HemorrhoidsHemorrhoidsOHHHH it BurnsOHHHH it Burns

Mike ParenteauMike Parenteau

Soooo AngrySoooo Angry

PathophysiologyPathophysiology

Hemorrhoids are varicosities (dilated Hemorrhoids are varicosities (dilated veins) that may occur outside the veins) that may occur outside the anal sphincter.anal sphincter.

Can be external or internalCan be external or internal

Most common health problem in Most common health problem in humans. Seen in ages 20 to 50 years humans. Seen in ages 20 to 50 years oldold

Etiology FactorsEtiology Factors

Straining at with increased Straining at with increased intraabdominal and hemrorrhoidal intraabdominal and hemrorrhoidal venous pressures. With repeated venous pressures. With repeated increased pressure and obstructed increased pressure and obstructed blood flow, permanent dilation occursblood flow, permanent dilation occurs

Stuff that causes itStuff that causes it

ConstipationConstipation

DiarrheaDiarrhea

PregnancyPregnancy

CHFCHF

Portal hypertensionPortal hypertension

Prolonged sitting or standingProlonged sitting or standing

InternalInternalInternal hemorrhoidsInternal hemorrhoids are those that are those that occur inside the occur inside the rectumrectum. As this area lacks . As this area lacks pain pain receptorsreceptors, internal hemorrhoids are , internal hemorrhoids are usually not painful and most people are usually not painful and most people are not aware that they have them. Internal not aware that they have them. Internal hemorrhoids, however, may bleed when hemorrhoids, however, may bleed when irritated. irritated.

Untreated internal hemorrhoids can lead Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids. prolapsed and strangulated hemorrhoids.

InternalInternalProlapsed hemorrhoidsProlapsed hemorrhoids are internal are internal hemorrhoids that are so distended that hemorrhoids that are so distended that they are pushed outside of the anus. they are pushed outside of the anus.

If the anal If the anal sphinctersphincter muscle goes into muscle goes into spasmspasm and traps a prolapsed hemorrhoid and traps a prolapsed hemorrhoid outside of the anal opening, the supply of outside of the anal opening, the supply of blood is cut off, and the hemorrhoid blood is cut off, and the hemorrhoid becomes a becomes a strangulated hemorrhoidstrangulated hemorrhoid. .

ExternalExternalExternal hemorrhoidsExternal hemorrhoids are those that are those that occur outside of the occur outside of the anal vergeanal verge (the (the distaldistal end of the end of the anal canalanal canal). They are ). They are sometimes painful, and can be sometimes painful, and can be accompanied by swelling and irritation. accompanied by swelling and irritation. Itching, although often thought to be a Itching, although often thought to be a symptom from external hemorrhoids, is symptom from external hemorrhoids, is more commonly due to skin irritation. more commonly due to skin irritation. If the vein ruptures and a If the vein ruptures and a blood clotblood clot develops, the hemorrhoid becomes a develops, the hemorrhoid becomes a thrombosed hemorrhoidthrombosed hemorrhoid. .

Clinical ManifestationsClinical Manifestations

The most common symptoms The most common symptoms associated with enlarged, abnormal associated with enlarged, abnormal hemorrhoids are prolapsed and hemorrhoids are prolapsed and bleeding. The bright red bleeding and bleeding. The bright red bleeding and prolepses usually occur at time of prolepses usually occur at time of defecationdefecation

Subjective AssessmentSubjective Assessment

Complaints of constipationComplaints of constipation

PruritusPruritus

Severe pain when dilated vain Severe pain when dilated vain becomes thrombosedbecomes thrombosed

Bleeding from the rectum that is not Bleeding from the rectum that is not mixed with feces (poop).mixed with feces (poop).

