Hemorrhoids, also known as piles, are swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. They can be internal (inside the rectum) or external (under the skin around the anus).
Causes
1. Increased pressure in the lower rectum due to:
👉Straining during bowel movements
👉Chronic constipation or diarrhea
👉Sitting for long periods, especially on the toilet
👉Obesity
👉Pregnancy (increased pelvic pressure)
👉Low-fiber diet
👉Heavy lifting
Symptoms
Internal
👉Painless bleeding during defecation
👉 Prolapsed hemorrhoid (may protrude)
External
👉Painful swelling
👉Itching or irritation
👉Bleeding
👉Hard lump near anus
Diagnosis
👉History and physical examination
👉Visual inspection of the anal region
👉Digital rectal examination (DRE)
👉Anoscopy or proctoscopy
👉Sigmoidoscopy or colonoscopy (to rule out other causes of rectal bleeding)
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Treatment
Conservative/Medical Management:
👉High-fiber diet (fruits, vegetables, whole grains)
👉Increased fluid intake
👉Stool softeners
👉Warm sitz baths
Topical treatments:
👉Lidocaine
👉Hydrocortisone creams
👉Oral pain relievers (acetaminophen, ibuprofen)
Minimally Invasive Procedures:
👉Rubber band ligation
👉Sclerotherapy (injection)
👉Infrared coagulation (laser)
Surgical Treatments:
👉Hemorrhoidectomy – surgical removal (for severe or prolapsed hemorrhoids)
👉Stapled hemorrhoidopexy – less painful, for internal hemorrhoids
Complications
👉Thrombosed hemorrhoid (blood clot)
👉Strangulated hemorrhoid (cut-off blood supply)
👉Anemia (due to chronic blood loss)
👉Infection or abscess
👉Recurrence
👉Fecal incontinence (rare)
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Prevention:
👉Eat high-fiber foods
👉Drink plenty of fluids
👉Exercise regularly
👉Avoid straining during bowel movements
👉Don’t delay going to the bathroom
👉Avoid prolonged sitting
👉Maintain healthy weight
Nursing Diagnosis
1. Acute pain related to inflamed or thrombosed hemorrhoids
2. Risk for constipation related to decreased mobility, poor diet
3. Impaired skin integrity related to hemorrhoid rupture or surgery
4. Anxiety related to fear of pain during defecation
5. Knowledge deficit regarding dietary management and prevention.
Nursing Considerations
👉Assess pain level and bowel habits
👉Encourage high-fiber, high-fluid diet
👉Educate patient on proper toilet habits (avoid straining)
👉Promote sitz baths to relieve discomfort
👉Monitor for signs of bleeding or infection
👉Provide perianal hygiene instructions
👉Administer medications as prescribed (topical or oral)
👉Encourage ambulation post-surgery to prevent complications
👉Provide emotional support and answer patient concerns
