Degree
Description
I
Hemorrhoids prolapse beyond the dentate line on straining
II
Hemorrhoids prolapse through the anus on straining but reduce spontaneously
III
Hemorrhoids prolapse through the anus; require manual reduction
IV
Prolapsed hemorrhoids cannot be manually reduced
If untreated, prolapsed hemorrhoids may end up with ulceration and necrosis.
Presentations and treatment.
Thrombosed external hemorrhoids
Cause unknown
Usually preceded by abrupt onset of anal mass and pain within 48 h
Pain diminishes after the fourth day and if left alone dissolves spontaneously in a few weeks.
Treatment:
Pain relief
Excision under local or general anesthesia
Quicker recovery than with medical treatment
Prevention of recurrent thrombosis
Prevention of residual skin tags
23.5 Strangulated Hemorrhoids
Usually arise from prolapsed grade 3 or 4 hemorrhoids that cannot be reduced due to excessive swelling
Edema may progress to ulceration or necrosis if not treated with urgent three quadrant hemorrhoidectomy.
Stapled hemorrhoidopexy without decompressing the edematous tissue is associated with more immediate pain (vs conventional hemorrhoidectomy technique in the immediate postoperative period) but subsides within 6 weeks.
23.6 Hemorrhoids in Pregnancy
Thrombosed or strangulated hemorrhoids due to hormonal changes and the pressure of the fetus on pelvic veins can cause a serious problem in pregnant and postpartum women.
Mild laxatives are helpful in the last 3 months of pregnancy.
Traumatic deliveries, such as perineal tear and heavy babies, are associated with thrombosed external hemorrhoids.
Requires hemorrhoidectomy under local anesthesia, ideally in the immediate postpartum period.
23.7 Hemorrhoids and Portal Hypertension
Quite common (almost 60 %).
Often associated with large esophageal varices but bleed less.
Bleeding from anorectal varices can be controlled with absorbable running sutures.
Bleeding hemorrhoids in patients with portal hypertension must be distinguished from anorectal varices, true consequence of portal hypertension.
23.8 Hemorrhoids in Inflammatory Bowel Disease
The treatment of hemorrhoids is accepted as safe in patients with ulcerative colitis, whereas is relatively contraindicated in patients with Crohn’s disease.Related posts:
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