QUIZZES ON HEMORRHOIDS l

Hemorrhoids: Key Points
1. Definition
• Hemorrhoids are swollen veins in the lower rectum or anus.
• Internal hemorrhoids: Located inside the rectum, often painless but can bleed.
• External hemorrhoids: Located outside the anus, often painful and can thrombose.
2. Classification of Hemorrhoids
• Grade 1: No prolapse; confined to the anal canal.
• Grade 2: Prolapse with straining but reduces spontaneously.
• Grade 3: Prolapse requiring manual reduction.
• Grade 4: Irreducible prolapse, often with pain or thrombosis.
3. Indications for Surgery
Surgical treatment is recommended for:
1. Grade 3 or 4 hemorrhoids.
2. Persistent symptoms despite conservative treatment.
3. Recurrent bleeding.
4. Chronic pain or thrombosed hemorrhoids.
5. Failure of non-surgical interventions.
4. Examination and Diagnosis
1. Physical Examination:
• Visual inspection for external hemorrhoids or prolapse.
• Digital rectal examination for internal hemorrhoids or masses.
2. Anoscopy: For better visualization of internal hemorrhoids.
3. Additional Tests (if needed):
• Sigmoidoscopy/Proctoscopy: To rule out other anorectal pathologies.
• Colonoscopy: For patients with suspicious or recurrent rectal bleeding.
5. Surgical Treatment Options
1. Hemorrhoidectomy:
• Procedure: Complete excision of hemorrhoidal tissue.
• Indication: Severe Grade 3 or Grade 4 hemorrhoids, external hemorrhoids.
• Advantages: Definitive treatment, prevents recurrence.
• Disadvantages: Postoperative pain, longer recovery (2-6 weeks).
2. Stapled Hemorrhoidopexy (PPH):
• Procedure: Circular stapler repositions and staples prolapsed hemorrhoids, cutting off blood supply.
• Indication: Internal prolapsed hemorrhoids.
• Advantages: Less pain, shorter recovery.
• Disadvantages: Higher cost, not effective for large external hemorrhoids.
3. Rubber Band Ligation (RBL):
• Procedure: Rubber band is applied to base of the hemorrhoid to cut off blood supply.
• Indication: Grade 1 or 2 internal hemorrhoids.
• Advantages: Outpatient procedure, minimal downtime.
• Disadvantages: Not suitable for large or prolapsed hemorrhoids.
4. Laser Hemorrhoid Surgery:
• Procedure: Laser energy is used to shrink hemorrhoids.
• Indication: Mild to moderate hemorrhoids.
• Advantages: Minimal bleeding, quick recovery.
• Disadvantages: Expensive, limited for severe cases.
6. Postoperative Care
1. Pain Management: Analgesics, sitz baths.
2. Dietary Changes: High-fiber diet and adequate fluid intake to prevent constipation.
3. Wound Care: Keep the area clean and dry; avoid straining during bowel movements.
4. Follow-Up: Monitor for complications like bleeding, infection, or recurrence.
7. Complications of Surgery
• Pain.
• Bleeding or infection.
• Urinary retention.
• Anal stenosis or incontinence (rare).
• Recurrence of hemorrhoids.