Haemorrhoids (piles)

Subject: Medical and Surgical Nursing I (Theory)

Overview

Swollen veins at the anus or in the lower rectum are hemorrhoids. There are two types of hemorrhoids: internal and external. Internal hemorrhoids form in the rectum or anus. Hemorrhoids that are external to the anus form. Another name for hemorrhoids is piles. It is divided into four stages. Its causes include straining during bowel motions, spending a lot of time on the toilet, chronic diarrhea or constipation, etc. It is characterized by discomfort and soreness in the area around the anus, difficult bowel movements, bleeding after urinating, etc. Surgery methods including sclerotherapy, hemorrhoids, rubber band ligation, etc. can be used to treat it. Spend at least 10 minutes each day in a warm tub of water to reduce pain. You can also sit on a warm water bottle to relieve the pain of external hemorrhoids.

Swollen veins at the anus or in the lower rectum are hemorrhoids. There are two types of hemorrhoids: internal and external. Internal hemorrhoids form in the rectum or anus. Hemorrhoids that are external to the anus form. Another name for hemorrhoids is piles.

External hemorrhoids are the more prevalent and problematic of the two types of hemorrhoids. Pain, intense itching, and trouble sitting are all symptoms of hemorrhoids. It's wonderful news that they can be treated.

Grades:

  • Grade I: 
    • Is small without protrusion. Painless, minor bleeding occurs from time to time after a bowel movement.
  • Grade II: 
    • Haemorrhoid may protrude during a bowel movement but returns spontaneously to its place afterward.
  • Grade III:
    • Haemorrhoid must be replaced manually.
  • Grade IV:
    • Haemorrhoid has prolapsed - it protrudes constantly and will fall out again if pushed back into the rectum. There may or may not be bleeding. Prolapsed hemorrhoids can be painful if they are strangled by the anus or if a clot develops.

 Causes:

  • Straining during bowel movements
  • Sitting for long periods of time on the toilet
  • Chronic diarrhea or constipation
  • Obesity
  • Pregnancy
  • Anal intercourse
  • Low-fiber diet

 Sign and symptoms

  • Irritation and pain around the anus
  • A painful bowel movement
  • Blood on your tissue after having a bowel movement
  • Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
  • Itching or irritation in your anal region
  • Pain or discomfort
  • A lump near your anus, which may be sensitive or painful
  • Leakage of feces

 Diagnosis

  • History taking
  • Physical examination:
    • Look for any abnormalities in your rectum and anal canal. A gloved, lubricated finger is inserted into your rectum during a digital rectal exam by your doctor. He or she feels around for any oddities, such growths. Your doctor may be able to determine from the examination what additional testing is necessary.
    • Visual examination of your rectum and anal canal. Your doctor may also use an anoscope, proctoscope, or sigmoidoscope to look at the lower part of your colon and rectum because internal hemorrhoids are frequently too soft to be felt during a rectal examination. These scopes provide your doctor access to your rectum and anus.

 Treatment

  • Rubber band ligation
    • To stop the internal hemorrhoid's circulation, your doctor wraps one or two thin rubber bands around the base of the growth. Within a week, a hemorrhoid withers and falls out. Many patients find this treatment, known as rubber band ligation, to be helpful.
    • Hemorrhoid banding can be painful and may result in bleeding, but this bleeding is rarely serious. It may start two to four days following the surgery.
  • Injection (sclerotherapy)
    • During this operation, your doctor shrinks the hemorrhoid tissue by injecting a chemical solution into it. Although the injection is not painful, it might not be as effective as rubber band ligation.
  • Coagulation (infrared, laser or bipolar)
    • Coagulation methods make use of heat, infrared light, or lasers. They induce internal hemorrhoids that are tiny and bleeding to stiffen and shrink.
  • Hemorrhoidectomy
    • The most thorough and effective method of treating severe or recurrent hemorrhoids is hemorhoidectomy. Urinary tract infections linked to this issue as well as temporary trouble emptying your bladder are potential complications.
  • Hemorrhoid stapling
    • Blood flow to hemorrhoidal tissue is blocked by the procedure known as stapled hemorrhoidectomy or stapled hemorhoidopexy. Hemorrhoidectomy typically causes more pain than stapling, which enables an earlier return to normal activities.

