PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

Submitted by,
Ms. Suma K.C
1st year Msc Nursing,
Medical Surgical Nursing,
Oriental College of Nursing,
Bangalore
560 010.

RAGIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

NAME OF THE CANDIDATE AND

ADDRESS

2.

NAME OF THE INSTITUTION

3.

COURSE
SUBJECT

4.

DATE OF ADMISSION OF COURSE

OF

THE

Ms. Suma K C,
1ST YEAR M.SC. NURSING
ORIENTAL COLLEGE OF NURSING,
#43/52,2NDMAIN,WEST OF CHORD
ROAD,RAJAJINAGAR,
BANGALORE. 560 010
Oriental College of Nursing,
Bangalore.
AND I st year M.Sc. Nursing,
Medical Surgical Nursing.

STUDY

10.05.2010
A study to assess the knowledge
regarding hemorrhoids among adults in
selected hospitals, Bangalore with a
view to develop an information
booklet.

5.

TITLE OF THE TOPIC

6.

BRIEF RESUME OF THE INTENDED

WORK
6.0 Introduction
Enclosed
6.1 Need for the study
Enclosed
6.1.1 Statement of the problem
Enclosed
6.2 Review of related literature
Enclosed
6.3 Objectives of the study
Enclosed
6.3.1 Operational definitions
Enclosed
6.3.2 Assumptions
Enclosed
6.3.3 Hypothesis
Enclosed
6.3.4 Sampling Criteria
Enclosed
(Inclusion and Exclusion criteria)
MATERIALS AND METHODS
7.1 Source of data - Data will be collected from adults in selected hospitals.
7.2 Method of data collection: Self administered questionnaire
7.3 Does the study require an investigation or interventions to be conducted on the
patients or other human being or animals?
- NO.
7.4 Has ethical clearance been obtained from your institutions?
- YES, ethical committee's report is here with enclosed.
LIST OF REFERENCES
Enclosed

7.

RAGIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

1

KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1

NAME OF THE CANDIDATE AND

Ms. Suma K C,

ADDRESS

1ST YEAR M.SC. NURSING

ORIENTAL COLLEGE OF NURSING,
#43/52,2NDMAIN,WEST OF CHORD
ROAD,RAJAJINAGAR,

BANGALORE. 560 010

Oriental College of Nursing,

NAME OF THE INSTITUTION

Bangalore.
3

COURSE OF THE STUDY AND

I st year M.Sc. Nursing,

SUBJECT
DATE OF ADMISSION

Medical Surgical Nursing.

10.05.2010

TITLE OF THE STUDY

A study to assess the knowledge

regarding hemorrhoids among adults
in selected hospitals, Bangalore with a
view to develop an information
booklet.

BRIEF RESUME OF THE INTENDED WORK

6.0. INTRODUCTION
The only way to keep your health is to eat what you don't want, drink what you don't
like, and do what you'd rather not.
2

Mark Twain.
There are several very painful experiences that one suffers in stillness as it
is a discomforting topic to be even discussed. Hemorrhoids is such a common
occurrence in adults but is very rarely talked about because of the embarrassing nature
of the condition. Many people are even too embarrassed to see their doctor about
hemorrhoids. Nearly every patient visiting the general or colon and rectal surgeon
with anal problems comes in complaining of "hemorrhoids". They are often assigned
blame for purities ani, anal fissures, condylomata acuminata, fistula in ano and
incontinence. Treatment for hemorrhoids is only needed if they are truly symptomatic.
The mere presence of hemorrhoids is not an indication for any therapeutic
intervention.1
Hemorrhoids if untreated can potentially pose serious medical problems
and can also be a symptom of a bigger problem. Hemorrhoids, also called piles or
varicose veins of the anus and rectum are masses or clumps or cushions of tissues
consisting of muscle and elastic fibers with enlarged, bulging blood vessels and
surrounding supporting tissues present in the anal canal of an individual suffering
from the disease. Many myths exist regarding the etiology and pathophysiology of
internal hemorrhoids. The development of hemorrhoids has been attributed to
prolonged periods of driving, sitting on cold seats or benches, eating spicy foods, and
doing manual labor. In addition to this there are misconceptions regarding the etiology
of hemorrhoids among the lay members of our community, there are equally
numerous misconceptions regarding the pathophysiology of hemorrhoids among the
medical community. 2

