Hemorroids overview

admin — Sun, 06 Jun 2010 02:33:10 +0000

In the upper anal canal, the hemorrhoids cushions are composed of three submucosal pillars of sinusoids within connective tissue, generally in the left lateral, right anterior, and right posterior. During the act of defecation, the hemorrhoids cushions become engorged with blood, cushioning the anal canal and supporting the anal canal lining. The pathologic term hemorrhoids is used to describe the downward displacement of the cushion along with dilation of the contained sinusoids and sometimes bleeding from the arteriole, venule, or sinusoidal portion.Hence, hemorrhoids develop when the supporting tissues of the anal cushion deteriorate or with extensive downward pressure, as in prolonged straining at stool or pregnancy.

The most common complaints of burning, itching, swelling, and pain usually are not from hemorrhoids but result from pruritus ani, anal abrasion, anal fissure, thrombosed external hemorrhoids, or prolapsed anal papilla. Symptoms are aggravated by constipation and diarrhea. The most common manifestation of hemorrhoids is painless, bright red rectal bleeding associated with bowel movement. With severe hemorrhoids,the patient commonly describes the bleeding episode as blood dripping into the toilet bowl. A feeling of incomplete evacuation is also common. In chronic prolapse, exposed rectal mucosa often causes perianal irritation and mucus staining on the underwear. Congestion of external hemorrhoids or skin tags can cause discomfort. Except in the presence of thrombosis, pain is rarely an early symptom of hemorrhoidal disease and other diagnoses should be excluded.

According to modern concepts, prolapse of anal cushions is initiated by the shearing effect of the passage of a hard stool or by excessive downward pressure as with constipation, pregnancy, or childbirth, or by the precipitous act of defecation as in urgent diarrhea. If prolapse of the vascular cushions can be prevented or if the congesting effect of a tight anal canal can be abolished, the anal cushions return to their normal state and symptoms are ameliorated without necessitating removal of the cushions themselves. Therefore, the rationale of giving bulk in the diet is to eliminate straining at defecation by producing soft, bulky stool. A high-fiber diet usually reduces symptoms of hemorrhoids and is ideal for first- and second-degree hemorrhoids.

Clinical Evaluation of Hemorrhoids Symptoms

admin — Mon, 07 Dec 2009 03:47:58 +0000

Bleeding and protrusion are among the most common symptoms of hemorrhoids. However, Mazier reported on a series of 500 patients with complaints of “hemorrhoids” and found that only one third had any significant hemorrhoids (personal communication). hemorrhoids bleeding typically results in bright red blood that drops into the toilet or is noted on the toilet. It is generally painless. More vigorous bleeding can occur as the hemorrhoids enlarge. Usually, prompt reduction of the protruding mass will cause this bleeding to abate. Acute thromboses of internal or external hemorrhoids are usually associated with severe pain that occurs with a palpable perianal mass. These patients are generally very uncomfortable, and the diagnosis is immediately obvious on clinical examination.

Examination of the patient with hematochezia, although dictated largely by the age of the patient, should include sufficient investigations to rule out a proximal source of bleeding, such as inflammatory bowel disease or neoplasia. Moreover, hemorrhoids bleeding is rarely a cause of iron-deficiency anemia.

The patient is examined in the left lateral position (or in the “head-down” position on the proctoscopy table) with the knees drawn up toward the chest as high as possible. This approach allows relative patient comfort and the ability to clearly inspect the perianal skin and to perform anoscopy and proctosigmoidoscopy. A careful digital examination of the anal canal and distal rectum should be performed, and the prostate should also be examined in male patients. An anoscope is essential to clearly inspect the hemorrhoidsal tissue and anal canal. The three common locations for hemorrhoids should be inspected, and the size, friability, and ease of prolapse of these areas should be recorded. After this, the decision regarding the need for more proximal colorectal evaluation should be considered, although rigid proctoscopy is a minimum. It cannot be emphasized enough that the examination must also be performed while the patient is seated on the toilet. The patient is asked to strain. Prolapsing hemorrhoidsal tissue in then sought. If none is found, but blood is present on the anal verge or examining finger, the patient has stage I disease. If the tissue prolapses, but reduces when the patient stops straining, the patient has stage II disease. If the prolapse must be reduced by the patient, it is stage III disease. Stage IV disease is obvious: an edematous nonreducing mass of internal and external hemorrhoidsal tissue is present at the anal verge. After the hemorrhoids are appropriately staged, treatment options should be explored.

Hemorroids overview

Hemorrhoids Update Review » Signs & Symptoms

Hemorroids overview

Related Articles

Clinical Evaluation of Hemorrhoids Symptoms

Related Articles