Haemorrhoids Flashcards
Discuss haemorrhoids
Commonly affect people age >40 to 65 y/o, 50% of people over 50 experience at some point
Rare in children/adults <20 y/o
Caused by downward pressure on haemorrhoidal cushion
What are the risk factors for haemorrhoids?
Excessive or recurrent straining (constipation)
Inc anal canal pressure
Intra-abdominal pressure = preg, space occupying lesion in pelvis
List the symptoms of haemorrhoids
Straining/pain on going to toilet
Blood on toilet paper or in toilet (bright red)
Internal haemorrhoids are graded 1-4 in size of prolapse
External haemorrhoid = felt outside anal canal, itch (pruritis), feeling of incomplete bowel movement, severe perianal pain (straining –> thrombosed external haemorrhoid)
Question to ask when someone presents with a potential haemorrhoid
What are symptoms? when did they first appear?
What else has been happening that is different from normal? (potential contributing factors [constipation], sign of something more serious)
If constipation present = what is normal bowel habit, what makes it worse/better? what have they tried?
Mention key considerations for haemorrhoids
History of straining with constipation
Slight rectal bleed associated with straining/defecation = bowl or on surface of stool
Perianal discomfort/pain with internal or external haemorrhoid = dull ache (inc when strain), sharp pain can be anal fissure
Anal itching (pruritis)
Symptom duration = refer >3 wks consistent symptoms
Symptoms should be localised
When should you refer someone with suspected haemorrhoids?
Persistent change in bowel habit, bleeding, unexplained bleeding in patient older than 40 y/o (less if cancer Hx)
Anything more mild than haemorrhoid, having to manually reduce haemorrhoid
Sever pain, blood mixed in stool, fever
symptoms >3 wks, symptoms not localised, medication making condition worse
Explain some differential diagnoses for haemorrhoids
Dermatitis (contact usually) = pruritis or itching, main feature
Anal fissure = tear in anal mucosa, painful bleeding on defecation (like passing glass), pain cont. described as burning, skin tag
IBD = rectal bleeding associated with diarrhoea, fam history
Colorectal cancer = altered bowel habit (diarrhoea and/or constipation), unexplained weight loss, abdominal pain, fam history
Rectal prolapse = protruding rectal mass, pain, discharge (mucous/blood), faecal incontinence
What do we aim to do with treatment of haemorrhoids?
Relieve symptoms, improve QoL, reduce risk/prevent complications
Prevent symptom recurrence through lifestyle mod = inc fibre, adequate fluids
Manage with evidence based treatment = pharmacy med, pharmacist only med, medical procedure (higher grades)
List the medication classes used in haemorrhoid treatment
Anaesthetics
Astringents
Corticosteroids
Protectorants
Antiseptics
Name the anaesthetics used in haemorrhoid treatment, mention key information
Lidocaine, lignocaine, cinchocaine
Shor-lived relief from discomfort, req freq application, may cause sensitisation
no direct evidence
Name the astringents used in haemorrhoid treatment, mention key information
Zinc, aluminium
Effect may be placebo, theoretically form protective coat
Name the corticosteroids used in haemorrhoid treatment, mention key information
hydrocortisone
Pharmacist only, anti-inflammatory effect, reduce swelling
Name the protectorants used in haemorrhoid treatment, mention key information
Shark oil
claimed to improve coating, NO EVIDENCE
Name the antiseptics used in haemorrhoid treatment, mention key information
Chlorhexidine = inhibit bacterial growth, kills bacteria
Concentration dependent and no evidence to support use
Mention some haemorrhoid prevention and self-care techniques
Diet rich in fibre (25g-30g) = food or supplements
adequate hydration, manage constipation if present
avoid straining, sitting on toilet for long
go to toilet when urge is felt
Moist gentle cleaning after bowel movement = wipes available
