haemorrhoids Flashcards
what are haemorrhoids
enlarged anal vascular cushions
assocw
constipation + straining pregnancy obesity inc age inc intra abdo pressure
why can they often occur in pregnancy
constipation
pressure from baby in pelvis
effects of hormones relaxing connective tissues
what are anal cushions
specialised submucosal tissue than contain connections between arteries and veins (so V vascualr)
help control anal continence
anal cushion blood supply
rectal arteries
where are anal cushions usually locates
3, 7 + 11 o’clock
classification: 1st degree
no prolapse
classification: 2nd degree
prolapse when straining + return on relaxing
classification: 3rd degree
prolapse when straining
doesn’t return on relaxing but can be pushed back
classification: 14h degree
prolapsed permanently
symptoms
painless, bright red bleeding: not mixed with stool
sore/itchy anus
feeling lump
on examination
external/prolapsed: visible on inspection
internal: may be felt onPR
may appear/prolapse if patient bears down
Mx - topical treatments
anusol
anusol with hydrocortisone
gremoloids cream (has lidocaine)
proctosedyl ointment
Mx - prevention and treatment of constipation
inc fibre
good fluid intake
laxatives
avoid straining
Mx- non surgical
- rubber band ligation
- injection sclerotherapy
- infra-red coagulation
- bipolar diathermy
