Haemorrhoids

Question 1

What is it?

Answer 1

Abnormal swelling and prolapse of the vascular cushions of the anal canal which help maintain continence

External arise below dentate line
Internal arise above dentate line

Question 2

What are the risk factors?

Answer 2

Constipation
Pregnancy
Chronic cough

Question 3

What are clinical features?

Answer 3

Painless fresh PR bleeding- typically noticed when wiping
Itching or irritation around anus
Severe pain if strangulation

If prolpased can visualise bluish bulging masses
If thrombosed then purple, oedematous and very tender

Question 4

What are the investigations?

Answer 4

Protoscopy
- to asses internal haemorrhoids and exlcude other causes of bleeding

Question 5

What is the management?

Answer 5

Conservative
- treat constipation with laxatives

Topical treatment
- symptom relief
- steroid of LA preparations

Secondary care
- non surgical= rubber band ligation for 1-2nd degree haemorrhoids (reducible or non prolapsing)
- surgical= haemorrhoidectomy for more severe cases