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Adut Heal t h Nur sing

Hemorrhoids
 Objectives
• At the end of this presentation the student will be
able to:
• Define hemorrhoids.
• Describe Pathophysiology of hemorrhoids.
• Identify types of hemorrhoids.
• Enlist signs, symptoms and causes of
hemorrhoids.
• Explain medical diagnosis and treatment.
• Discuss nursing diagnosis and nursing intervention
for hemorrhoids.
 Hemorrhoids
• Hemorrhoids

Hemorrhoids are
painful, swollen veins
in the lower portion
of the rectum or
anus.
 Pathophysiology
• Hemorrhoid cushions are a part of normal
human anatomy and only become a pathological
disease when they experience abnormal
changes.
• There are three cushions present in the normal
anal canal.
• They are important for continence, contributing
to at rest 15-20% of anal closure pressure and
act to protect the anal sphincter muscles during
the passage of stool.
 Causes
Hemorrhoids may be caused by:
• Straining during bowel movements
• Constipation
• Sitting for long periods of time
• Anal infections
• Pregnancy
• Certain diseases such as liver cirrhosis
• Obesity
• Genetics
• Low fiber diet
 Type
• s of
There are two types
hemorrhoids i.e.
• Internal hemorrhoids
occur just inside the
anus, at the beginning
of the rectum
• External hemorrhoids
occur at the anal
opening and may hang
outside the anus
 Sign and symptoms
• Anal itching
• Rectal pain
• One or more hard tender lumps near the anus
• Bleeding
 Diagnosis
• Visual examination

• Anoscopy

• Endoscopic image

• Sigmoidoscopy
 Treatment
❑ Conservative Treatment
• Increase dietary fiber
• Oral fluids
• NSAID
• Sitz bath
• Rest
• Steroids ointments or creams
 Conti
❑ Fixative Procedures …
The goal of nonsurgical
procedures used to treat hemorrhoids is called fixative
procedures.
It include tying off the
hemorrhoids
• with a rubber band
• using heat
• Lasers
• electric current
❑ Hemorrhoidectomy
Surgical removal of hemorrhoid is
 Prevention
• Drink plenty of water, at least eight
glasses per day
• Eat high fiber diet of fruits, vegetables,
and whole grains
• Empty bowels as soon as possible after
the urge occurs
• Regular exercise
Nursing Diagnosis for Hemorrhoids
• Pain (acute or chronic) related to rectal
swelling
• Constipation related to ignore the urge to
defecate due to pain during defecation
• Anxiety related to plan surgery
• Impaired Urinary Elimination related to the
fear of postoperative pain.
 Conti…
.
• Risk for infection related to inadequate
primary defenses.
• Deficient knowledge related to the lack of
information about home care.
 Nursing Intervention for
Hemorrhoids
• As needed, provide warm sitz baths
to reduce local pain and swelling
• Check for signs and symptoms of anal
infection, such as increases pain and foul
smelling anal drainage.
• Teach the patient about hemorrhoidal
development, predisposing factors, and tests.
 Conti
…
• Emphasize the need for good anal hygiene.
• Encourage the use of toilet paper
without dyes or perfumes.
• Provide the patient with high fiber diet and
encourage adequate fluid intake and exercise
to prevent constipation.
 Conti…
.
• Prepare the patient for surgery if necessary
• Monitor the patient’s pain level and the
effectiveness of the prescribed medications.
 Reference
• s JH (2006). Hemorrhoids and
Dozois EJ, Pemberton
other anorectal disorders. In MM Wolfe et al., eds.,
Therapy of Digestive Disorders, 2nd ed., pp.
945-958. Philadelphia: Saunders Elsevier.
• Hull TL (2006). Hemorrhoids section of Diseases of
the anorectum. In M Feldman et al., eds., Sleisenger
and Fordtran's Gastrointestinal and Liver Disease,
8th ed., vol. 2, pp. 2833-2852. Philadelphia:
Saunders Elsevier.
 tform
al P la
o n
ucati
, Ed
is h
D an
ul l ah
d
Ab