Haemorrhoids

First degree haemorroid bulge into lumen of anal canal resulting in painless bleeding at end of daefecation. Second degree has pruritus ani and reduce spontaneously. Third degree has mucous discharge with sense of incomplete evacuation and reduced manually. Fourth degree is permanently prolapsed and irreducible.

Haemorroids can become thrombosed causing acute pain, tender, bluish lump at distal anus with ulceration and bleeding. The end result is skin tags. Differential diagnosis includes anal fissure, perianal abscess, proctitis, Inflammatory bowel disease (IBD), Colorectal cancer and anal Polyps. Relevant investigations include anoscopy, sigmoioscopy and colonoscopy.

Medical management includes avoidance of constipation and hard stools, minimize straining the stool, dietary and lifestyle modifications, fluid and fiber in diet. Supplemental fibre agents add moisture to stool. Sitz bath (warm 40 C – degree symbol) with soaking time limited to 15 minutes, ice packs and drugs like daflon (Flavonoids) gives acute symptoms relief by decreasing capillary permeability and increasing lymphatic transport.

First degree haemorrhoids can be treated with rubber band ligation as an office procedure. Surgical modalities include open haemorroidectomy, sclerotherapy, harmonic ultrasonic scalpel hemorrhoidectomy, stapled haemorrhoidopexy and Laser Haemorrhoidopexy. Thrombosed external haemorrhoids presents itself as painful perianal mass that peaks in 48 hours and subsides after 3 days. Treatment is pain relief. Severe pain might require excision of thrombus under anaesthesia.