 Medical management

  • Pain Relief
    • Spend at least 10 minutes each day in a warm tub of water to reduce pain. To ease the discomfort of external hemorrhoids, you can also sit on a warm water bottle. You can use an over-the-counter medicated suppository, ointment, or cream to relieve the burning and itching if the pain is too much to bear.
  • Dietary Fiber
    • You can increase your intake of dietary fiber as part of your at-home treatment. The likelihood of having hemorrhoids later on can be reduced by eating meals high in dietary fiber.
    •  Good dietary fiber sources include:
      • Whole wheat
      • Brown rice
      • Oatmeal
      • Pears
      • Carrots
      • Buckwheat
      • Bran
  • Dietary fiber aids in the development of intestinal bulk, which softens the stool and makes it simpler to pass.
  • You can also use an over-the-counter fiber supplement if you have constipation to assist soften your stools.
  • Apply topical remedies. Use pads with witch hazel or a numbing ingredient, or apply an over-the-counter hemorrhoid cream or suppository with hydrocortisone.
  • Regularly take sitz baths or warm baths. Take a 10- to 15-minute bath in plain, warm water twice or three times daily to treat your anal area. The toilet may fit over a sitz bath. Most drugstores have one available.
  • Keep the anal region tidy. Take a shower or a bath every day to gently cleanse the skin surrounding your anus. Soap is unnecessary and could make the issue worse. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair dryer after bathing.
  • Use moist toilet paper only. Use damp toilet paper or moist towelettes without alcohol or scent to assist keep the anal area clean after a bowel movement.
  • Apply ice. To reduce swelling, place cold compresses or ice packs on your anus.
  • Take painkillers that are oral. To temporarily ease your discomfort, you can take acetaminophen (Tylenol, other brands), aspirin, or ibuprofen (Advil, Motrin IB, other brands).

 Nursing management

  • Avoid hard, dry stools.
  • Drink plenty of water daily.
  • Eat more fiber diets.
  • Take stool softeners or bulk laxatives as directed.
  • Exercise regularly.
  • Apply medicated cream or ointment as directed by doctors.
  • Sitz bath: soak the anal area in warm tap water for 10-20 minutes several times daily.

Complications

  • Blood clots in the swollen vein
  • Bleeding
  • Iron deficiency anemia caused by blood loss.

References

  • aarpmedicareplans.com/health/hemorrhoids
  • docshare.tips › Topics › Documents
  • es.scribd.com/document/174489868/Hemorrhoids-Pain-Nursing-Plan
  • healthline.com › Reference Library
  • findhemorrhoidtreatment.com/hemorrhoids-bleeding-after-bowel-movement/
  • microdoshirok.wordpress.com/2016/01/04/homoeopathy-3/
  • murrasaca.com/english/hemorrhoids.html
  • pharmacypedia.org/diseases-and-conditions/hemorrhoids/
  • rmedicare.com/diagnosing-hemorrhoids
Things to remember
  • Hemorrhoids are swollen veins located around the anus or in the lower rectum.
  • Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
  • Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. 
  • To minimize pain, soak in a warm tub of water for at least 10 minutes every day. 
  • Consuming foods that are high in dietary fiber can minimize 
  • Drink plenty of water daily.
  • iron deficiency anemia caused by blood loss
Questions and Answers

Haemorrhoid

Swollen veins at the anus or in the lower rectum are hemorrhoids. There are two types of hemorrhoids: internal and external. Internal hemorrhoids form in the rectum or anus. Hemorrhoids that are external to the anus form. Another name for hemorrhoids is piles.

External hemorrhoids are the more prevalent and problematic of the two types of hemorrhoids. Pain, intense itching, and trouble sitting are all symptoms of hemorrhoids. It's wonderful news that they can be treated.

