HemorrhoidsEvaluation IJessie Hester & Candice PerkinsOctober 1, 2003

What Are Hemorrhoids?Alternative NamesRectal LumpPilesLump in the RectumDefinition:Dilated or enlarged veins in the lower portion of the rectum or anus.

Cont.Two Types:Internal- Under the skinExternal- Around the anusGrades:I- Hemorrhoids only bleedII- Prolapse and reduce spontaneouslyIII- Require replacement!V- Permanently Prolapsed

Frequency10 millionPeak ages: 45-65 years of adults experience hemorrhoids by age 50Common among pregnant womenTemporary

SymptomsRectal BleedingBright red blood in stoolPain during bowel movementsAnal ItchingRectal ProlapseThrombus

CausesPressureConstipation DiarrheaSitting or standing for long periods of timeObesityHeavy LiftingPregnancy

Signs and TestsRectal ExaminationVisualDigitalTestsStool Guaiac (FOBT)SigmoidoscopyAnaoscopyProctoscopy

ReferralGastroenterologists

Seek emergency care if :large amounts of rectal bleedingLightheadednessWeaknessRapid HR < 100 BPM

ComplicationsThe blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis)This causes painful lumps in the anal area.Severe bleeding can occur causing iron deficiency anemia.

Treatment Non-surgicalMild cases are controlled by:Preventing constipationDrinking FluidsHigh-fiber dietUse of Fiber supplementsStool softeners

Cont.Apply and OTC cream or suppository containing hydrocortisoneKeep anal area cleanSoak in a warm bathApply ice packs or compresses x 10min

Cont.If prolapses, gently push back into anal canalUse a sitz bath with warm waterUse moist towelettes or wet toilet paper instead of dry toilet paper.

TreatmentsFor painful or persistant hemorrhoids:Tying off a hemorrhoidSclerotherapyInfered LightLaser TherapyFreezingElectrical CurrentSurgery

Hemorrhoid SurgeryAlternative Name: Hemorrhoidectomy

Hemorrhoid surgery is the removal of enlarged veins around the anus

Cont.IndicationsPersistent itchingAnal bleedingPainBlood clotsInfection

Cont.RisksReactions to medications of anestesiaBleedingInfectionNarrowing of the anus

*The outcome is usually very good in the majority of cases.

PreventionEat high fiber dietDrink Plenty of LiquidsFiber SupplementsExerciseAvoid long periods of standing or sittingDont StrainGo as soon as you feel the urge

QuestionsWhat grade of hemorrhoids prolapse and reduce spontaneously?A) Grade IB) Grade IIC) Grade IIID)Grade IV

How many people are treated for hemorrhoids yearly?A) 3 millionB) 8 millionC) 10 millionD) 20 million

What are two causes of hemorrhoids?A) Standing on your headB) Heavy liftingC) Jeans being too tight D) Constipation

What is a sigmoidoscopy?An internal examination of the rectum, distal colon and large bowel using a type of small camera.Detects the presence of hidden blood in the stool.A procedure that enables a physician to view the anus, anal canal, and lower rectum using a lubricated plastic scope into the rectum.

Questions????