Nursing Made Simple - NMS

HAEMORRHOIDS ( PILES)

QUESTIONS AND ANSWERS
1. Define haemorrhoids
2. State five predisposing factors
3. Outline two classifications of haemorrhoids
4. Explain the haemorrhoids grading scale
5. Discuss five investigation to be done to confirm the diagnosis
6. Mention 4 approaches to permanent haemorrhoids
7. Explain five points you would give on discharge on haemorrhoids IEC
MARKING KEY
DEFINITION
These are masses of dilated blood vessel that lie beneath the lining of the skin in the a**l ca**l.
Hemorrhoids or emerods, or piles are swelling and inflamation of veins in the rectucm and a**s. The anatomical term ”hemorrhoids” technically refers to “’Cushions of tissue filled with blood vessels at the junction of the re**um and the a**s.
PREDISPOSING FACTORS OF HAEMORRHOIDS
🟪Pregnancy
🟪Obesity
🟪Congestive heart failure
🟪Chronic liver disease with portal hypertensions.
🟪Sedentary occupation that involve long periods of sitting or standing
🟪Chronic constipation and diarrheal diseases
CLASSIFICATION OF HAEMORRHOIDS
1. INTERNAL HAEMORRIDS: -These occur above the a**l sphincter and are asymptomatic. Bleeding is self-limiting but usually causes the person seek medical treatment. But if it persist, it may deplete iron leading to anaemia.
2. EXTERNAL HAEMORRHOIDS:-These occur below the a**l sphincter.The classic ‘skin tag’ consists of small lumps of fibrous tissue and folds of a**l skin that have stretched by bulging of the haemorrhoids.
HAEMORRHOIDAL GRADING SCALE
❤️‍🩹First degree: The haemorrhoid bulges into the lumen of the anore**al ca**l but not protrudes through the a**s.
❤️‍🩹Second degree: The haemorrhoid prolapses out of the a**s with defeacation or straining but spontaneously returns to its normal anatomic position.
❤️‍🩹Third degree: The haemorrhoid prolapses out of the a**s with defecation or straining and requires manual reduction to return it to its normal anatomic position.
❤️‍🩹Fourth degree: The haemorrhoid prolapses out of the a**s, is irreducible, and is at risk of strangulation
SIGNS AND SYMPTOM OF HAEMORRHOIDS
💊Bleeding: As the name haemorrhoids implies, is the principle earliest symptoms. The bleeding is bright red and occurs during defaecation. Haemorrhoids that bleed but do not prolapse outside are called First Degree Haemorrhoids
💊Prolapse: Is a much later symptom. In the beginning the protrusion is slight and occurs only on stool.
💊Discharge: A mucoid discharge is a frequent accompaniment of pr*****ed haemorrhoids. Pruritis follows the discharge.
💊Pain: Is absent unless complication supervenes, such as thrombosis of external haemorrhoids. Pain also occurs on defeacation accompanied by re**al bleeding associated with a**l fissure
💊Anaemia: can be caused by persistent profuse bleeding from haemorrhoids.
MANAGEMENT
AIM
 To give psychological care
 To prevent complications such as bleeding.
INVESTIGATIONS
 History to obtain symptom presentation.
 On inspection there may be no evidence of internal haemorrhoids. When the patient strains, internal haemorrhoids may come into view transiently, or if they are of the third degree, they prolapse and remain pr*****ed.
 Digital examination: Internal haemorrhoids cannot be felt unless they are thrombosed.
 Proctoscopy: A proctoscope is passed to its fullest extent and the obturator removed. The instrument is then withdrawn. Just below the a**l re**al ring internal haemorrhoids if present, will bulge into the lumen of the proctoscope.
 Stool occult blood and sigmoiscopy are performed to rule out cancer of the colon and re**um which may aggravate haemorrhoidal symptoms or produce similar manifestations.
 Colonoscopy to rule cancer
TREATMENT
Conservative treatment
 Provide a high-fibre diet to loosen the stool
 Bulk-forming laxatives to loosen stool
 Warm sitz baths to relieve pressure, and get cleansing.
 If severe pain, bleeding, or thrombosis is present, more definitive management may be indicated.
TREATMENT OF PERMANENT HAEMORRHOIDS
a) RUBBER BAND LIGATION
The haemorrhoid is grasped with forceps and pulled into special instrument that slips the rubber over the haemorrhoid and onto the re**al mucosa above it and tie. The band constricts circulation and causes necrosis and the tissue usually sloughs off within a week.
b) SCLERAOTHERAPY
A sclerosing solution such as phenol 5% in oil is injected into the haemorrhoidal tissue, producing an intense inflammatory reaction.
C ) CRYOSURGERY AND PHOTOCOGULATION
The probe is used to expose the haemorrhoidal tissue to liquid nitrogen or radiation. This cause local tissue destruction necrosis occurs, later sloughs off, though it causes a foul-smelling discharge for several days or more.
c) HAEMORRHOIDECTOMY
This is the surgical removal of haemorrhoids, for the third and fourth degree, and strangulated haemorrhoids or haemorrhoids that does not respond to conservative treatment.
INDICATIONS FOR HAEMORHOIDECTOMY
 Chronic symptoms
 Permanent prolapse
 Chronic bleeding and anaemia
 Painful thrombosed haemorrhoids
IEC ON PREVENTION OF HAEMORRHOIDS
 Information, education and communication to the patient and family
 Take sitz baths after each bowel movement for at least 1 – 2 weeks after suregry
 Drink at least 2 litres of fluid a day
 Eat adequate dietary fibre and exercise moderately to prevent constipation that lead to straining on stooling
 Take stool softeners as prescribed
 To keep the perineal area clean at all times to prevent infection
 To avoid standing in position for a long time
 To open bowels as soon as he feels like doing.
BY FUNWELL NYANGA
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