hemorrhoids have a number of causes or risk
in Medical factors but often the exact cause is unknown.
Management of
HEMORRHOIDS
 • What are the causes of hemorrhoids?
Fundamentals
and Generalities Hemorrhoids can develop from increased
in Medical pressure in the lower rectum due to:
Management of
HEMORRHOIDS • Straining during bowel movements
• Sitting for long periods of time on the toilet
• Having chronic diarrhea or constipation
• Being pregnant when the growing uterus
presses on the veins
• Regular heavy lifting
• Others
• Unknown reasons
 • How common are hemorrhoids?
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • How common are hemorrhoids?
Fundamentals
and Generalities Hemorrhoids are very common in both men and
in Medical women.
Management of It has been projected about half of all people will
HEMORRHOIDS have hemorrhoids at some point in their life by
age 50.
Approximately, 5% of population suffer from
hemorrhoids at any given point in time.
Many women get hemorrhoids during pregnancy
and childbirth. The pressure of carrying a baby in
the belly puts extra stress on the blood vessels in
the pelvic area.
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Cues for hemorrhoids
in Medical Primary cue:
Management of • Something protruding from anus or coming out
HEMORRHOIDS per rectum

Secondary cues:
• Bleeding through anus particularly on
defecation
• Pain in the anus
• Perianal swelling
• Itchiness in the anus
• Mucus discharge in the anus
 • Clinical diagnosis of hemorrhoids Hemorrhoids can be:
Fundamentals
and Generalities Cues for hemorrhoids
in Medical Primary cue: Symptomatic or
Management of • Something protruding from anus or coming out Asymptomatic
HEMORRHOIDS per rectum

Secondary cues:
• Bleeding through anus particularly on
defecation
• Pain in the anus
• Perianal swelling
• Itchiness in the anus
• Mucus discharge
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities
Types of Hemorrhoids
in Medical
Management of
• External hemorrhoids
HEMORRHOIDS • Internal hemorrhoids
• Mixed external and internal
hemorrhoids
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities External hemorrhoids
in Medical • Diagnosis: By looking at the anus, one can
Management of recognize an external hemorrhoids.
HEMORRHOIDS • External hemorrhoids - under the skin around
Thrombosed external
the anus (below dentate line)
hemorrhoids with blood
External hemorrhoids do not clots.
prolapse as in internal
hemorrhoids
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Internal hemorrhoids
in Medical • Diagnosis: One has to examine the anal canal
Management of and rectum, not just at the anus.
HEMORRHOIDS • Digital examination. Inserting a gloved,
lubricated finger into the rectum to feel for
the internal hemorrhoids Prolapsing Internal
• Visual inspection. Inserting a scope (anoscope hemorrhoids
or proctoscope)

External
hemorrhoids
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Diagnosing INTERNAL
in Medical hemorrhoids, not
Management of prolapsing to be seen at
HEMORRHOIDS the anus, Stage 1 and 2
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Diagnosing INTERNAL
in Medical hemorrhoids,
Management of prolapsing to be seen at
HEMORRHOIDS the anus, Stage 3 and 4

May be seen on the

anus. Mixed hemorrhoids
Use anoscope to check – External and
upper extent and other internal
lesion. hemorrhoids with
prolapsing internal
hemorrhoids
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Severity of Hemorrhoids
in Medical
Management of
HEMORRHOIDS
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Severity of Hemorrhoids
in Medical
Management of
HEMORRHOIDS
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Severity of Hemorrhoids - number of piles (1, 2,
in Medical 3, 4, etc.; >50% circumferential - <50%
Management of circumferential)
HEMORRHOIDS
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Severity of Hemorrhoids
in Medical
Management of Bleeding – mild – occasional episodic (most
HEMORRHOIDS common)
Bleeding – moderate - recurrent / frequent
episodes during defecation
Bleeding – severe
Bleeding – very severe, bleeding in jets and
splashes, needing blood transfusion (rare)
 • Clinical diagnosis of hemorrhoids
Fundamentals
and Generalities Severity of Hemorrhoids
in Medical
Management of Thrombosis – caused by blood clots preventing
HEMORRHOIDS blood flow – causing pain (usually severe)

• Thrombosed external hemorrhoids vs non-

thrombosed (thrombosed ones – very painful)

• Thrombosed prolapsing internal hemorrhoids –

also painful
 • Paraclinical diagnostic procedures for
Fundamentals
hemorrhoids
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Paraclinical diagnostic procedures for
Fundamentals
hemorrhoids
and Generalities
in Medical A paraclinical diagnostic procedure is needed if
Management of one wants to check whether there is an internal
HEMORRHOIDS hemorrhoid and to check for other lesion in the
anus and rectum that may be causing the bulge or
mass or bleeding.
• Rectal exam – inserting a gloved, lubricated
finger into the rectum to feel for the internal
hemorrhoids and other lesions that might be
present
• Scope –inserting an anoscope or proctoscope
to visualize the rectum
 • Paraclinical diagnostic procedures for
Fundamentals
hemorrhoids
and Generalities
in Medical NOT all bleeding per anus appearing right after a
Management of defecation are due to hemorrhoids.
HEMORRHOIDS
Other causes are possible such as polyps and
rectal cancer.

