Haemorrhoids

Causes of haemorrhoids:
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The primary aetiology is believed to be excessive straining due to either chronic constipation or diarrhoea.
Other causes:an increase in intra-abdominal pressure can be caused by pregnancy or ascites;
the presence of space-occupying lesions within the pelvis

Types of haemorrhoids:
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1) External haemorrhoids
:Haemorrhoids that are located in the distal anal canal, distal to the dentate line, and covered by sensate anoderm or skin.

2) Internal haemorrhoids
:Haemorrhoids that originate proximal to the dentate line and covered by insensate transitional epithelium

    Grade 1 - protrusion is limited to within the anal canal.

    Grade 2 - protrudes beyond the anal canal but spontaneously reduces on cessation of straining.

    Grade 3 - protrudes outside the anal canal and reduces fully on manual pressure.

    Grade 4 - protrudes outside the anal canal and is irreducible.

This grading of internal haemorrhoids is only a reflection of the degree of prolapse but is not a measure of either the disease severity or of the size of haemorrhoidal prolapse.


Rx:
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For all grades:
 Straining or spending excessive time at stool should be discouraged.
 Constipation can be avoided by adding fibre and fluids to the diet; consuming 25 to 30 g of fibre daily .

(+- stool softeners short-term)


grade 1 haemorrhoids

 Creams and ointments are generally used for external haemorrhoids
 and suppositories are generally used for internal haemorrhoids

 hydrocortisone rectal :
 (1 to 2.5%) apply twice daily for a maximum of 5-7 days;
 25 mg (1 suppository) into the rectum twice daily for 14 days


grade 2

 rubber band ligation or sclerotherapy or infrared photocoagulation or haemorrhoid arterial ligation or stapled haemorrhoidopexy


grade 3

 rubber band ligation

grade 4

 Surgical haemorrhoidectomy


Thrombosed haemorrhoid:

Treatment of acute thrombosis of internal hemorrhoids is usually conservative.

In thrombosed external hemorrhoids, surgical evacuation of the hemorrhoid with excision of the skin overlying the thrombosed hemorrhoid can produce immediate relief. As an alternative, oral and topical analgesics, stool softeners, and sitz baths may provide adequate relief until spontaneous resolution occurs


{간략히

똥
stool softener
누기
don't strain
dietary fiber
아파
topical analgesic

grade I : corticosteroid cream / suppository

> grade I: band ligation / haemorrhoidectomy
}