Dilated blood vessels beneath the lining of the skin in the anal canal. These may be internal or external depending on their position in relation to the anal sphincter. It may be caused by:
- Chronic constipation
- Pregnancy
- Obesity
- Prolonged sitting or standing
- Wearing constricting clothing
- Disease conditions like liver cirrhosis and RSCHF.
Assessment Findings
- Constipation may be induced by the patient voluntarily or involuntarily in an attempt to prevent pain or bleeding associated with defecation.
- Anal pain and itchiness and rectal (often bright red; hematochezia) bleeding
- Pain is often more severe in external hemorrhoids. Internal hemorrhoids may prolapse, but are often painless.
- Mucous anal secretions
- Feelings of incomplete evacuation of the anus
Nursing Interventions
- Diet: high fiber, liberal fluids
- Bulk-Forming Laxatives
- Hot Sitz Bath, Warm Compress, Witch Hazel Cream (all used to reduce hemorrhoid size)
- Nupercaine, a local anesthetic.
Pre-operative Care
- Implement a low-residue diet and stool softeners to reduce stool bulk.
Post-operative Care
- Promotion of comfort: analgesics, side-lying or prone positioning, hot sitz bath 12 to 24 hours post-op for healing and comfort.
- Promotion of elimination: stool softeners, analgesics are given before initial defecation post-op; encourage the patient to defecate as soon as the urge is felt. Provide enemas as prescribed using a small-bore rectal tube.
Patient Education
- Clean the rectal area thoroughly after each defecation.
- Use a sitz bath at home, especially after defecation.
- Avoid constipation via a high-fiber diet, high fluid intake, regular exercise, regular scheduling, and using stool softeners until healing is complete.
- Notify the physician if the patient observes rectal bleeding, suppurative (pus-containing) drainage, continued pain, and continued constipation.
Surgical Management
- Hemorrhoidectomy
- Sclerotherapy: closing off veins via a minimally invasive injection of 5% phenol in oil.
- Cryosurgery: cooled gas is used to freeze external hemorrhoids.
- Rubber Band Ligation: a rubber band is wrapped around internal hemorrhoids.