Management of Haemorrhoids by Prof Ganiyu Rahman
- 1. Haemorrhoids: Choice of treatment Prof Ganiyu Rahman Department of Surgery School of Medical Sciences University of Cape Coast
- 2. Introduction What is haemorrhoid? • Dilated or enlarged veins in the lower portion of the rectum or anus
- 3. Anal canal
- 5. 3 Loops of external sphincter Subcutaneous (C), superficial (B), deep (A)
- 8. Upper anal canal • Endodermal origin –MM is columnar • Nerve supply Autonomic – insensitive • Venous drainage- superior rectal, tributary of inf. mesenteric
- 9. Predisposing factors • Heredity • Age • Sex • Pregnancy • Puerperal state • Temperament
- 10. Precipitating factors • Constipation • Diarrhoea • Cathartic abuse • Enemata • Infection • Atony • Anal spasm or atony of anal sphincter • Obesity, • Raised intra-abdominal pressure • Sitting or standing for a long time
- 11. Symptoms • Rectal Bleeding • Bright red blood in stool • Pain during bowel movements • Anal Itching • Rectal Prolapse • Thrombus
- 13. Signs and Tests • Rectal Examination – Visual – Digital • Tests – Stool Guaiac (FOBT) – Sigmoidoscopy – Proctoscopy
- 14. Complications • Anaemia • Congestion and Thrombosis • Ulceration • Ascending infection, Pyelophebitis • Pyogenic liver abscess
- 16. Rectal prolapse
- 17. Differential diagnosis • Rectal prolapse • Anal fissure/ Sentinel pile • Peri-anal inflammatory foci • Peri-anal haematoma • Rectal/ Colonic cancer • Chondylomata
- 18. Treatment Non-surgical • Mild cases are controlled by: –Preventing constipation –Drinking Fluids –High-fiber diet –Use of Fiber supplements –Stool softeners
- 19. Cont. • Apply and OTC cream or suppository containing hydrocortisone • Keep anal area clean • Soak in a warm bath • Apply ice packs or compresses x 10min
- 20. Cont. • If prolapses, gently push back into anal canal • Use a sitz bath with warm water • Use moist towelettes or wet toilet paper instead of dry toilet paper.
- 21. Surgical Treatments – Injection sclerotherapy – Rubber band ligation – Infrared coagulation – Cryosurgery – Haemmorhoidal artery ligation – Surgery
- 22. Recommendation • Defined history and Examination (DRE!!) • Endoscopy (at least SpLenic Flexure) • Dietary modification • Office procedures (I II III) • Treatment of Acute phase • Choice of surgical procedure
- 23. Evaluation Defined history and Examination • Extent, severity • Duration of symptoms – Bleeding, prolapse, itching, pain etc • Bowel habit • Family history of intestinal disease
- 24. Colonoscopy Complete endoscopy in selected patients • Based on history exam, proctoscopy/ sigmoidoscopy • Colonoscopy • Flexible sigmoidoscopy+ Barium enema
- 25. Dietary modification • Fluid and fibre as 1st line of non-operative management
- 26. Office procedures (I II III) • Goals of office procedure – Reduce vascularity – Reduce redundant tissue – Minimize prolapse • Banding (most effective) • Sclerotherapy • Infrared coagulation • Haemmorhoidal Artery Ligation ( HAL )
- 27. Treatment of Acute phase Thrombosed haemorrhoid surgery within 72 hrs • Rapid symptom resolution • Low incidence of recurrence • Longer remission interval
- 28. Choice of surgical procedure Indications: • Refractory to office procedure • Unable to tolerate office procedure • Large external haemorrhoids • Combined internal & external haemorrhoids (grades III, IV)
- 29. Surgical haemorrhoidectomy • Surgical Excision • Haemorrhoidopexy
- 30. Complications of Surgery • Pain • Urinary retention • Haemorrhage (reactionary, secondary) • Infection • Stenosis • Incontinence • Skin tag
- 31. Prevention • Eat high fiber diet • Drink Plenty of Liquids • Fiber Supplements • Exercise • Avoid long periods of standing or sitting • Don't Strain • Go as soon as you feel the urge
- 32. Thanks
- 33. • Specialist ultrasonic device for hemorrhoid surgery. • Surgery is recommended if the patient has not benefited from the