Hemorrhoids

1. Hemorrhoids Evaluation I Jessie Hester & Candice Perkins October 1, 2003

2. What Are Hemorrhoids? • Alternative Names • Rectal Lump • Piles • Lump in the Rectum • Definition: • Dilated or enlarged veins in the lower portion of the rectum or anus.

3. Cont. • Two Types: • Internal- Under the skin • External- Around the anus Grades: I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement !V- Permanently Prolapsed

6. Frequency • 10 million • Peak ages: 45-65 years • ½ of adults experience hemorrhoids by age 50 • Common among pregnant women • Temporary

7. Symptoms • Rectal Bleeding • Bright red blood in stool • Pain during bowel movements • Anal Itching • Rectal Prolapse • Thrombus

8. Causes • Pressure • Constipation • Diarrhea • Sitting or standing for long periods of time • Obesity • Heavy Lifting • Pregnancy

10. Signs and Tests • Rectal Examination • Visual • Digital • Tests • Stool Guaiac (FOBT) • Sigmoidoscopy • Anaoscopy • Proctoscopy

11. Referral • Gastroenterologists • Seek emergency care if : • large amounts of rectal bleeding • Lightheadedness • Weakness • Rapid HR < 100 BPM

12. Complications • The 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.

14. Treatment Non-surgical • Mild cases are controlled by: • Preventing constipation • Drinking Fluids • High-fiber diet • Use of Fiber supplements • Stool softeners

15. Cont. • Apply and OTC cream or suppository containing hydrocortisone • Keep anal area clean • Soak in a warm bath • Apply ice packs or compresses x 10min

16. Cont. • If prolapses, gently push back into anal canal • Use a sitz bath with warm water • Use moist towelettes or wet toilet paper instead of dry toilet paper.

17. Treatments • For painful or persistant hemorrhoids: • Tying off a hemorrhoid • Sclerotherapy • Infered Light • Laser Therapy • Freezing • Electrical Current • Surgery

18. Hemorrhoid Surgery • Alternative Name: Hemorrhoidectomy • Hemorrhoid surgery is the removal of enlarged veins around the anus

19. Cont. • Indications • Persistent itching • Anal bleeding • Pain • Blood clots • Infection

20. Cont. • Risks • Reactions to medications of anestesia • Bleeding • Infection • Narrowing of the anus *The outcome is usually very good in the majority of cases.

21. Prevention • Eat high fiber diet • Drink Plenty of Liquids • Fiber Supplements • Exercise • Avoid long periods of standing or sitting • Don’t Strain • Go as soon as you feel the urge

22. Questions • What grade of hemorrhoids prolapse and reduce spontaneously? A) Grade I B) Grade II C) Grade III D)Grade IV

23. How many people are treated for hemorrhoids yearly? A) 3 million B) 8 million C) 10 million D) 20 million

24. What are two causes of hemorrhoids? A) Standing on your head B) Heavy lifting C) Jeans being too tight D) Constipation

25. 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.

26. Questions????