Hemorrhoid

Incidence
• Age: Most patients who develop hemorrhoids
are between the ages of 30 and 50.
• Hemorrhoids occur in both sexes. However,
pregnancy and childbirth are the prime causes of
hemorrhoids in young females.
• Medical history: Some patients with leukemia or
bleeding diathesis will have complications from
hemorrhoids.
• Excessive straining
• Lack of fiber in diet
• Spending hours or reading books on the
bathroom
• weight lifters and tennis players
• practice anorectal intercourse
• Prolonged sitting and lack of activity
 Pathophysiology
• chronic straining secondary to constipation or occasionally
diarrhea may result in pathologic hemorrhoids.
• Eventually, with repeated straining, the hemorrhoids may
lose their attachment (Treitz’s ligaments) to the
underlying rectal wall, leading to the prolapse of the tissue
into the anal canal.
• The engorged tissue becomes more friable, which may
contribute to bleeding.
• These tissues communicate with the superficial
subcutaneous venules at the anal verge, which may result
in external hemorrhoidal dilation
 Symptoms
• Principal : bleeding & prolapse
• Secondary : mucus discharge, pain, pruritus,
anemia, fecal incontinence
 Diagnostic
• Rectal examination
• Proctoscopy/anoscopy
 Classification

• Grade I—bleeding without prolapse.

• Grade II—prolapse with spontaneous
reduction.
• Grade III—prolapse with manual reduction.
• Grade IV—incarcerated, irreducible prolapse.
 Treatment
• Early disease (Grade I and early Grade II) is often managed
with medications designed to cause vasoconstriction and
treat inflammation for the engorged friable hemorrhoid.
• More advanced disease frequently requires operative
management which may include sclerotherapy,
cryosurgery, infrared coagulation, rubber band ligation,
and various modes of surgical excision.
• These therapies attempt to remove the redundant tissue
and create cicatrices to fix the remaining mucosa within
the anal canal once again.
 Conservative treatment
• there are three mainstays of conservative
management:
1. Bulking agents
2. Sitz baths/warm compresses
3. Local applications
Sclerotherapy
Rubber band ligation
Stapled Hemorrhoidopexy
Open hemorrhoidectomy
Manage hemorrhoid complication

If left untreated, the edema progresses to ulceration

and necrosis.
• relieving the pain with analgesics (intravenous
if necessary);
• Reducing perianal swelling with either hot
soaks, sitzbaths, or ice packs;
• bed rest; and prevention of constipation
• Manual reduction, urgent hemorrhoidectomy