From the Research
Introduction to Hemorrhoids
Hemorrhoids are a common source of anorectal symptoms, which are determined by their size 1. They are defined as the symptomatic enlargement and distal displacement of the normal anal cushions 2. Hemorrhoids are engorged fibrovascular cushions lining the anal canal, and constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids 3.
Classification and Symptoms
Hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid 4. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement 2. Bright red, painless rectal bleeding during defecation is the most common presentation 3.
Treatment Options
Non-Surgical Treatment
Nonsurgical treatment for nonthrombosed hemorrhoids includes:
- Increased fiber intake
- Sitz baths
- Drugs Rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids 3.
Surgical Treatment
Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred 4. Several surgical approaches for treating hemorrhoids have been introduced, including:
- Hemorrhoidectomy
- Stapled hemorrhoidopexy
- Ligasure hemorrhoidectomy
- Doppler-guided hemorrhoidal artery ligation
Special Considerations
- Acutely thrombosed external hemorrhoids: excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management 3.
- Prolapsed and strangulated hemorrhoids: managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery; residual hemorrhoids are banded or excised later 3.
- Hemorrhoids in complicated situations, such as pregnancy, immunocompromised patients, cirrhosis or portal hypertension, and patients having antithrombotic agents, require special consideration 4.
Nursing Interventions
Nursing interventions for patients with hemorrhoidal disease include education on signs, symptoms, risk factors, classification, treatment, and self-care measures 5.
Caveats
Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer should still undergo colonoscopy to exclude cancer as the etiology 3. Postoperative pain is a common complication of surgical treatment for hemorrhoids, and some surgical treatments may cause appreciable morbidity, such as anal stricture and incontinence 2.