The misconceptions related to hemorrhoids have been perpetuated

throughout many surgical texts. Hemorrhoids are part of the normal anatomy within
the anal canal and are believed to be important in maintaining continence. When an
individual coughs, strains or sneezes, these fibro vascular cushions engorge and
maintain closure of the anal canal in order to prevent leakage of stool in the presence
of increased intrarectal pressure. Therefore, surgical removal may result in varying
degrees of incontinence particularly in individuals with marginal preoperative control
about which most people are unaware.3
Hemorrhoids are of two types; the one which is placed inside is named as
Internal Hemorrhoids and is structured just under the tissue that lines the inside of the
rectum. They are not noticeable till they become big and will make them to collapse
and jut out through the anus. On the other hand, the vein that forms outside the rectum
and surround the anus is called the External Hemorrhoids. The main causes that utter
into this painful position, is hereditary, postponing of visits to toilet. 1
Nearly1 million new cases are reported annually in U S , 47 per 1000 and
increases with age ,age group of 45-65yrs,it is estimated that 50-85% 0f people
around the world have hemorrhoids. In India 75% of the population is estimated.
Among this almost half million population are experiencing conditions that are
related to hemorrhoids. Usually, many are not aware that they have the symptoms
associated to this condition. 1
A Retrospective Study was conducted regarding Evaluation of Rubber
Band Ligation as a Treatment of Hemorrhoids at Srinagar, over a period of one year
on outpatient basis. In this study fifty cases were subjected to this treatment, majority
(70%) of were grade 2 and in the age range of 18 to 70 years with 32% in the 21-30
4

year age group. The results of

the treatment were excellent or good in 90% cases,

fair in 4% and poor in 4%, with failure after completion of treatment in 2% of cases.
Moreover, the benefits of this method of treatment were far better than other
modalities of treatment. These observations confirm the fact that hemorrhoids can
recur even after expert surgical treatment and a large number of patients insist on
undergoing band ligation rather than hemorrhoidectomy.4
Hemorrhoid bleeding should be considered severe only if you start losing a
lot of blood and you get dizzy and weak. Even though hemorrhoids are usually the
most common reason for your rectum to bleed, one should still see a doctor if he or
she have this symptom. There are lots of other serious conditions such as ulcerative
colitis, anal fissures, polyps and certain types of cancers that will cause rectal
bleeding, which is why it is crucial that one eliminate the possibilities with the
doctor.5
Hemorrhoids are the arteries supplying blood to the anal canal descend
into the canal from the rectum above and form a rich network of arteries that
communicate with each other around the anal canal. Because of this rich network of
arteries, hemorrhoid blood vessels have a ready supply of arterial blood. This explains
why bleeding from hemorrhoids is bright red arterial blood rather than dark red
venous blood, and why bleeding from hemorrhoids occasionally can be severe. One of
the most obvious signs of hemorrhoids occurs when one person bleed while having a
bowel movement and a lot of pain with this, which will happen if one have
hemorrhoids.6
Even though a precise definition of hemorrhoids does not exist, they can
be described as masses or clumps "cushions" of tissue within the anal canal that
5

contain blood vessels and the surrounding, supporting tissue made up of muscle and
elastic fibers. The anal canal is the last four centimeters through which stool passes as
it goes from the rectum to the outside world. Most people think hemorrhoids are
abnormal, but they are present in everyone. It is only when the hemorrhoid cushions
enlarge hemorrhoids can cause problems and be considered abnormal or a disease.
Majority of people who suffer from hemorrhoids tend to ignore this condition. But no
matter how one try to disregard it, the symptoms are still felt and it is getting worse
day by day. Hemorrhoids should not be considered a taboo subject especially now that
there are many remedies discovered in curing hemorrhoids. These treatments may range
from medical to natural remedies. And many are unaware of these sfacts.6