Thus, a paraclinical diagnostic procedure is

needed to check if the bleeding is just caused by
the hemorrhoids and not by other lesion,
particularly rectal cancer.
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoid symptoms usually go away on their
in Medical own.
Management of Treatment plan will depend on how SEVERE the
HEMORRHOIDS HEMORRHOIDS are.

Basic Treatment Modalities for Hemorrhoids:

• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoid symptoms usually go away on their
in Medical own.
Management of Treatment plan will depend on how SEVERE the
HEMORRHOIDS HEMORRHOIDS are.
Indications for Outright Surgery
(hemorrhoidectomy)
• Very severe bleeding (jets and splashes)
needing blood transfusion
• Permanently prolapsing internal hemorrhoids,
circumferential
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities For non-thrombosed external hemorrhoids with
in Medical no pain
Management of Options:
HEMORRHOIDS 1. Non-surgical management – watchful waiting;
dietary and lifestyle modification; medications
2. Surgical management if patient is severely
bothered / distressed

Hypertrophic papillae
– not external
hemorrhoids
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities For thrombosed external hemorrhoids with pain
in Medical Options:
Management of 1. Non-surgical management – watchful waiting;
HEMORRHOIDS dietary and lifestyle modification; warm sitz
bath; medications Non-thrombosed
2. Surgical management if patient is severely external hemorrhoids
bothered / distressed
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities For internal hemorrhoids Grade 3 (prolapsing but
in Medical has to manually reduce):
Management of Options:
HEMORRHOIDS 1. Surgical management
2. Non-surgical management – watchful waiting;
dietary and lifestyle modification; warm sitz
bath; medications; (if patient can tolerate the
discomfort)
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities For internal hemorrhoids Grade 2 (prolapsing but
in Medical spontaneously reducing):
Management of Options:
HEMORRHOIDS 1. Non-surgical management – watchful waiting;
dietary and lifestyle modification; warm sitz
bath; medications
2. Surgical management if patient is severely
bothered / distressed
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities For internal hemorrhoids Grade 1:
in Medical
Management of Non-surgical management – watchful waiting and
HEMORRHOIDS dietary and lifestyle modification
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoid symptoms usually go away on their
in Medical own.
Management of
HEMORRHOIDS Simple dietary and lifestyle changes can often
relieve mild hemorrhoid symptoms within 2 to 7
days.

Pain and bleeding usually spontaneously

disappear after a few days.

If symptoms cannot be tolerated, then take

additional measures like medications.
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoids are swollen and inflamed veins
in Medical around the anus or in the lower rectum, similar to
Management of varicose veins on the legs.
HEMORRHOIDS
What are the problems with hemorrhoids?
• Discomfort especially of the prolapsing
hemorrhoids which remain outside, on the
anus (Grade 2 to Grade 4); external
hemorrhoids
• Pain and itchiness
• Bleeding
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoids are swollen and inflamed veins
in Medical around the anus or in the lower rectum, similar to
Management of varicose veins on the legs.
HEMORRHOIDS
For those in which surgery is not indicated yet,
what are the non-surgical management that can
be done?
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Non-surgical management of hemorrhoids
in Medical
Management of Pain control:
HEMORRHOIDS • Analgesics-anti-inflammatory oral medications
• Topical / suppository medications - steroids,
analgesics
• Venoprotective medications
• Wam sitz bath
Dietary changes
• High fiber diet Then, wait and see!
• Fiber supplements
• Laxatives or stool softeners
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Non-surgical management of hemorrhoids
in Medical
Management of Pain control:
HEMORRHOIDS • Analgesics-anti-inflammatory oral medications
- Paracetamol; NSAIDs; Tramal

• Topic medications – cream, ointment,

suppository (Preparation H; Faktu; Xylocaine)

