Haemorrhoids (Piles)

Last updated 13.02.13

 

Definition

-  Dilated veins of lower rectum &/or anus

 

Features

-  Very common

-  Internal or external

-  External = distal to dentate line

-   May be concealed from view

-   Drain inferior rectal arteries off internal pudendal arterues

-  Internal = proximal to dentate line

-   Drain superior rectal arteries

-   Usually not painful

-   Grade 1: nil prolapse

-   Grade 2: prolapse w defecation, spontaneous reduction

-   Grade 3: prolapse w defecation, manually reduced

-   Grade 4: prolapsed & not manually reducible

-  If present w PR bleed must exclude other causes: bowel Ca..

 

Associated S/S

-  Uncomplicated are painless

-  Symptoms usually resolve over several days

-  Anal itching

-  Anal ache, pain

-  May be increased or relieved when seated

-  Worse if thrombosed

-  Haematochezia +/- clots

-  In toilet

-  Within stool

-  Toilet tissue

-  Internal usually painless bleed

-  External often painful bleed

-  Dyschezia

-  Visible hard tender lumps around anus

-  Protrusion of haemorrhoid

 

Causes

-  Increased venous pressure

-  Constipation

-  Straining during bowel movements

-  Labour, Pregnancy

-  Sitting at stool for prolonged periods

-  Portal hypertension: chronic liver disease..

-  Crohns disease

 

DDx

-  Rectal prolapse

-  Bowel Ca

-  Anal fissue

-  Polyps: anal or rectal

 

Complications

-  Skin tags

-  Severe bleeding

-  Iron deficiency anaemia

-  Thrombosis

-  More common in external haemorrhoids

 

Ix

-  Visual examination of anus

-  PR

-  Blood stained finger

-  Palpable internal haemorrhoids

-  +/- proctoscope/sigmoidoscope 

 

Mx

-  Reassurance

-  Annusol ointment

-  Proctosydl suppositories

-  Surgery

-  Grade 2: Rubber band ligation

-  Sclerotherapy

-  Haemorrhoidectomy (GA)

-  Prevention

-  +/- Stool softeners

-  Coloxyl

-  Metamucil

-  Adequte fluids

 

 

 

References

 

PubMed Health: Haemorrhoids, May 16 2011