Anorectal Disorders

Question 1

Describe: Types of Internal Hemorroids

Answer 1

-1st degree= enlarged but do not prolapse into the anal canal
-2nd degree= protrude into the anal canal and return spontaneously upon defecation
-3rd degree= protrude into the anal canal on defecation but can be returned to the original position manually
-4th degree= permanently prolapsed

Question 2

Contributing Factors: Hemorroids

Answer 2

-constipation
-diarrhea
-pregnancy
-erect posture (prolonged standing)
-lack of fiber in diet
-heavy lifting with straining
-straining on the toilet for >5 minutes

Question 3

What are the exclusions for self care for hemorroids?

Answer 3

-patient <12 yo
-pain (intense stimulation of sensory fibers)
-bleeding
-seepage
-change in bowel patterns
-prolapse
-thrombosis
-diagnosed illness associated with rectal bleeding (ulcerative colitis, crohn’s)
-family history of colon cancer
-if symptoms do not respond after 7 days of self treatment

Question 4

Describe: Local Anesthetics

Answer 4

-MOA= reversibly block the transmission of nerve impulses
-indication= temporary relief of external anal symptoms
-products= pramoxine, lidocaine, dibucaine, benzocaine
-apply 4-6 times a day

Question 5

Describe: Vasoconstrictors

Answer 5

-MOA= stimulate alpha receptors causing vasoconstriction and decrease in swelling
-indication= relief of itching, discomfort, and irritation and shrink hemorrhoids
-products= phenylephrine (preparation H), epinephrine
-caution= diabetes, thyroid disease, HTN, BPH

Question 6

What is the first line therapy for hemorrhoids?

Answer 6

creams then suppositories