• Venoprotective medications - MPFF (Daflon);

calcium dobesilate (Doxium)
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities
Surgical treatment
in Medical
Management of
• Sclerotherapy
HEMORRHOIDS
• Infrared coagulation
• Rubber band ligation
• Hemorrhoidectomy (suture / stapled)
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Sclerotherapy
in Medical
Management of
HEMORRHOIDS
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Infrared coagulation
in Medical
Management of
HEMORRHOIDS
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Rubber Banding
in Medical
Management of A rubber band is placed around
HEMORRHOIDS the base of the symptomatic
hemorrhoid to stop blood flow
to the tissue, which then dries
up and falls off on its own in a
week or two (usually during a
bowel movement).
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities Hemorrhoidectomy
in Medical
Management of
HEMORRHOIDS
 • Basic treatment modalities for hemorrhoids
Fundamentals
and Generalities
in Medical
BRCA Process in selecting cost-effective treatment
Management of
modality.
HEMORRHOIDS
 • Clinical course of hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Clinical course of hemorrhoids
Fundamentals
and Generalities Hemorrhoid symptoms usually go away on their
in Medical own.
Management of
HEMORRHOIDS Treatment plan will depend on how severe the
symptoms are.

Simple dietary and lifestyle changes can often

relieve mild hemorrhoid symptoms within 2 to 7
days.
 • Clinical course of hemorrhoids
Fundamentals
and Generalities Once with hemorrhoids, exert more efforts to
in Medical avoid constipation through dietary changes and
Management of lifestyle modifications.
HEMORRHOIDS
These are essential strategies to avoid
progression of hemorrhoids and to avoid
operations.
 • Prevention of hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Prevention of hemorrhoids
Fundamentals
and Generalities To prevent hemorrhoids, avoid too much straining
in Medical when poohing. Avoid CONSTIPATION.
Management of
HEMORRHOIDS • Eat foods high in fiber with adequate fluid
intake can make stools softer and easier to
pass through the anus.
• Use fiber supplements if you cannot get
enough fiber from foods.
 • Prevention of hemorrhoids
Fundamentals
and Generalities
in Medical
Management of • Exercise. Physical activity, like walking a half-
HEMORRHOIDS hour every day, keeps your blood and your
bowels moving.
• Don't wait to go. Use the toilet as soon as you
feel the urge.
• Don’t strain during a bowel movement or sit on
the toilet for long periods. This puts more
pressure on your veins.
 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities
in Medical
Management of
HEMORRHOIDS
 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities
Fact: People can develop hemorrhoids at any age.
in Medical
Management of
Older people at risk:
HEMORRHOIDS
as people age, the connective tissue between the anus and rectum
weakens, making them more susceptible to hemorrhoids.

more than 75 percent of people will experience hemorrhoids at least

once in their lifetime.
 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities Myth: Spicy Foods Cause Hemorrhoids
in Medical
Management of False
HEMORRHOIDS
 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities Myth: What You Eat Doesn’t Affect Hemorrhoids
in Medical
Management of Fact: Constipation is one of the biggest risk factors
HEMORRHOIDS for developing hemorrhoids.

Eating a high-fiber diet and staying well hydrated can help keep
bowel movements soft and prevent constipation and straining.
The American Society of Colon and Rectal Surgeons (ASCRS)
recommends consuming 20 to 35 grams of fiber daily. If you
aren’t getting enough dietary fiber, fiber supplements that may
be beneficial.
 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities Fact: It’s unusual to need surgery for hemorrhoids because symptoms
in Medical generally clear up on their own or with conservative treatment.
Management of
HEMORRHOIDS The cornerstones of hemorrhoid treatment are dietary changes and
lifestyle modifications. Avoid progression of hemorrhoids through these
dietary and lifestyle modifications (AVOID CONSTIPATION).

Only less than 10 percent of people with hemorrhoids require surgery.

 • Myths and Facts on Hemorrhoids
Fundamentals
and Generalities Fact: Hemorrhoids are not cancer. They do not lead to cancer.
in Medical
Management of Just make sure that the anal symptoms are due to hemorrhoids and not
HEMORRHOIDS due to a co-existing rectal cancer.
 Contents of PEP TALK on HEMORRHOIDS
Fundamentals Summary
• What are hemorrhoids?
and Generalities
• What are the different types of hemorrhoids? Take Away
in Medical
• What are the causes of hemorrhoids?
Management of
• How common are hemorrhoids?
HEMORRHOIDS
• Clinical diagnosis of hemorrhoids
• Paraclinical diagnostic procedures for
hemorrhoids
• Basic treatment modalities for hemorrhoids
• Clinical course of hemorrhoids
• Prevention of hemorrhoids
• Myths and facts on hemorrhoids
 Fundamentals Be always in touch with reliable medical Take Away in
and Generalities information on fundamentals and relation to
in Medical generalities in medical management of Patient
Management of HEMORRHOIDS. Empowerment
HEMORRHOIDS
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of HEMORRHOIDS.
 Empowerment
Health Disorder
Course– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management of the MEDICAL
HEMORRHOIDS MANAGEMENT of
HEMORRHOIDS.