Hemorrhoids.pptx

For 2nd year B.Sc Nursing students

1. HEMORRHOIDS Presented By: Mr. Nandish. S Asso. Professor Mandya Institute of Nursing Sciences

2. They are symptomatic downward displacement of normal anal cushions causing venous dilation. It is also called as piles They are swollen veins in the anus and lower rectum similar to varicose veins. Anal region composed of tuft of vascular tissue like arterioles and venules along with smooth muscles and connective tissue lined by epithelium.

3. Types / Classification: It is classified into 2 types. Internal Hemorrhoids : These are above internal sphincter. External Hemorrhoids : They appear outside the external sphincter. Internal Hemorrhoids are classified by degree of prolapse. First Degree : They do not prolapse & protrude into anal canal. Second Degree : prolapse outside the anal canal during defecation but reduce spontaneously. Third Degree : prolapsed to the extent that they require manual reduction. Fourth Degree : prolapsed to the extent that they may not be reduced.

4. Etiology Decreased venous return Straining on defecation Constipation Pregnancy induced pressure on anal canal Portal hypertension

5. Risk Factors: Prolonged bedridden status Familial tendency Obesity Chronic Diarrhea Colonic cancer Hepatic diseases Rectal Surgeries Episiotomy IBD

6. Pathophysiology Straining during defecation Reduced venous return from anal canal Weakening of the supportive structures Displacement of normal anal blood vessels Enlargement of anal vessels Clinical manifestations

7. Clinical Manifestations : Internal Hemorrhoids may be asymptomatic Perianal Itching Pain Bright red Bleeding after passing the stool Patient show discomfort External Hemorrhoids is associated with severe pain Edema caused by thrombosis (clotting of blood within Hemorrhoids ) Ischemia of the area & Necrosis Burning sensation & bleeding associated with defecation.

8. Diagnostic Studies : History collection & Physical examination (Digital Examination) Anoscopy Sigmoidoscopy

9. Management : General : Maintain good personal hygiene. Avoid excessive straining during defecation. Provide high fiber diet, fruits and bran along with plenty of fluids. Ointments like Nupercainal , creams, suppositories & impregnated pads that contain anti inflammatory agents. Stool softners can be adviced to keep stool soft. Sitz bath ordered to relieve pain. Application of ice packs for a few hours followed by warm packs used for external hemorrhoids .

10. Non Surgical / Conservative treatment : Infra red photocoagulation (infra red or electrical current waves are used) Cryotherapy (involves rapid freezing) Laser Therapy (most expensive procedure) Sclerotherapy : injection of sclerosing agents (5% phenol in saline) into the base of hemorrhoids . Rubber band ligation procedure ( hemorrhoid is visualized & identified through anoscope , ligatetd using rubber band). Distal part becomes necrotic after several days and sloughs off.

11. Surgical Treatment : Hemorrhoidectomy ,is surgical excision of hemorrhoids (It is indicated when there is prolapse , excessive bleeding or large hemorrhoids ). Stapled Hemorrhoidopexy (use surgical staples to treart prolapse).

12. Nursing management: Teach about measures to prevent constipation, avoidance of prolonged standing or sitting. Sitz bath two to three times per day (15 to 20 minutes). Topical Nitroglycerin preparations are used to decrease pain. Anal packing is inserted into rectum to absorb drainage. T- Binder is placed in position. Monitor the patient for bleeding. Stool softners are adviced in the first 2-3 days after surgery. Teach the patient about diet and anal area hygiene.

13. Thank you