6.1. NEED FOR THE STUDY

Hemorrhoids, or piles, are one of mankind's most common and nagging

disorders. By themselves, hemorrhoids are rarely serious, but they can be extremely
troublesome. In some instances, they may mask a more serious disorder, such as colon
or rectal cancer. Therefore, hemorrhoids require the proper diagnosis and treatment by
a physician. Hemorrhoids that cause problems are found equally in men and women,
and their prevalence peaks between 45 and 65 years of age.7
Swelling in the anal or rectal veins causes hemorrhoids. The factors that
may cause this swelling are chronic constipation or diarrhea, straining during bowel
movements, sitting on the toilet for long periods of time, lack of fiber in the diet,
being overweight, weakening of the connective tissue in the rectum and anus that
occurs with age and Pregnancy in which increasing pressure in the abdomen. 8

Excessive straining, rubbing, or cleaning around the anus may make

symptoms, such as itching and irritation, worse. Hemorrhoids are not dangerous or
life threatening as symptoms usually goes away within a few days, and some people
with hemorrhoids never have symptoms. But there are times that one must seek out
medical attention for hemorrhoids. Before taking any over the counter medications for
hemorrhoids, one should consult a doctor if he or she is taking anticoagulants.
Bleeding regularly should be checked out by a physician as soon as possible. Certain
lifestyle changes can be beneficial to avoiding future problems with hemorrhoids.
This includes drinking more water, eating more fiber, reducing weight if one is
overweight and exercising more. All of these can help control and prevent the
symptoms of hemorrhoids. 9

With proper treatment, hemorrhoids may start to improve over a few days to
a week. In four to six weeks, the "lump" from an external hemorrhoid should decrease
in size. When hemorrhoids become persistent or very painful, other treatments may be
necessary. Most of these treatments have complications, and most doctors try to avoid
them, and use them only as a last resort. They are Clot removal, Rubber band ligation,
Sclerotherapy, Infrared coagulation, hemorrhoidectomy. Keeping the anal area clean,
Sitz baths (sitting in warm water), Over-the-counter wipes

which is a natural

astringent, creams, gels, and suppositories that are also sold over-the-counter may
help reduce swelling and provide relief from symptoms and helps in preventing
hemorrhoids. 9
Most hemorrhoids are considered mild, and symptoms are often relieved by
a few changes in diet and lifestyle. One goal of treatment is to ensure that stool should
7

is soft and easily passed. this can be easily achieved by changes in life style which
include increasing fiber in the diet will help stool to be more easily passed without
straining, drinking more water.10
An article regarding the use of squatting type of defecation and incidence of
hemorrhoids reported, Hemorrhoids are an extremely common problem, especially in
Western countries. A lifetime incidence of 50-85% has also been reported globally.
Considering the widespread pain and suffering as well as medical expense involved, it
is surprising that there has been so little research into the methods of preventing
hemorrhoids. Hemorrhoids are very rare in nations where people squat to defecate; it
was found that patients and even medical personnel are usually hesitant to discuss
topics such as anal incontinence. This delays the process of awareness to the public
regarding hemorrhoids and its prevention.11
It is estimated that about 75 percent of people will have hemorrhoids at
some point in their lives. Hemorrhoids are most common among adults ages 45 to 65
and also common in pregnant women; they become large and cause problems in only
4% of the general population. Hemorrhoids that cause problems are found equally in
men and women, and their prevalence peaks between 45 and 65 years of especially
with mild hemorrhoids.12
Seventy percent of Indian population lives in villages where the dominant
mode of defecation still is squatting in the fields. In cities also, by and large, squatting
type of latrine seats have dominated the scenario in Indian set-up till recently. Thus,
besides the role of pedestal latrines in the etiology of hemorrhoids, there is also an
issue of aesthetics and culture for Indians. 12