Rectum darn near killed themRectum darn near killed them

Objective AssessmentObjective Assessment

Observing external hemorrhoids and Observing external hemorrhoids and palpating internal hemorrhoids on palpating internal hemorrhoids on examinationexamination

Bleeding and constipation are signs Bleeding and constipation are signs of cancer of the rectum, all patients of cancer of the rectum, all patients with these symptoms should have a with these symptoms should have a thorough examination to rule out thorough examination to rule out cancercancer

Medical ManagementMedical ManagementThere is no medicine that will cure hemorrhoids, There is no medicine that will cure hemorrhoids, but local treatments such as warm sitz baths, but local treatments such as warm sitz baths, using a using a bidetbidet, extendable showerhead, cold , extendable showerhead, cold compress, or topical analgesic (such as compress, or topical analgesic (such as NupercainalNupercainal), can provide temporary relief. ), can provide temporary relief. Consistent use of medicated creams (such as Consistent use of medicated creams (such as AnusolAnusol) during the early stages of a hemorrhoid ) during the early stages of a hemorrhoid flare-up will also provide relief and may stave off flare-up will also provide relief and may stave off further development and irritation. Keep the area further development and irritation. Keep the area clean and dry, with some lubrication provided by clean and dry, with some lubrication provided by hemorrhoidal creams. hemorrhoidal creams. SuppositoriesSuppositories are of little are of little help since all of the symptoms come from the help since all of the symptoms come from the external tissues and not in the rectum where the external tissues and not in the rectum where the suppository is placed. suppository is placed.

Medical ManagementMedical ManagementRubber band ligationRubber band ligation: elastic bands are applied : elastic bands are applied onto an internal hemorrhoid to cut off its blood onto an internal hemorrhoid to cut off its blood supply. Within several days, the withered supply. Within several days, the withered hemorrhoid is sloughed off during normal bowel hemorrhoid is sloughed off during normal bowel movement. movement. Hemorrhoidolysis/Galvanic ElectrotherapyHemorrhoidolysis/Galvanic Electrotherapy: : desiccation of the hemorrhoid by electrical desiccation of the hemorrhoid by electrical current. current. SclerotherapySclerotherapy (injection therapy) (injection therapy): sclerosant or : sclerosant or hardening agent is injected into hemorrhoids. hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the This causes the vein walls to collapse and the hemorrhoids to shrivel up. hemorrhoids to shrivel up.

Medical ManagementMedical ManagementCryosurgeryCryosurgery: a frozen tip of a : a frozen tip of a cryoprobecryoprobe is used to destroy hemorrhoidal tissues. is used to destroy hemorrhoidal tissues. Rarely used anymore because of side Rarely used anymore because of side effects effects Laser, infrared or BICAP coagulationLaser, infrared or BICAP coagulation: : laserlaser, infrared beam, or , infrared beam, or electricityelectricity is used is used to cauterize the affected tissues. Lasers to cauterize the affected tissues. Lasers are now much less popular. are now much less popular. HemorrhoidectomyHemorrhoidectomy: a true surgical : a true surgical procedure to excise and remove procedure to excise and remove hemorrhoids. hemorrhoids.

Medical ManagementMedical ManagementStapled HemorrhoidectomyStapled Hemorrhoidectomy: Also called the procedure for : Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions. bleed and is not helpful for painful outside conditions. EnemaEnema: This Practice is only used to clean the rectum in : This Practice is only used to clean the rectum in some cases and only done by an M.D. Water is injected into some cases and only done by an M.D. Water is injected into the rectum and then flushed out cleaning the area. the rectum and then flushed out cleaning the area. Doppler Guided Hemorrhoidal Artery LigationDoppler Guided Hemorrhoidal Artery Ligation : The  : The only evidence based surgery for all grades of hemorrhoids. only evidence based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same hospital; patients are usually back to work on the same day. Best treatment for bleeding piles, as the bleeding day. Best treatment for bleeding piles, as the bleeding stops immediately.stops immediately.

Rubber band ligation Stapled HemorrhoidectomyStapled Hemorrhoidectomy

Diseases with similar symptoms Diseases with similar symptoms

Symptoms associated with rectal Symptoms associated with rectal cancer, anal fissure, anal abscess, cancer, anal fissure, anal abscess, anal fistula, and other diseases may anal fistula, and other diseases may be similar to those produced by be similar to those produced by hemorrhoids and may be reduced by hemorrhoids and may be reduced by the topical analgesic, so it is the topical analgesic, so it is important to have the Doctor important to have the Doctor examine the patient.examine the patient.