Hemorrhoid (AHN)

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1. •Subject: Adult Health Nursing
•Topic: Hemorrhoids

2. Objectives
•At the end of this presentation the student will be
able to:
•Define hemorrhoids.
•Describe Pathophysiology of hemorrhoids.
• Identify types of hemorrhoids.
•Enlist signs, symptoms and causes of hemorrhoids.
•Explain medical diagnosis and treatment.
•Discuss nursing diagnosis and nursing intervention
for hemorrhoids.

3. Hemorrhoids
•Hemorrhoids

Hemorrhoids are
painful, swollen veins
in the lower portion
of the rectum or
anus.

4. Pathophysiology
•Hemorrhoid cushions are a part of normal human
anatomy and only become a pathological disease
when they experience abnormal changes.
•There are three cushions present in the normal
anal canal.
•They are important for continence, contributing
to at rest 15-20% of anal closure pressure and act
to protect the anal sphincter muscles during the
passage of stool.

5. Causes
Hemorrhoids may be cause by:
•Straining during bowel movements
•Constipation
•Sitting for long periods of time
•Anal infections
•Pregnancy
•Certain diseases such as liver cirrhosis
•Obesity
•Genetics
•Low fiber diet

6. Types
•There are two types of
hemorrhoids i.e.
•Internal hemorrhoids
occur just inside the
anus, at the beginning of
the rectum
•External hemorrhoids
occur at the anal opening
and may hang outside
the anus

7. Sign and symptoms
•Anal itching
•Rectal pain
•One or more hard tender lumps near the anus
•Bleeding

8. Diagnosis
•Visual examination
•Anoscopy
•Endoscopic image
• Sigmoidoscopy

9. Treatment
 Conservative Treatment
• Increase dietary fiber
• Oral fluids
•NSAID
• Sitz bath
• Rest
• Steroids ointments or creams

10. Conti…
 Fixative Procedures
The goal of nonsurgical procedures
used to treat hemorrhoids is called fixative procedures.
It include tying off the hemorrhoids
• with a rubber band
• using heat
•Lasers
• electric current
 Hemorrhoidectomy
Surgical removal of hemorrhoid is
called hemorrhoidectomy.

11. Prevention
• Drink plenty of water, at least eight glasses
per day
• Eat high fiber diet of fruits, vegetables, and
whole grains
• Empty bowels as soon as possible after the
urge occurs
•Regular exercise

12. Nursing Diagnosis for Hemorrhoids
•Pain (acute or chronic) related to rectal
swelling
•Constipation related to ignore the urge to
defecate due to pain during defecation
•Anxiety related to plan surgery
•Impaired Urinary Elimination related to the
fear of postoperative pain.

13. Conti….
•Risk for infection related to inadequate
primary defenses.
•Deficient knowledge related to the lack of
information about home care.

14. Nursing Intervention for
Hemorrhoids
•As needed, provide warm sitz baths to reduce
local pain and swelling
•Check for signs and symptoms of anal
infection, such as increases pain and foul
smelling anal drainage.
•Teach the patient about hemorrhoidal
development, predisposing factors, and tests.

15. Conti…
•Emphasize the need for good anal hygiene.
•Encourage the use of toilet paper without
dyes or perfumes.
•Provide the patient with high fiber diet and
encourage adequate fluid intake and exercise
to prevent constipation.

16. Conti….
•Prepare the patient for surgery if necessary
•Monitor the patient’s pain level and the
effectiveness of the prescribed medications.

17. References
•Dozois EJ, Pemberton JH (2006). Hemorrhoids and
other anorectal disorders. In MM Wolfe et al.,
eds., Therapy of Digestive Disorders, 2nd ed., pp.
945-958. Philadelphia: Saunders Elsevier.
•Hull TL (2006). Hemorrhoids section of Diseases of
the anorectum. In M Feldman et al., eds., Sleisenger
and Fordtran's Gastrointestinal and Liver Disease,
8th ed., vol. 2, pp. 2833-2852. Philadelphia: Saunders
Elsevier.