Hemorrhoid bleeding should be considered severe if one start losing a lot

of blood and you get dizzy and weak. Even though hemorrhoids are usually the most
common reason for your rectum to bleed, one should still see a doctor if he or she
have this symptom. The effort to consult a doctor does not occur due to hesitation.
Taking over the counter medication to deal with the pain, and can usually treat
hemorrhoids by improving the diet, drinking lots of water, and getting more exercise.
If these steps help control the symptoms, sticking with the lifestyle changes will help
you avoid future problems. If one finds that these lifestyle changes aren't enough, he
or she must visit a doctor who may prescribe a stronger medication. One may need a
stronger medication or procedure to alleviate the symptoms. 5
Nearly half of the world's population will experience some form of
hemorrhoids - especially when they reach the golden age of fifty. In many cases, the
hemorrhoid is a harmless or acute condition that does not affect normal daily life. But
one should seek to prevent the occurrence of constipation so that a smooth passage of
stool during bowel movement is experienced.13
As such hemorrhoids is a topic that an individual hesitate to express about
and this result in most cases hidden signs and symptoms that later lead to
complications like rectal cancer. At the same time hemorrhoids can be prevented
easily by certain life style modifications and few compromises in daily activities of an
individual. And now days new better treatment methods are developed for treatment
of hemorrhoids which also prevent its recurrence. The researcher had come across a
came of hemorrhoids during clinical experience that was complicated due to patients
reluctance to speak out the complaints and to get treated. Knowing about the public

reluctance and their unawareness the researcher felt the need to make public, aware of
the causes, complications and treatment, mainly prevention of hemorrhoids.

6.2.REVIEW OF LITERATURE
Review of literature is categorized under the following headings.
Review of literature provides the basis for future investigations, justifies
the need for replications, justifies the need for replication, and throws light up. On
feasibility of the study and indicates constrains of data collection and help to elate
findings of one another.
1. Review related to the incidence of hemorrhoids.
2. Review related to adults knowledge regarding hemorrhoids.
3. Review related to management of hemorrhoids.

Review related to the incidence of hemorrhoids.

In India approximately 40,723,288 people are reported to have

hemorrhoids. 1 million new cases are reported annually , 47 per 1000 and increases
with age ,age group of 45-65yrs,it is estimated that 50-85% 0f people around the
world have hemorrhoids and in India 75% of the population is estimated. Current
statistics suggest that almost half of people in their fifties have piles. Age is not the
only factor though, and hemorrhoids can affect people of any age group or gender.14
A study conducted in United States, regarding the incidence and
prevalence of hemorrhoids, it is found that approx 1 in 26 or 3.82 percent or 10.4
million people have hemorrhoids in United States of America. In the US, about 4.4%
10

of the general population has hemorrhoids which occur more often in Caucasians
from rural areas and in those with higher socio-economic status. Prevalence of
hemorrhoids increases with age and peaks in people aged 45-65 years. According to
the same statistics (1983-87) the Mortality: 17 deaths, Hospitalizations: 316, 000,
Physician office visits: 3.5 million, Prescriptions: 1.5 million, Disability: 52,000
people.14
According to an article published regarding symptoms of hemorrhoids in
U.S, the number of people living with hemorrhoids in the USA rose to 13 million
out of a total population of about 298 million, which is a prevalence rate of 4.4%.
About a million new cases of hemorrhoids are discovered yearly. The shocking truth
however is that of all these large number of hemorrhoid cases, about half to three
million cases per annum do not seek proper treatment. So to conclude that there are
about 10 million people with hemorrhoids paying little of no attention to their
symptoms.11
A study was conducted regarding the prevalence of hemorrhoids, in
which the clinical records of 835 patients were reviewed. Five hundred ninety four
had symptoms of hemorrhoids and 241 had no symptoms asymptomatic group.
Eight-six per cent of the entire group, 88 per cent among the symptomatic group and
82 per cent among the asymptomatic group had hemorrhoids. It was felt that if the
prevalence rate of hemorrhoids in the symptomatic and asymptomatic groups is
similar or close to similar in every age, it is likely that a certain number of people
will have hemorrhoids in every age group irrespective of the presence or absence of
symptoms. 15
A study was conducted regarding symptomatic hemorrhoids its
11

complications and complications of operative therapy over a period of 66-month.

