External hemorrhoid: Difference between revisions
No edit summary |
No edit summary |
||
| Line 18: | Line 18: | ||
{{Lower GI bleeding DDX}} | {{Lower GI bleeding DDX}} | ||
==Management== | ==Management== | ||
Revision as of 19:48, 5 January 2016
Background
Template:Hemorroids background
Clinical Features
- Occur distal to dentate line
- Can be seen at external inspection
- More prominent with Valsalva
- Thrombosed hemorrhoids (bluish-purple discoloration) cause painful defecation
- Non-thrombosed hemorrhoids are usually painless
- If patient complains of pain but hemorrhoids are not thrombosed suspect:
- Perianal/intersphincteric abscesses
- Anal fissures
- If patient complains of pain but hemorrhoids are not thrombosed suspect:
- Non-thrombosed hemorrhoids are usually painless
- Prolapse
- Requires periodic reduction by the patient
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Management
Not Thrombosed
- Usually self-limiting with resolution in 1 week
Thrombosed
- Consider sitz baths and bulk laxatives if:
- Thrombosis has been present >48 hr
- Swelling has started to shrink
- Pain is tolerable
- Conservative management with topical 0.3% nifedipine and 1.5% viscous lidocaine is alternative[1]
- Consider excision if:
- Pt is not immunocompromised, child, pregnant woman, has portal HTN, coagulopathic
- Thrombosis is acute (<48 hr)
- Extremely painful
- See External Hemorrhoid Excision
Disposition
See Also
External Links
References
- ↑ Perrotti P. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. 2001 Mar;44(3):405-9.