Grade

  • Grade I
    • Is thin and has no protrusion. After a bowel movement, there may occasionally be some minor, painless bleeding.
  • A grade II
    • A hemorrhoid may pop out during a bowel movement, but it usually settles back into place on its own afterward.
  • In grade III
    • Hemorrhoids need to be manually changed.
  • A grade IV
    • Hemorrhoid has prolapsed; if forced back into the rectum, it will slip out once more. Bleeding may or may not be present. If the hemorrhoids are strangled by the anus or form a clot, prolapsed hemorrhoids may be uncomfortable.

 

Sign and Symptoms

  • Discomfort and soreness near the anus
  • A bowel movement that hurts
  • Having a bowel movement and having blood on your tissue
  • You may observe tiny blobs of bright red blood on your toilet paper or in the toilet bowl after painless bleeding during bowel movements.
  • Inflammation or itching in the anal area
  • Any discomfort or pain
  • A sensitive or uncomfortable bump close to your anus
  • Feces leakage

Treatment

  • Rubber Band Ligation
    • To stop the internal hemorrhoid's circulation, your doctor wraps one or two thin rubber bands around the base of the growth. Within a week, a hemorrhoid withers and falls out. Many patients find this treatment, known as rubber band ligation, to be helpful.
    • Hemorrhoid banding can be painful and may result in bleeding, but this bleeding is rarely serious. It may start two to four days following the surgery.
  • Injection (Sclerotherapy)
    • During this operation, your doctor shrinks the hemorrhoid tissue by injecting a chemical solution into it. Although the injection is not painful, it might not be as effective as rubber band ligation.
  • Coagulation (Infrared, Laser or Bipolar)
    • Coagulation methods make use of heat, infrared light, or lasers. They induce internal hemorrhoids that are tiny and bleeding to stiffen and shrink.
  • Hemorrhoidectomy
    • The most thorough and effective method of treating severe or recurrent hemorrhoids is hemorhoidectomy. Urinary tract infections linked to this issue as well as temporary trouble emptying your bladder are potential complications.
  • Hemorrhoid Stapling
    • Blood flow to hemorrhoidal tissue is blocked by the surgery known as stapled hemorrhoidectomy or stapled hemorhoidopexy. Hemorrhoidectomy typically causes more discomfort than stapling, which enables a sooner return to normal activities.

 

Haemorrhoid

Swollen veins at the anus or in the lower rectum are hemorrhoids. There are two types of hemorrhoids: internal and external. Internal hemorrhoids form in the rectum or anus. Hemorrhoids that are external to the anus form. Another name for hemorrhoids is piles.

External hemorrhoids are the more prevalent and problematic of the two types of hemorrhoids. Pain, intense itching, and trouble sitting are all symptoms of hemorrhoids. It's wonderful news that they can be treated.

Grade

  • Grade I
    • Is thin and has no protrusion. After a bowel movement, there may occasionally be some little, painless bleeding.
  • A grade II
    • A hemorrhoid may pop out during a bowel movement, but it usually settles back into place on its own afterward.
  • In grade III
    • Hemorrhoids need to be manually changed.
  • A grade IV
    • Hemorrhoid has prolapsed; if pushed back into the rectum, it will fall out once more. Bleeding may or may not be present. If the hemorrhoids are strangled by the anus or form a clot, prolapsed hemorrhoids may be painful.

Causes

  1. Squeezing when going to the bathroom
  2. Sitting on the toilet for extended lengths of time
  3. Constipation or chronic diarrhea
  4. Obesity
  5. Pregnancy
  6. A sexual encounter
  7. Diet low in fiber

Sign and Symptoms

  • Discomfort and soreness near the anus
  • A bowel movement that hurts
  • Having a bowel movement and having blood on your tissue
  • You may observe tiny blobs of bright red blood on your toilet paper or in the toilet bowl after painless bleeding during bowel movements.
  • Inflammation or itching in the anal area
  • Any discomfort or pain
  • A sensitive or uncomfortable bump close to your anus
  • Feces leakage

Diagnosis

  • History study
  • Inspection of the body
  • Look for any abnormalities in your rectum and anal canal. A gloved, lubricated finger is inserted into your rectum during a digital rectal exam by your doctor. He or she feels around for any oddities, such growths. Your doctor may be able to determine from the examination what additional testing is necessary.
  • Visual examination of your rectum and anal canal. Your doctor may also use an anoscope, proctoscope, or sigmoidoscope to look at the lower part of your colon and rectum because internal hemorrhoids are frequently too soft to be felt during a rectal examination. These scopes provide your doctor access to your rectum and anus.