Over 21,000 patients presented to the practice with bleeding, thrombosis, or
prolapsed. And 9.3 percent of patients required operative therapy; conservative
therapy was given to 45.2 percent of patients, while rubber band ligation was
performed on 44.8 percent of patients. The study retrospectively reviewed the
complications and length of stay for a subset of patients undergoing operative
therapy during the 66-month study period. The study

concluded that over 90

percent of symptomatic hemorrhoids can be treated conservatively or with rubber

band ligation, and as surgery is reserved for only the most severe cases,
complication rates may not decrease.16
An article published reported the Summer, high incidence of
hemorrhoids. Summer is a period of high incidence of hemorrhoids, because there
are many relationships with the water.17

Review related to adults knowledge regarding hemorrhoids.

According to an article, hemorrhoids have been identified as one of the

most common ailments even recorded in adults. It is very hard to find an adult who
has never been diagnosed of this ailment at one time or the other in a lifetime. A
handful of people are even living with hemorrhoids, managing it year after year,
because they have no knowledge of how to treat or get rid of it. The sufferer will
usually develop an internal hemorrhoid mostly due to constipation. However, most

12

people do not even know what is wrong and so they keep on with their lifestyle and
more harm is done to the already injured rectum.18
An article regarding how do you Get hemorrhoids? lot of people don't even
know they have hemorrhoids. The rectum is not an area one can readily see.
Sometimes one don't know he or she has hemorrhoids until blood in the toilet water
after a bowel movement, or having pain or discomfort in the rectum, or feel of extra
tissue around the rectum are noticed. Constipation is not the only way you can get
hemorrhoids. Other additional ways include alcoholism, being pregnant and not
eating enough fiber, doing daily heavy lifting , eating excessive processed foods ,
-postponing a bowel movement, having a weak liver, being overweight, Sitting in a
chair at home, at work, in a car, or in a truck for long periods.19
According to an article Treatment for hemorrhoids-5 critical Action You
Must Take, more than 40 percent of the adult population suffers from the piles in their
lifetime, yet not many people know the reason theyre having a hemorrhoids or the
proper care for hemorrhoids. There are common mistakes that people make when they
try to solve the problems on hemorrhoids. If one wants to avoid those mistakes that a
lot of people are making, then one should take these critical actions for hemorrhoid
treatments.20
According to another article, almost everyone gets hemorrhoids at some
time. It's painful, aggravating problem that no one seems to talk about. And the reason
why no one wants to talk about is that it is embarrassing and considered as the thing
people dont like to discuss. And all the secrecy is probably the reason most people
don't know what to do for them and they're embarrassed to ask. Hemorrhoids occur
13

universally in adults and children and half of all people all over the age of 50 live with
this painful nuisance. To conclude if one follow preventive measures properly it will
keep oneself free from this painful and embarrassing situation.21

Review related to management of hemorrhoids.

A study was conducted on Stapled hemorrhoidectomy vs. closed
diathermy-excision hemorrhoidectomy without suture-ligation: a case-controlled trial.
A series of 108 patients had indication for stapled hemorrhoidectomy in which (76)
underwent stapled hemorrhoidectomy and were compared to patients submitted to
closed diathermy-excision hemorrhoidectomy. Resumption of activities occurred after
9 days after stapling and 14 days after diathermy surgery. The result showed that there
was no difference regarding complications during the follow-up, after one year, 45
(80.4%) patients in the stapled group and 18 (78.3%) in the diathermy group were
asymptomatic, and none of the patients needed a second operation and there was no
fecal incontinence. The study concluded that stapled hemorrhoidectomy selectively
indicated is less painful, not associated to greater morbidity and has the same longterm efficacy when compared to closed diathermy excision without suture-ligation.22
A study was conducted on suture less closed hemorrhoidectomy: a new
technique. The study was to compare a new technique of radical hemorrhoidectomy
using an electro thermal device originally devised to seal vessels in abdominal
operations, with the conventional open Milligan-Morgan procedure performed with
diathermy. Both carry risks of postoperative bleeding, urinary retention, and late anal
stenosis and convalescence is similarly long and difficult after both operations. In the
study group (n = 40), an electro thermal system was used. The operative time and
14

time off work were significantly shorter in the study group and there were also fewer
postoperative complications in this group. This pilot study shows that suture less
closed hemorrhoidectomy is a new technique that is simple and safe, significantly
shortens the operation, and is followed by a significantly easier and shorter recovery.23

