HEMORRHOID

Definition
• Hemorrhoid comes from the Greek word that
means blood flow (haem = blood, rhoos = flow).
• Hemorrhoid is dilation of the veins the
hemorrhoidal plexus with submucosal tissues
consist of venules, arterioles, and fine muscle fibers
(Treitz muscle) located in the anal canal
Classification
• External hemorrhoids (outside or below the
dentate line)
• Internal hemorrhoids (inside / above the dentate
line). Internal hemorrhoids can be grouped in 4
degrees:
Epidemiology
• The incidence of hemorrhoidal cases is estimated
to be 4.4% of the world's population.
• The incidence of men = women, especially at the
age of 45-65 years.
• More common in white people than black people
Etiology
• Due to the portal circulation dam as a result of organic
abnormality
a.Hepar on hepatic cirrhosis
fibrosis of the tissue will increase venous flow resistance
to the hepar - hypertension portal, it will form collateral
into the esophagus and hemoroidal plexus.
b. Portal vein dam thrombosis.
c. Intra abdominal tumors, especially pelvic areas that
suppress the veins so that the flow is disrupted, eg
ovarian tumors, rectal tumors, etc.
• Idiopathic
Risk factor
• Anatomic – Vein on anorectal area have no valve and
the hemoroidal plexus receives less support from the
surrounding muscles and fascia.
• Age - In old age there is degeneration of all body
tissues, also sphincter muscles become thin and atonic.
• Heredity - The walls of blood vessels are weak and thin
• Work - People who have to stand, sit for long time, or
have to lift heavy items have predisposes to
hemorrhoids.
• Mechanical - prostate hypertrophy, pelvic tumor,
chronic constipation and frequent strains during
defective times, chronic diarrhea or acute excessive
diarrhea.
Patogenesis
• The cause is unknown, but may be due to the high
venous pressure, which arises during excessive
straining effort, which causes distension and stasis
within the veins. Patients pay attention to acute
swelling at the edge of the anus that can be very
painful. Pain may persist for several days and then
gradually subside spontaneously, but edema may be
continuous for 3 to 4 weeks. Sometimes the clot looks
through the skin underneath and protrudes.
• Acute thrombosis of the internal hemorrhoidal plexus is
an unpleasant condition. Patients experience severe
sudden anus pain, followed by protrusion of the
thrombotic area. Pain can be very severe and can last
for 1 week. Gradually the edema subsides and the
thrombus is absorbed
Principles of diagnosis (Clinical Manifestations
and Supporting examination
Clinical Manifestations
Internal hemorrhoids : External hemorrhoids :

- Bleeding from the anus • Bump or skin tag

- Hot around the anus
- Pain • pain
- Protrusion in the anus
- There is a mucus or a
liquid
- Itchy
Supporting examination
• Anoscopy
• To see internal hemorrhoids
that do not stand out. Anoscop
is inputted and rotated to
assess all four quadrants. In
the internal hemorrhoids will
be seen protrusion of the
vascular structure into the
lumen and protrusion will be
more visible when the patient
is straining.
Supporting examination
• Proctoscopy
• Indicated if rectal prolapse is suspected
Management before referring
Non Pharmacology
• Improved lifestyle,
• Improved diet and drinking,
• Fix the defective way: Bowel management program
(BMP)
Pharmacology
• 1. Drugs to repair defecation: There are two drugs
included in BMP that is fiber supplement (fiber
supplement) and (stool softener)
• 2. Symptomatic drugs
• 3. Drug bleeding cure: diosmin mixture (90%) and
hesperidine (10%) in micronized form
Complications and Prognosis
Complications of this disease :
- Great bleeding
- Abscess
- Fistulas and inkarserata
Prognosis :
• With appropriate therapy, all symptomatic
hemorrhoids become asymptomatic.
• Haemorrhoidectomy generally gives good results,
although recurrence may occur
• Deaths from hemorrhoid bleeding are very rare