Treatment

  • Rubber Band Ligation
    • To stop the internal hemorrhoid's circulation, your doctor wraps one or two thin rubber bands around the base of the growth. Within a week, a hemorrhoid withers and falls out. Many people find this procedure, known as rubber band ligation, to be effective.
    • Hemorrhoid banding can be uncomfortable and may result in bleeding, but this bleeding is rarely severe. It may start two to four days after the procedure.
  • Injection (Sclerotherapy)
    • During this procedure, your doctor shrinks the hemorrhoid tissue by injecting a chemical solution into it. Although the injection is not painful, it might not be as effective as rubber band ligation.
  • Coagulation (Infrared, Laser or Bipolar)
    • The application of heat, infrared light, or lasers is a coagulation technique. They make small, bleeding internal hemorrhoids stiffen and shrivel.
  • Hemorrhoidectomy
    • The most thorough and effective method of treating severe or recurrent hemorrhoids is hemorhoidectomy. Urinary tract infections linked to this issue as well as temporary trouble emptying your bladder are potential complications.
  • Hemorrhoid Stapling
    • Blood flow to hemorrhoidal tissue is blocked by the procedure known as stapled hemorrhoidectomy or stapled hemorhoidopexy. Hemorrhoidectomy typically causes more pain than stapling, which enables an earlier return to normal activities.

Medical Management

  • Pain Relief
    • Spend at least 10 minutes each day in a warm tub of water to reduce pain. To ease the discomfort of external hemorrhoids, you can also sit on a warm water bottle. You can use an over-the-counter medicated suppository, ointment, or cream to relieve the burning and itching if the pain is too much to bear.
  • Dietary Fiber
    • You can increase your intake of dietary fiber as part of your at-home treatment. The likelihood of developing hemorrhoids later on can be reduced by eating foods high in dietary fiber.
  • Good Sources of Dietary Fiber Include:
    • Whole wheat
    • Brown rice
    • Oatmeal
    • Pears
    • Carrots
    • Buckwheat
    • Bran
  • Dietary fiber aids in the development of intestinal bulk, which softens the stool and makes it simpler to pass.
  • You can also use an over-the-counter fiber supplement if you have constipation to assist soften your stools.
  • Apply topical remedies. Use pads with witch hazel or a numbing ingredient, or apply an over-the-counter hemorrhoid cream or suppository with hydrocortisone.
  • Regularly take sitz baths or warm baths. Take a 10- to 15-minute bath in plain, warm water twice or three times daily to treat your anal area. The toilet may fit over a sitz bath. Most drugstores have one available.
  • Keep the anal region tidy. Take a shower or a bath every day to gently cleanse the skin surrounding your anus. Soap is unnecessary and could make the issue worse. Avoid using wipes with alcohol or scent. After showering, gently use a hair dryer to dry the region.
  • Use moist toilet paper only. Use damp toilet paper or moist towelettes without alcohol or scent to assist keep the anal area clean after a bowel movement.
  • Apply ice. To reduce swelling, place cold compresses or ice packs on your anus.
  • Take painkillers that are oral. To temporarily ease your discomfort, you can take acetaminophen (Tylenol, other brands), aspirin, or ibuprofen (Advil, Motrin IB, other brands).

Nursing Management

  • Beware of dry, firm stools.
  • Drink a lot of water every day.
  • Eat a diet rich in fiber.
  • Use bulk laxatives or stool softeners as indicated.
  • Regular exercise
  • As instructed by doctors, apply a medicated cream or ointment.
  • Sitz bath
    • Soak the anal area for 10–20 minutes, several times per day, in warm tap water.

Complications

  • The enlarged vein has blood clots in it
  • Bleeding
  • Blood loss-induced iron deficiency anemia

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