HEMRRHOIDS IN ENGLISH

                                                       

                                               HEMRRHOIDS IN ENGLISH

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HEMORRHOIDS-

Ø  Hemorrhoids (piles) are dilated portions of veins in the anal canal. They are very common; by 50 years of age, about 50% of people have hemorrhoids.

Hemorrhoids are of two types-

Ø  Internal Hemorrhoids

Ø  External Hemorrhoids

Ø  Hemorrhoids which are above the internal sphincter are called internal hemorrhoids, and those appearing outside the external sphincter are called external hemorrhoids.

CAUSES-

Ø  Hemorrhoids may be caused by increased pressure in lower rectum due to-

Ø  Straining during defecation.

Ø  Sitting for long time on toilet.

Ø  Chronic diarrhea

Ø  Chronic constipation

Ø  Other causative factors  includes-

Ø  Obesity.

Ø  Chances of hemorrhoids are increased in pregnancy.

Ø  Low fiber diet.

Ø  Regular heavy lifting.

CLINICAL MANIFESTATIONS-

Ø  Hemorrhoids results in –

Ø  Itching and pain

Ø  Bright-red bleeding with defecation.

Ø  External hemorrhoids are associated with severe pain from the inflammation and edema caused by thrombosis

Ø  This may also lead to ischemia (lack of blood supply to tissue) of the area and eventual necrosis.

Ø  Internal hemorrhoids are not usually painful until they bleed or prolapse when they become enlarged.

Ø  Chronic bleeding may lead to anaemia.

DIAGNOSITIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of hemorrhoids)

Ø  Proctoscopy.

Ø  Stool examination for occult blood Or fresh blood

Ø  Complete blood count and HB.

TREATMENT-

Ø  The goals Treatment  is to promote the passage of soft, bulky stools to prevent straining.

Ø  Health education is provided to the patient that symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation

Ø  A high-residue diet with an increased fluid intake may necessary to promote the passage of soft, bulky stools to prevent straining.

Ø  If this treatment is not successful, the addition of hydrophilic bulk-forming agents such as psyllium husk (isabgol)  may be given. Warm compresses, sitz baths, analgesic ointments and suppositories, and bed rest help to reduce inflammation.

Ø  Infrared photocoagulation, bipolar diathermy, and laser therapy are used to affix the mucosa to the underlying muscle. Injection of sclerosing agents is also effective for small, bleeding hemorrhoids. These procedures help prevent prolapse of hemorrhoids.

Ø  surgical treatment of internal hemorrhoids is the rubber-band ligation procedure. The hemorrhoid is visualized through the anoscope, grasped with an instrument and a small rubber band is then slipped over the hemorrhoid. Tissue distal to the rubber band becomes necrotic after several days and sloughs off.

Ø  Cryosurgical hemorrhoidectomy is an another method for removing hemorrhoids. it involves freezing the hemorrhoid for a sufficient time to cause necrosis. Although it is relatively painless but this procedure is not widely used because the discharge is foul-smelling and wound healing is prolonged.

NURSING  MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  Nutritional history is very important in the assessment of hemorrhoid patients.

Ø  Patient is encouraged to discuss the problem and ask doubts and concerns.

Ø  The nurse assesses the patient’s vital signs and reports tachycardia and hypotension, which may indicate anemia from due to bleeding hemorrhoids.

Ø  Prescribed medicines are given on time to reduce pain and increase comfort.

Ø  The patient is advised to avoid straining at defecation and report if stool passing becomes difficult.

Ø  The nurse assesses the patient for malnutrition and weight loss and anemia. After recovery from an acute phase disease , the patient is advised about intake high fiber diet and more liquids .

Ø  Postoperatively the nurse monitors fluid and electrolyte balance .

Ø  IV fluids are given as prescribed to maintain fluid and electrolyte balance  

Ø  Health education is provided to prevent recurring of hemorrhoids during discharge planning such as avoiding straining at defecation and regular lifting of heavy objects.

Ø  Patient is advised to take medicines as prescribed and return for follow up if symptoms re appear.