A study was reported, on the challenge to the medical fraternity in terms of

finding satisfactory cure of the disease Kshar Sutra Ligation (KSL), a modality of
treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation
(RBL) for grade II and grade III hemorrhoids. The study was conducted in 20 adult
patients of either sex with grade II and grade III hemorrhoids at two different
hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I
patients underwent RBL, whereas patients of group II underwent KSL. The result
showed that the difference was statistically insignificant. And study concluded that
Share Sutra Ligation is a useful form of treatment for Grades II and III internal
hemorrhoids.24
According to an article hemorrhoid, almost everyone gets them at some time. It's
painful, aggravating problem that no one seems to talk about. And the reason no one
wants to talk about, is as it is embarrassing and considered as the thing people dont
like to discuss. And all the secrecy is probably the reason most people don't know
what to do for them - they're embarrassed to ask. Its surprising that hemorrhoids occur
universally in adults and children.In fact, half of all people all over the age of 50 live
with this painful nuisance. Hemorrhoids are very similar to varicose veins in the legs they are swollen, tender veins either inside the rectum or outside the around the rectal
area. The veins get swollen and tender from too much pressure which may be from
15

the strain of constipation, diarrhea or pregnancy, or it comes from disorders such as

obesity and liver disease. The treatment of hemorrhoids begins with simple advice:
"No strain, no pain" which signifies few changes in life style of an individual.This
include stop straining when you go to the bathroom,eat more fiber to avoid
constipation and hard stools, drinking lots of liquids to soften your stools, staying
away from caffeine and alcoholic beverages, avoid using laxatives that contain
ingredients other than simple stool softeners. To conclude if one follow preventive
measures properly it will keep oneself free from a painful and embarrassing
situation.25
A study was conducted regarding the re interventions after complicated or
failed stapled hemorrhoidopexy. The aim of the study was to analyze the causes for
and the outcome of reintervention following either severely complicated or failed
stapled hemorrhoidopexy. The study was conducted in a total of 232 primary stapled
hemorrhoidopexies and 65 reinterventions after stapled hemorrhoidopexy were
performed by the authors in five centers devoted to colorectal surgery. After the
reintervention, proctoscopy was performed in 61 patients (92 percent) and median
follow-up of 5.5 months the reoperation rate after stapled hemorrhoidopexy was 11
percent. The study reported that reintervention was associated with a high bleeding
and soiling rate, but was effective in treating pain and other symptoms in the majority
of patients.26

6.2.1. STATEMENT OF THE PROBLEM

16

A study to assess the knowledge regarding hemorrhoids among adults in selected

hospitals, Bangalore with a view to develop an information booklet.

6.3. OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding hemorrhoids among adults.
2. To find out the association between knowledge regarding hemorrhoids and selected
demographic variables.
3. To develop an information booklet for adults regarding hemorrhoids.

6.3.1. OPERATIONAL DEFINITIONS

Knowledge: Refers to the level of understanding of adults regarding hemorrhoids as
assessed by their responses to the items of knowledge questionnaire.

Hemorrhoids: It is a disease condition in which the veins around the anus or lower
rectum gets inflamed and swollen, caused due to several factors like hereditary.
weightlifting, improper diet, constipation, prolonged sitting and standing and vigorous
exercises.

Information booklet: It is organized information regarding the meaning, causes,

symptoms, complications, precautions, prevention and management of hemorrhoids.

Adults: Refers to both men and women of age 30-60yrs, who are attending OPD and
inpatient department in selected hospitals Bangalore.

17

6.3.2. ASSUMPTION
It is assumed that adults may have some knowledge regarding hemorrhoids.

6.3.3. HYPOTHESIS
There will be significant association between knowledge regarding
hemorrhoids and selected demographic variables.

6.3.3. SAMPLING CRITERIA

INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA
1. Adults who are available at the time of data collection.
2. Adults who are willing to participate in the study.
3. Adults who are able to understand and read english or kannada.

EXCLUSION CRITERIA
1. Adults who are diagnosed with hemorrhoids
2. Adults who are having previous source of information about hemorrhoids.

