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Haemorrhoids

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AETIOLOGY AND RISK FACTORS

Abstract

VOL: 99, ISSUE: 07, PAGE NO: 28

AETIOLOGY AND RISK FACTORS
- Anal cushions are important structures within the anal canal that help form a seal within the canal when it is at rest. Haemorrhoids, commonly known as piles, occur when the anal cushions are enlarged and swollen, or displaced.

- They can be described as follows:

By location: Internal haemorrhoids occur just above the anal sphincter, while external haemorrhoids are found just under the skin at the lower end of the anal canal;

By area: Left lateral, right posterior or right anterior anal cushion;

Primary (found within anal cushion) or secondary (found between anal cushions).

- In addition, they can be classified into four degrees:

First degree: bleeding but no prolapse;

Second degree: prolapse outside anal canal but retracts spontaneously;

Third degree: prolapse requiring manual replacement into anal canal;

Fourth degree: prolapsed and cannot be manually replaced. Usually strangulated and/or thrombosed.

CAUSES
- Increased pressure from straining to defecate.

- Decreased venous pressure due to pregnancy or obesity.

- Weakening of the support structures due to ageing.

- Prolonged sitting on toilet may interfere with venous return due to tourniquet effect.

SIGNS AND SYMPTOMS
- Fresh bleeding during/after bowel movements.

- Prolapse of external haemorrhoids.

- Itching, pain.

- Mucous discharge.

- Difficulty cleaning after opening bowels due to skin tags caused by external haemorrhoids.

TREATMENT AND THERAPIES
- High-fibre diet and increased intake of fluids.

- Education on toilet habits, for example reduce time on toilet, open bowels only when feel urge to do so.

- Regular warm baths, cold compresses to relieve symptoms.

- Soothing haemorrhoidal preparations.

- Rubber band ligation.

- Sclerotherapy.

- Haemorrhoidectomy.

- Stapled haemorrhoidectomy.

 

NURSING IMPLICATIONS
- Both surgical and non-surgical patients require health education regarding causes of haemorrhoids, complemented by advice on diet, toilet habits, prevention of constipation and self-management of symptoms.

- For surgical patients, consideration should be given to the type of analgesia supplied, as opiates are likely to increase the risk of postoperative constipation.

- Provision of a stool softener may be appropriate. A high-fibre diet should not be recommended until patient can open the bowels without pain, as there is a risk that they will become impacted. Risks associated with haemorrhoidectomy include temporary urinary retention, anal stenosis, excessive bleeding and a - usually temporary - reduced ability to control flatus.

 

RESEARCH AND DEVELOPMENT
- Haemorrhoidectomy is performed as a day case in many centres.

- Stapled haemorrhoidectomy - developed in the mid-1990s - is reported to reduce postoperative pain and speed up return to normal activity. Its long-term effect on anal function requires further study.

WEBSITES
National Institute of Diabetes and Digestive and Kidney Diseases: www.niddk.nih.gov

American Society of Colon and Rectal Surgeons: www.fascrs.org

Healthfinder: www.healthfinder.gov

NHS Direct: www.nhsdirect.nhs.uk/nhsdoheso/display.asp?sTopic=Haemorrhoids

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