Haemorrhoids (B)

Question 1

Definition

Answer 1

Venous “vascular cushions” that have become enlarged due to increased pressure (e.g. secondary to straining in constipation)

Question 2

Describe the varying degrees

Answer 2

• 1st degree: no prolapse
• 2nd degree: prolapse when straining and return on relaxing
• 3rd degree: prolapse when straining, do not return on relaxing but can be pushed back
• 4th degree: prolapsed permanently

Question 3

Symptoms

Answer 3

• No symptoms
• Constipation
• Painless bright red bleeding (on toilet paper or dripping)
• Sore / itchy anus
• Feeling a lump around or in anus

Question 4

What causes a thrombosed haemorrhoid?

Answer 4

•Caused by strangulation at base of haemarrhoid causing thrombosis (a clot) in the haemarrhoid

Question 5

Describe thrombosed haemorrhoid

Answer 5

• Can be extremely painful
• Appear as purple, very tender swollen lumps around anus
• PR exam will be impossible due to pain

Question 6

Examination findings

Answer 6

• External haemorroids visible on inspection
• Internal haemorrhoids difficult to feel (may not be possible) on PR exam
• Appear as swellings covered in mucosa, may appear (prolapse) if the patient is asked to” bear down” during inspection
• Proctoscopy is required for proper visualization and inspection

Question 7

Management

Answer 7

Consider differential diagnoses (e.g. fissure, cancer, inflammatory bowel disease)
•Symptomatic (anusol cream, local anaestetic e.g. instillagel, topical steroids)
•Laxatives
•Band ligation (tight rubber band around base to cut off blood supply)
•Surgical haemorrhoidectomy