البواسير

Definition

Haemorrhoids are enlarged normal vascular cushions in the anal canal.

Types

• Internal: above the dentate line, usually painless, bleed
• External: below the line, may thrombose with severe pain

Risk factors

Constipation and straining, prolonged toilet sitting, pregnancy and low fibre.

Symptoms

• Bright red blood on stool or tissue
• Itching and discomfort
• Prolapse that reduces or not
• Severe pain with thrombosis

Diagnosis

External and digital examination and proctoscopy; colorectal cancer is excluded in older adults or with altered habit or anaemia.

Treatment

• Fibre, adequate water and no straining
• Sitz baths and short-term topical creams
• Rubber band ligation or sclerotherapy for internal haemorrhoids
• Surgical haemorrhoidectomy for advanced disease

Post-operative care

Analgesia before defecation, softeners, sitz baths, and watching for bleeding and urinary retention.

Exam point

Rectal bleeding in someone over 50 is not attributed to haemorrhoids before cancer is excluded.