MATERIALS AND METHODS

18

7.1. SOURCES OF DATA: Data will be collected from adults between 30-60 yrs of
age attending OPD and in patient department in selected hospitals, Bangalore.

7.2. METHODS OF DATA COLLECTION

i. Research approach : Survey approach.
ii. Research design

: Non experimental descriptive design

iii. Setting

: Study will be conducted in selected hospitals.

iv. Population

: All adults in selected hospitals.

v. Sample

: Adults in selected hospitals, Bangalore.

vi. Sample size

: 60

vii. Sampling technique: Simple random sampling technique.

viii. Method of data collection: Structured interview schedule.
ix. Tool for data collection: Structured knowledge questionnaire.
x. Method of data analysis and interpretation:
The data will be analyzed by using descriptive and inferential statistics.

The investigator will use appropriate statistical techniques for data

analysis and present data in the form of tables, graphs and diagrams.

Demographic variables will be analyzed by frequency and percentage

distribution.

Level of knowledge will be assessed by mean and standard deviation.

Chi- square test will be used to determine the association between the
knowledge and selected demographic variables.

xi. Duration of study

: 4 weeks.

xii. Variables
19

Research variable

: Knowledge of adults regarding hemorrhoids.

Demographic variables: Age, sex, education status,

Socio economic status, occupation.
xiii. Projected outcome

: The study will be successful in improving the knowledge

of adults regarding hemorrhoids and help them to take preventive measures.

7.3. Does the study require any investigations or intervention to be conducted on

patients or other human beings or animals?
NO, the study doesnt require any investigations or intervention.

7.4. Has ethical clearance been obtained from your institution?

YES, ethical clearance report is here with enclosed.

8. LIST OF REFERENCES
1. Total health tips.Hemorrhoids.Kiva microfinance.30 March 2010.
Available from URL:http://totalhealthtips.org/2010/03/30hemmorrhoidsIntroduction/
2. Gollamaully Nazima.Discovering Truth about what causes a Hemorrhoid.
A1articles.10th November 2010; URL Available from
: http://www.a1articles.com/article_1833101_17.html .
3. Catalo preterm D. Hemmorrhoids.American Society of Colon & Rectal
Surgeons (ASCRS).2005Available from: URL
: http://www.fascrs.org/physicians/education /core subjects//2005/hemorrhoids/.
4. N.A.Wani, Fazzilli.A et al.A Retrospective Study and Evaluation of Rubber Band
Ligation as a Treatment of Hemmorrhoids.Indian Journal For Practicing
Doctor.(2009-01-20002).5;6.Available from URL:http:/
20

/www.indmedica.com/ Journals.php?journalid=3&issueid=1378articleid
1807&articleid=18078&action=article.
5. Do You Think You Have Hemmorrhoids? Free online article directory. More
More Free Information. Available from URL:http://www.moreinformation
.com/Art/81852/88/Do-You-Think-You-Have-Hemmorrhoids.html.
6. Marks Jay .W.Hemmorrhoids (PILES).Medicine Net.com.November 21,2010
Available from URL:http://www.medicinenet.com/hemm0rrhoids/
Article.htm.
7. Jackson.W.Frank; M D.Hemmorrhoids.Jackson / Siegelbam Gasteroenterology.
Available from URL:http://www.gicare.com/diseases/hemmorrhoids.

8. Hemmorrhoids.National Digestive Diseases Information clearing house (NDDIC).

A Service of the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK).Available from URL: httpdigestive.niddk
.nin.gov/ddiseases/pubs/hemmorrhoids/
9. Tresca.J.Amber.Hemmorrhoids Frequently Asked Questions.About .com:
Inflammatory Bowel Disease(IBD).May 18 ,2019.Available from URL:
http://ibdcrohns.about.com/cs/related conditions/a/faqhemmorrhoid.htm.

