Hemorrhoids: Difference between revisions

Latest revision as of 02:29, 6 January 2022

Background

Anatomy of the anus.

Internal and external hemorrhoids divided by pectinate (dentate) line

Pathologic state cccurs when internal or external hemorrhoid plexus become engorged, prolapsed, or thrombosed
Bleeding is usually limited (surface of stool, on toilet tissue, at end of defecation)
- Passage of blood clots requires evaluation for colon lesions

Risk Factors

Constipation and straining at stool
Frequent diarrhea
Older age
IBD

Types

External hemorrhoid

Thrombosed external hemorrhoid

Internal hemorrhoid
- Originate above the dentate line
- Painless
External hemorrhoid
- Originate below the dentate line
- Painful

Internal hemorrhoid chart

Internal hemorrhoid grades
Grade	Description	Diagram	Picture
I	Luminal protrusion above dentate line No prolapse Painless bleeding
II	Prolapse with spontaneous reduction Prolapse during straining
III	Prolapse requires manual reduction Prolapse during straining
IV	Prolapse—nonreducible Can result in edema and strangulation

Treatment

Increase fiber
Sitz baths
Topical steroid - Hydrocortizone
Topical anti-spasmodic - Nifedipine
See also treatment by specific type:
- Internal hemorrhoid
- External hemorrhoid

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+{{Hemorrhoid background}}
+==Types==
-* most common cause of anal pathology
+[[File:M 44 anus 22.jpg|thumb|[[External hemorrhoid]]]]
-* pt may present with mild symptoms (pruritis) or concerning symptoms (pain, bleeding)
+[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[external hemorrhoid]]]]
-* 2 classifications:
+*[[Internal hemorrhoid]]
-* internal: above pectinate line (usuallypainless)
+**Originate above the dentate line
-* external: below pectinate line (usually painful)
+**Painless
-* typically affects Caucasians from higher socioeconomic classes and rural areas, as well as pregnant females
+*[[External hemorrhoid]]
+**Originate below the dentate line
+**Painful
-==Diagnosis==
+{{Internal Hemorrhoid Chart}}
-External:
-* physical may reveal redundant tissue, skin tags from old thrombosed external hemorrhoids, fissures or fistulas, rectal or hemorrhoidal prolapse
-* Thrombosed hemorrhoids: painful mass at rectum that peaks at 48-72 hours and will start declining by day 4 as thrombus organizes
-* be aware of concominant anal fissure
-Internal:
-* Grade I: may protrude with defecation only
-* Grade II: prolapses and spontaneously reduces
-* Grade III: prolapses and requires manual reduction
-* Grade IV: prolapsed and unable to reduce
-==Work-Up==
-* cbc to look at hemoglobin, wbc as marker for infection
-* anoscopy/proctoscopy
-==DDx==
-* condyloma acuminata
-* proctitis
-* rectal prolapse
-* anal cancer, fissure, fistula
-* pedunculated polyp
-* perianal abscess
-* pruritis ani
-* colorectal tumor
 ==Treatment==
+*Increase fiber
+*Sitz baths
+*Topical steroid - Hydrocortizone
+*Topical anti-spasmodic - Nifedipine
+*See also treatment by specific type:
+**[[Internal hemorrhoid]]
+**[[External hemorrhoid]]
+==See Also==
+*[[Anorectal disorders]]
-* Nonsurgical
+==References==
-* Stool softener
+<references/>
-* No straining
-* Sitz baths x15min tid
-* Steroid/Abx/Anusol cream
-* increased fiber and fluid intake
-* anal hygiene
-* if there is prolapse that you cannot manually reduce, try placing some sugar on the area of prolapse and see if it will reduce spontaneously
-* Surgical
-* Thrombosed external
-* Excision (elliptical) is usually necessary only for severe pain
-* Contraindications:
-* >72 hours
-* Crohn’s disease
-* minimal pain
-* uncooperative patient
-* pregnant women
-* Grade III/IV internal hemorrhoid
-* surgical hemorrhoidectomy is best treatment
-==Source==
-Adapted from Donaldson
 [[Category:GI]]