HEMORRHOID

HAEMORRHOID (PILES)

DEFINITION:-

It is an enlargement of normal spongy blood filled cushions in the walls of anus or dilation of anal veins and lower rectum.

TYPES:-

  1. External: Always visible.
  2. Internal: Not visible.


CAUSES/AETIOLOGY:-

  • Chronic constipation
  • Prolonged standing
  • Pregnancy
  • Tumor in colon
  • Due to rectal surgery or infection
  • Increase intra-abdominal pressure
  • Portal hypertension
  • Obesity.


CAUSES:-

  • Pain during defecation
  • Constipation
  • Bright red bleeding from the anus
  • Itching surrounding anal area (pruritus)
  • Sensation of incomplete evacuation
  • Visible palpable mass
  • Anaemia
  • Melaena (blood in stool)
  • Rectal pain.


PATHOPHYSIOLOGY:-

    Increase abdominal pressure
    ↓
    Dilation of anal vein
    ↓
    Chronic constipation
    ↓
    Abdominal pressure till long time
    ↓
    Permanent dilation of anal vein
    ↓
    Bleeding from veins


DIAGNOSTIC EVALUATION:-

  • Pressure of signs and symptoms.
  • Barium enema for internal digital palpation.
  • Anoscopy.
  • Sigmoidoscopy.
  • Proctoscopy.


COMPLICATIONS:-

  • Anaemia.
  • Incontinence.


MEDICAL MANAGEMENT:-

  • Stool softener, e.g., Docusate sodium, Magnesium sulphate.
  • High fibers diet.


SURGICAL MANAGEMENT:-

  • Rubber bend ligation
  • Haemorrhoidectomy (surgical removal of haemorrhoid)
  • Cryo surgery (by cold therapy)
  • Laser therapy (by light).

NURSING MANAGEMENT:-

  • To relieve constipation, provide high fibre diet and laxatives or stool softener.
  • Advice to patient to apply xylocaine ointment before and after evacuation for relieve pain during evacuation.
  • To relieve anxiety
  • To help in activity of daily living.

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