Hemorrhoids : Types, Signs, Symptoms, Diagnosis, management, Complications

Hemorrhoids:

Hemorrhoids are vascular masses in the lower rectum or anus that have become loosened from connective tissue.

Etiology:

The exact cause is not known, Predisposing factors

1.Heredity.

2.Occupation requiring long period of standing or sitting.

3.Structural absence of valves in the hemorrhoidal veins.

4.Increased Intra-abdominal pressure (caused by constipation, straining for defecation and pregnancy)

5.Loosing of vessels from surrounding connective tissue occurs with protrusion or prolapsed into anal canal.

Types of Hemorrhoids:

External Hemorrhoids:

External Hemorrhoids are those, which appear outside the anal sphincter. They bleed rarely and seldom cause pain unless a hemorrhoidal vein ruptures.

Internal Hemorrhoids:

Internal Hemorrhoids are those, which appear above the internal sphincter. They are not visible unless they protrude through anus where they become constricted and painful. At times they may bleed on defecation.

Signs and symptoms:

1.     Sensation of incomplete fecal evacuation.

2.     Visible (if external) and palpable mass.

3.     Constipation

4.     anal itching.

5.     Bleeding during defecation, (bright red blood on stool due to injury of mucosa covering hemorrhoids).

6.     Infection or ulceration, mucus discharge.

Diagnosis:

1.     History of fresh bleeding during defecation

2.     Rectal examination with proctoscope

Management:

Asymptomatic hemorrhoid requires no treatment.

Medical Management:

1.     Regulating bowel movements with non-irritating stool softeners and high fibre diet to keep stool soft.

2.     Frequent warm sitz bath to ease pain and combat swelling.

3.     Insertion of soothing suppository 2-3 times daily as prescribed.

4.     In controlling itching by improved anal measures and sitz baths.

5.     Injection of sclerosing solutions to produce scar tissue and prevent prolapse.

Surgical Management:

Indications for surgery:

Prolonged bleeding.

Disabling pain.

Intolerable itching.

General unrelieved discomfort.

haemorrhoidectomy - excision of dilated blood vessels

Nursing Management:

1.     After surgery assist with frequent positioning by using pillow support for comfort.

2.     Monitor vital signs

3.     Watch the operated site for any unusual bleeding.

4.     Apply anal creams or suppositories if ordered to relieve discomfort.

5.     Provide analgesics and antibiotics as ordered.

6.     Provide warm sitz bath from fifth post-operative day onwards

7.     Encourage proper anal hygiene to prevent infection

8.     Monitor the signs for infection at the incision site , drainage, bleeding , itching etc

9.     Administer stool softener to assist with bowel movement soon after the surgery to reduce the risk of stricture.

10.                        At discharge encourage the patient to take a balanced diet with high fibre content adequate fluid and regular exercise to prevent constipation and straining

Complications:

1.     Hemorrhage,

2.     anemia.

3.     Incontinence of motion.

4.     Rectal prolapse and strangulation.