10. Pinneck Vera.Be Aware of These Hemorrhoids Symptoms. Article alley(AA).13th

13th October,2010.Available from URL:http://www.article alley .com/article1787994-17.html
11. Gbenga Bello. How To Detect Hemmorrhoids.Article Snatch.com Symptoms of
Hemmorrhoids.Available from URL:http://www.article snatch.com/Article/
Symptoms-of-Hemmorrhoids-How-To-Detect-Hemmorrhoids-Early11552530.
21

12.Singh Amarjeet.Do We Really Need to Pedestal Type of Latrines in India?.Indian

Journal of Community Medicine.2007-10,2001-12.32;4.Available
from URL:http://www.indmedica.com/journals.php?journalid=7&issued
=102&articleid=13998action=article.
13.Buller A Anthony.What Every Sufferer Should Know About Hemmorrhoids.
Ezine@rticles.Article .Available from URL:http://

ezine articles.com/?what-every-sufferer-Should-know-About-Hemorrhoid=
5074287.
14. Statistics by country for Hemmorrhoids.Wrong diagnosis.NIH publication
No;94-1447,NIDDK,1994.Available from URL:http://www.wrongdiagnosis
.com/h/hemorrhoids/stats-country-htm.
15.P.A.Haas,Haas.G.P et al.The Prevalence of Hemmorrhoids.Hemmorrhoids1983
July ; 26(7);435-9.Available from URL:http://www.the doctors
.com/diseases/hemorrhoids.htm.
16. Bleday Ronald, Juan.P.Penna et al.Symptomatic hemorrhoids: current incidence
and complications of operative therapy. 35; 5;477-481.
Available from URL:http://www.spingerlink.com/content/m532544210
; 70785/spinger link.
17. Berg Craig; DSCI, Jerry E Blode; MD; FACP.Health Benefits of the National
Squatting Position. Natures Platform the Basis for a healthier life. May 12
2010: Available from URL:http://www.naturesplatform.com/Hemmorrhoids
.html
18. Aqboole Temitope.Treatment for external Hemorhoids.Ezine articles. Available
from URL:http://ezinearticles.com/?Treatment_For_External_Hemorrhoids&
22

id=5313143.
19. Rudy Silva. How do you Get Hemorrhoids? Ezinearticles.com. Available from
URL:http://ezinearticles.com/?How-Do-You-

Get- Hemorrhoids?5/id=29537.
20. Treatment for Hemorrhoids.Treatment for Hemorrhoids-5 critical Action You
Must Take.January 30th,2010;Available from URL:
http://www.cdhcc.com/.
21. Kao Irsan.The No pain, No strain ways to prevent hemorrhoids. Ezine articles.
Available from URL:http://ezinearticles.com/?The No-Pain,-No strain-Ways
-to-Prevent-Hemorrhoids&id=4120069.

22. S.E.Araujo,de Caratto PP.Stapled hemorrhoidectomy vs closed diathermyExcision hemorrhoidectomy without suture-ligation: a case trial.
Pubmed.2007 December, 54(80); 2243-B.
Available from URL:http://www.ncbi.nlm.nih.gov/pubmed//18265642.
23. J.Sayfan, Becker .A, Kottun.L.Department of Surgery, Israel.Suture closed
Hemorrhoidectomy: a new technique.2001 July 23;4;(1).Available form
URL:http://www.ncbi.hlm.nih.gov/pubmed/11420479.

24. Singh Rakhi, Rakhi C Arya et al .A Comparative study of Barrons rubber

Band Ligation with Kishar Sutra Ligation in hemorrhoids.2010;
1 ;2;73-8.Available from URL:http://www.ijaronline
.com/article.asp?issn=0974-7788,year=2010,volume=1,spage=73,
epage=81,aulast=singh,type=0.

23

25. Kao Irsan.The No pain,No strain ways to prevent hemorrhoids.Ezine articles.

Available from URL:http://ezinearticles.com/?The No-Pain,-No strain-Ways
-to-Prevent-Hemorrhoids&id=4120069.

26. L.Brusciano, S.M.Ayabace et.al.Re interventions After Complicated or Failed

Stapled Hemorrhoidopexy.Disease of the colon & Rectum. 4;
1846-1851.Available from URL:http://www.springerlink.com/content
/n8uxuucypqpwpuwq/.

9. Signature of the candidate

10. Remarks of the guide

11. Name and designation (in block letters)

11.1 Guide

11.2 Signature

11.3 Head of the department

:
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11.4 Signature

12.1 Remarks of chairman / principal

12.2 Signatures

25