HEMORRHOIDS

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Incidence & Epidemiology

Symptomatic hemorrhoids
Affects > 1 million individuals in Western
civilization per year

Prevalence
not selective for age or sex
less in underdeveloped countries
hemorrhoids

Permanently distended veins that protrude

into the anal canal (Saladins anatomy)

Most common cause of lower GI bleeding

(med. Secrets)

Blood on the toilet paper, on the surface of

the stool or dripping into the toilet (Bates)
The Staging and Treatment of
Hemorrhoids
Diagnosis of HD

physical examination

inspection of the perianal region for evidence

of thrombosis or excoriation is performed

followed digital examination

Treatment

elliptical excision
acutely thrombosed hemorrhoid can be excised
within the first 72 h

Additional therapy for bleeding hemorrhoids

banding
sclerotherapy
sutured hemorrhoidectomy
stapled hemorrhoidectomy
 Banding
bands are placed around the engorged tissue
aids in fixing the tissue proximally in the anal canal
patients may complain of a dull ache for 24 h
following band application

Sclerotherapy
12 mL of a sclerosant (sodium tetradechol sulfate)
is injected using a 25-gauge needle into the
submucosa of the hemorrhoidal complex
 sutured and stapled
hemorrhoidectomy

equally effective in the treatment of symptomatic 3rd

& 4th degree hemorrhoids

sutured hemorrhoidectomy
involves the removal of redundant tissue down to
the anal verge, unpleasant anal skin tags are
removed

stapled hemorrhoidectomy
less discomfort
this procedure does not remove anal skin tags
NOTE ! ! !

No procedures on hemorrhoids should

be done in patients who are
immunocompromised or who have active
proctitis
complications

Acute complications

pain
infection
recurrent bleeding
urinary retention
 Late complications
fecal incontinence
injury to the sphincter during the dissection

anal stenosis
overzealous excision, with loss of mucosal skin bridges
for reepithelialization

ectropion (prolapse of rectal mucosa from the anal canal)

Patients complain of a "wet" anus as a result of inability
to prevent soiling once the rectal mucosa is exposed
below the dentate line.