Aug 302013
 

Haemorrhoid are dilated portions of the veins in the anal canal are varicosities in the superior or inferior haemorrhoidal venous plexus. Dilation and enlargement of the superior haemorrhoidal venous plexus above the dentate line cause internal haemorrhoid.

Enlargement of the plexus of the inferior haemorrhoidal veins below the dentate line cause external haemorrhoid, which may protrude from the rectum. Haemorrhoid occurs in both sexes. Incidence is generally highest between ages 20 and 50.

 Causes:

  • Constipation, low fiber diet.
  • Obesity
  • Pregnancy
  • Prolonged sitting
  • Straining at defecation

Types:

  1. Internal haemorrhoid
  2. External haemorrhoid

Patho-physiology:


Results from activities that increases intravenous pressure, causing distention and enlargement. Predisposition factors include prolonged sitting, straining at defecation, constipation, low fiber diet, pregnancy and obesity. Other factors include hepatic disease such as cirrhosis, amoebic abscesses, or hepatitis, alcoholism and ano-rectal infections.

Classification of haemorrhoid:
1st degree : confined to the anal canal.
2nd degree: prolapsed during defecation but reduce spontaneously.
3rd degree: prolapsed haemorrhoid require manual reduction
4th degree: irreducible

Sign & Symptoms

  • Painless, intermittent bleeding during defecation from irritation and injury to the haemorrhoid mucosa.
  • Bright red blood on stool or toilet tissues due to injury to haemorrhoid mucosa.
  • Anal itching from poor and hygiene.
  • Vague feeling of an anal discomfort when bleeding occurs.
  • Prolapsed of rectal mucosa forms straining.
  • Pain from thrombosis of external haemorrhoid.

Complications:

  • Constipation
  • Local infections
  • Thrombosis of haemorrhoids
  • Secondary anemia from severe or recurrent bleeding

Diagnosis:

  • History taking
  • Physical examination confirms external haemorrhoid
  • Anoscopy and flexible sigmoidoscopy visualize internal haemorrhoid.

 Management
A conservative management/ Medical management:

  • Good personal hygiene, anal hygiene
  • Avoiding excessive straining during defecation
  • A high residue diet contains fruit and bran along with or increased fluid intake may be all the treatment that is necessary to promote the passage of soft, bulky stools to prevent straining.
  • Bulk forming agents hydrophilic such as, psyllium and mucilloid suppositories, astringents (e.g. witch hazel) and bed rest allow the engorgement to subside.
  • Avoidance of prolonged sitting on the toilet to prevent venous congestion.
  • A local anesthetic to decrease local swelling and pain.
  • Hydrocorticostone cream and suppositories to reduce edematous, prolapsed haemorroids and itching.
  • Warm sits bath to relieve pain.
  • Injection selerotherapy or rubber band ligation to reduce prolapsed haemorrhoid.

Nursing Management

Patient care for haemorrhoid includes pre-operative and post-operative support.

  • To prepare the patient for haemorrhoidectomy, administer an enema, as ordered (usually 2-4 hours before surgery) and record if the enema produced faeces, water or nothing. Shave the perineal area and clean the anus and surrounding skin.
  • Post operative check for sign or prolonged rectal bleeding, administer an analgesic and provide sits bath as ordered.
  • When the patient can resume oral feeding, administer bulk medications, such as pryllum about 1 hour after the evening meal, to ensure a daily stool. Wash against using stool softening medications soon after haemorrhoidectomy because a firm stool acts as a natural dilator to prevent anal stricture form the scar tissue. (some patients may need repeated dilation either digitally or with an anal dilator to prevent such narrowing;
  • Keeping the wound site clean to prevent infection and irritation.
  • Before discharge, stress the importance of regular bowel habits and good anal hygiene.
  • Warm against too vigorous wiping with wash clothes and against using harsh soap.
  • Encourage the use of medicated astringents pad and white, unscented toilet paper ( the fixative in colored paper and fragrances can irritate the skin)


 Posted by at 8:36 am