HEMORRIODS DEFINITION • Hemorrhoids are swollen, enlarged veins that form inside and outside the anus and rectum. They can be painful, uncomfortable and cause rectal bleeding. Hemorrhoids are also called piles. ANATOMY There are two types of hemorroids ; internal and external hemorroids � � Internal hemorroids : internal of hemorroids are usually painful but these bleed when they are irritated such as during passage of the hard stools. They can be classified into four grade. External hemorroids : external of hemorroids presents as swelling outside the anus. It creates irritation and itching. Those can be painful sometimes and usually do not bleed. INTERNAL HEMORROIDS I. First degree : Don’t protrude outside the anal canal II. Second degree : Protrude during bowel movement and retract spontaneously III. Third degree : Prolape and don’t retract spontaneously IV. Fourth degree : Prolapse and can’t be manually push back in. CAUSE � Straining during bowel movements � Chronic diarrhea or Constipation � Obesity � Prenacy � Old age PATHOGENESIS INTERNAL HEMORROIDS • Don’t cause symptoms • Inflamed Itching Burning Vague discomfort Painless EXTERNAL HEMORROIDS • Innervated somatically • Painful • Swelling DIAGNOSIS • VISUAL AND DIGITAL EXAM • FLEXIBLE SIGMOIDOCOPY OR COLONSCOPY • INTERNAL HEMORROIDS ANOSCOPY Grade I • Bulging purplish-blue viens Grade II • Dark pink • Glistening Thrombose external • Tender • Purplish hue TREATMENT � FIBER INTAKE � DRINKING WATER � STOOL SOFTENERS � ORAL OR LOCAL NSAIDs IBUPROFEN ACETAMINOPHEN � SITZ BATH TREATMENT ( OFFICE-BASED PROCEDURES ) o Rubber band ligation o Sclerothery o Infrared cauterization for coagulation ( SURGERY ) � Hemorrhoids that don’t impove home based and office based procedured � Internal grade IV hemorrhoids � Strangulated internal hemorroids � ANAL FISSURE • Tear to the anoderm • Anal pain bleeding � PILONIDAL DISEASE • Hair follicle infection � ANORECTAL FISTULA � ANAL CANCER
