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Recommended For…….
• third- and fourth-degree internal
hemorrhoids (with or without external
• For patient with severe bleeding,
intolerable pain , pruritus & large
Contraindicated For….

• Blood dyscrasias ( acute Leukemia)

• Aplastis anemia or hemophilia
• GI carcinoma
• During the first trimester of pregnancy
• Explain procedure and ensure consent form signed
• Stop any anticoagulant medication like aspirin &
NSAIDS 1 or 2 weeks before procedure
• Check baseline vital sign, such as urine test, chest
x-ray, ECG and bleeding profile
• Administer premedication drug to relieve anxiety
• Keep patient NBM for 6 to 8 hour before
• Administer laxative or enema to empty bowel
• Skin preparation at perianal area & clean with
antiseptic detergent
• Administer second enema 3 hours
before surgery
• Administer sedative for patient to relax
and induced drowsiness
• Make sure patient have IV line to
administer fluid & medication
before,during and after surgery
• Monitor vital sign
• Observe for prolonged rectal hemorrhage and
urinary retention
• Administer analgesic to reduce post operative
• Administer a bulk medication such as psyllium,
one hour after the evening meal to ensure
daily stool
• Warn against using stool softening
medication soon after surgery, because
a firm stool act as natural dilator to
prevent anal stricture from the scar
• Teach anal hygiene, measures to control
moisture to prevent itching
• Keep the wound site clean to prevent
infection and irritation
• Before discharge, stress the importance of
regular bowel habits and good anal hygiene
• Warn against too-vigorous wiping with
washcloths & using harsh soaps
• Encourage the use of medicated astringent
pads and white toilet paper ( the fixative in
colored paper can irritate the skin)
• Anal fistula or fissure
• Constipation
• Excessive bleeding
• Excessive discharge of fluid from the rectum
• Inability to urinate or have a bowel movement
• Severe pain, especially when having a bowel
• Severe redness and/or swelling in the rectal
• Prevent constipation by responding quickly
to urge to defecate
• Modify diet to include fluid & high fiber
• Obtain regular ambulation, prevent standing
or sitting for prolonged period of time
• Keep perineal area clean & dry
• Avoid regular use of laxatives
Picture of stapled
Picture Internal Hemorrhoids
in Anal Canal
Picture of a Hollow Tube Inserted into
the Anal Canal and Pushing up the
Picture of Suturing the Anal Canal
through the Hollow Tube
Picture of Bringing Expanded
Hemorrhoidal Supporting Tissue into
the Hollow Tube by Pulling on Suture
Picture of Hemorrhoids Pulled Back
Above Anal Canal after Stapling and
Removal of Hemorrhoidal Supporting
Hemorrhoids can occur inside the rectum, or at its opening (A).
To remove them, the surgeon feeds a gauze swab into the anus
and removes it slowly. A hemorrhoid will adhere to the gauze,
allowing its exposure (B). The outer layers of skin and tissue are
removed (C), and then the hemorrhoid itself (D). The tissues and
skin are then repaired (E).
• Lippincott content review for NCLEX-RN
Book page: 507
• Mini Encyclopedia of Nursing (Page: 252)
• Professional guide of disease (Page: 290)
• www.pubmedcentral.nih/gov/pagerender
My group
• Siti fatimah • Thilagavathy
• Nurakma • Shamini Devi
• Noor Azizah • Nathiaya
• Norfarhanimsuhaida • Latha
• Nur Nadia Tasha • Mohd Fauzi
• Nur Farihah • Zuraini