Evaluation I Jessie Hester & Candice Perkins October 1, 2003 Hemorrhoids Evaluation I Jessie Hester & Candice Perkins October 1, 2003

What Are Hemorrhoids? Alternative Names Rectal Lump Piles Lump in the Rectum Definition: Dilated or enlarged veins in the lower portion of the rectum or anus.

Cont. Two Types: Grades: Internal- Under the skin External- Around the anus Grades: I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement !V- Permanently Prolapsed

Frequency 10 million Peak ages: 45-65 years ½ of adults experience hemorrhoids by age 50 Common among pregnant women Temporary

Symptoms Rectal Bleeding Bright red blood in stool Pain during bowel movements Anal Itching Rectal Prolapse Thrombus

Causes Pressure Constipation Diarrhea Sitting or standing for long periods of time Obesity Heavy Lifting Pregnancy

Signs and Tests Rectal Examination Tests Visual Digital Stool Guaiac (FOBT) Sigmoidoscopy Anaoscopy Proctoscopy

Referral Gastroenterologists Seek emergency care if : large amounts of rectal bleeding Lightheadedness Weakness Rapid HR < 100 BPM

Complications The blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis) This causes painful lumps in the anal area. Severe bleeding can occur causing iron deficiency anemia.

Treatment Non-surgical Mild cases are controlled by: Preventing constipation Drinking Fluids High-fiber diet Use of Fiber supplements Stool softeners

Cont. Apply and OTC cream or suppository containing hydrocortisone Keep anal area clean Soak in a warm bath Apply ice packs or compresses x 10min

Cont. If prolapses, gently push back into anal canal Use a sitz bath with warm water Use moist towelettes or wet toilet paper instead of dry toilet paper.

Treatments For painful or persistant hemorrhoids: Tying off a hemorrhoid Sclerotherapy Infered Light Laser Therapy Freezing Electrical Current Surgery

Hemorrhoid Surgery Alternative Name: Hemorrhoidectomy Hemorrhoid surgery is the removal of enlarged veins around the anus

Cont. Indications Persistent itching Anal bleeding Pain Blood clots Infection

Cont. Risks Reactions to medications of anestesia Bleeding Infection Narrowing of the anus *The outcome is usually very good in the majority of cases.

Prevention Eat high fiber diet Drink Plenty of Liquids Fiber Supplements Exercise Avoid long periods of standing or sitting Don’t Strain Go as soon as you feel the urge

Questions What grade of hemorrhoids prolapse and reduce spontaneously? A) Grade I B) Grade II C) Grade III D)Grade IV

How many people are treated for hemorrhoids yearly? A) 3 million B) 8 million C) 10 million D) 20 million

What are two causes of hemorrhoids? A) Standing on your head B) Heavy lifting C) Jeans being too tight D) Constipation

What is a sigmoidoscopy? An internal examination of the rectum, distal colon and large bowel using a type of small camera. Detects the presence of hidden blood in the stool. A procedure that enables a physician to view the anus, anal canal, and lower rectum using a lubricated plastic scope into the rectum.

Questions????