Hemorrhoids

• Hemorrhoids is the dilated portion of veins in the anal canal. It is the most common cause of bright-red bleeding
• Causes of hemorrhoids:

  • chronic constipation or diarrhea
  • straining during bowel movements
  • prolonged sitting or standing
  • lack of fiber in diet
• Cause of hemorrhoids:

  • weaking of connective tissues in the rectum and anus
  • pregnancy
  • wearing of constricting clothing
  • liver cirrhosis and RSHF
• 3 types of hemorrhoids:

  • internal - less pain
  • external - more pain
  • mixed

  cause itchy and pain

  prolapsed hemorrhoids can become inflamed and thrombosed
• Interventions:

  • good hygiene
  • avoid excessive straining upon defecation
  • promote soft bulky stools:
  • high-residue diet
  • increased fluid intake
  • hydrophilic bulk-forming agents: psyllium (metamucil)
• Intervention:

  • reduce engorgement
  • apply cold packs; after warm sitz bath - relieve soreness and pain by relaxing sphincter spasm
  • analgesic ointments
  • suppositories
  • astringents (calamine, witch hazel and zinc oxide) - cause coagulation of proteins in the cell of the perianal skin or the lining of the anal canal
  • bed rest
  • prone position at intervals
• Intervention:

  • patient teaching
  • set aside time for bowel movement
  • heed urge to defecate ASAP
  • prevent constipation
  • moderate exercise
• Nonsurgical treatment:

  • infrared photocoagulation - use heat to shrink hemorrhoid
  • bipolar diathermy - use of heat
  • laser therapy - use of heat
  • injection of sclerosing agents
• Surgical treatment:

  • rubber-band ligation
  • cryosurgical hemorrhoidectomy - freezing to cause necrosis
  • stapled hemorrhoidectomy
• Surgical treatment:

  • preop care of client undergoing hemorrhoidectomy
  • low residue diet - to reduce bulk of feces
  • stool softeners
  • postop care
  • promote comfort - analgesics as prescribed
  • side lying or prone position
  • apply ice packs over dressing for the first 12 hrs
  • warm sitz bath 12-24 hrs postop (best time: after BM)
  • stool softeners, increase fluids, high fiber foods