Haemorrhoids (Hemorrhoids) - Overview (pathophysiology, investigations and treatment)

Summary

This video provides an informative overview of hemorrhoids, explaining the anatomy, causes, symptoms, and treatment options. Hemorrhoids are enlarged veins within the anal canal that can cause discomfort. The script compares internal and external hemorrhoids, describing the pain, risk factors, and stages of internal hemorrhoids. Treatment varies depending on severity, with options like high-fiber diets, steroid creams, and surgical procedures for advanced stages. Emphasis is placed on the importance of understanding hemorrhoid anatomy, such as the significance of the pectinate line, and the differences in pain perception based on location within the anal canal.

Takeaways

• 😀 Hemorrhoids are normal anatomical structures in the anal canal, consisting of rectal veins that can enlarge and cause discomfort.
• 😀 The pectinate (dentate) line divides the anal canal into endodermal (above) and ectodermal (below) regions, influencing pain localization.
• 😀 Pain above the pectinate line is diffuse, while pain below the line is localized and often intense due to skin sensitivity.
• 😀 Internal hemorrhoids are located above the pectinate line, and external hemorrhoids are found below it, affecting the anal skin area.
• 😀 External hemorrhoids are extremely painful, especially when thrombosis occurs, and can cause severe perianal pain and swelling.
• 😀 Internal hemorrhoids are generally painless, but they can cause a sensation of fullness, discomfort, or mucus discharge.
• 😀 Risk factors for hemorrhoids include increased intra-abdominal pressure from constipation, pregnancy, obesity, heavy lifting, and portal hypertension.
• 😀 The examination for hemorrhoids includes a left lateral position with knees up to expose the anal area, with a proctoscope or anoscope used for internal hemorrhoids.
• 😀 Internal hemorrhoids are staged from 1 to 4, with treatment varying based on the severity of the condition.
• 😀 Treatment for hemorrhoids includes dietary changes (high-fiber diet), topical creams, sitz baths, and for severe cases, procedures like rubber band ligation or hemorrhoidectomy.

Q & A

What are hemorrhoids and where are they located?

Hemorrhoids are normal anatomical structures made up of veins within the anal canal. They are part of the hemorrhoidal plexus and can become enlarged, causing symptoms when they protrude outside the anal canal.

What is the significance of the pectinate (dentate) line in relation to hemorrhoids?

The pectinate line separates the anal canal into areas with different embryological origins. Anything above the pectinate line is derived from the endoderm, leading to less localized pain, while below the line is ectoderm, which is sensitive and leads to localized pain, especially when affected by hemorrhoids.

What are the different types of hemorrhoids?

There are two main types of hemorrhoids: internal and external. Internal hemorrhoids are located above the pectinate line and are often painless but can cause discomfort, while external hemorrhoids are below the pectinate line and can cause sharp, localized pain, particularly during defecation.

What are the key symptoms of internal hemorrhoids?

Internal hemorrhoids can cause symptoms like a feeling of rectal fullness, discomfort, and mucus discharge. They are usually painless but may cause problems when they become prolapsed.

What are the main symptoms of external hemorrhoids?

External hemorrhoids cause intense localized pain, especially during defecation. A perianal mass may be felt, and if thrombosis occurs, the pain becomes more severe.

What risk factors contribute to the development of hemorrhoids?

Risk factors for hemorrhoids include increased intra-abdominal pressure, which can be caused by severe constipation, pregnancy, obesity, portal hypertension, and heavy lifting.

How should a patient be positioned during a hemorrhoid examination?

The patient should be positioned in a left lateral position with their knees up to their chest to expose the anal area, making it easier to detect external hemorrhoids. Internal hemorrhoids may require a proctoscope or anoscope for examination.

What is the staging system for internal hemorrhoids, and what does each stage indicate?

Internal hemorrhoids are staged from 1 to 4. Stage 1 involves slight enlargement, Stage 2 sees the hemorrhoid protrude past the pectinate line but reduces spontaneously, Stage 3 involves hemorrhoids that require manual reduction, and Stage 4 is when the hemorrhoids permanently protrude.

What are some common treatment options for hemorrhoids?

Treatment for hemorrhoids varies by stage. For stages 1 and 2, options include a high-fiber diet, sits baths, and topical treatments like steroid creams and anesthetics. For stages 3 and 4, treatments include rubber band ligation, photocoagulation, and hemorrhoidectomy.

What happens when thrombosis occurs in external hemorrhoids?

When thrombosis occurs in external hemorrhoids, the pain becomes significantly more intense. However, these hemorrhoids usually resolve within two weeks and may leave behind skin tags after healing.