Haemorrhoids

• Enlarge vascular cushions in lower rectum and anal canal
• 3 o'clock, 7 o'clock and 11 o'clock positions

Symptoms

• Asymptomatic
• Rectal bleeding
• Prolapse
• Itching

• Only painful if thrombose
• Examine abdomen to exclude other lesions
• Rectal examination

Investigations

• Sigmoidoscopy
• Proctoscopy
• Barium enema if any doubt about source of bleeding

Treatment

• Sclerotherapy -
  • phenol in almond oil
  • suitable for 1st degree and small 2nd degree
• rubber band ligation
• cryosurgery
• photocoagulation
• haemorroidectomy
  • large 2nd degree and 3rd degree
  • Complications
    • acute retention of urine
    • haemorrhage
    • stricture, anal stenosis

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