(GP)

Overview

• Vascular-rich connective tissue cushions (lumps) within the anal canal that may abnormally enlarge or protrude
• Age → 45-65 yrs old
• Aetiology → excessive straining due to either chronic constipation or diarrhoea, increase in intra-abdominal pressure (pregnancy or ascites), presence of space-occupying lesions within the pelvis
• Classified Grades I-IV (For Internal Haemorrhoids)
• Also classified into Internal & External
  • External ⇒ originate below dentate line, prone to thrombosis, may be painful
  • Internal ⇒ originate above dentate line, do not generally cause pain

Making Diagnosis

Clinical Features:

• Rectal Bleeding → usually bright bleeding (on tissue paper, painless)
• Perianal Pain/Discomfort → may be associated with feeling of incomplete evacuation
• Anal Pruritus → itchy bum
• Tender Palpable Perianal Lesion
• Anal Mass
• Abscence of ALARM symptoms

Thrombosed Haemorrhoids → significant pain and tender lump. Purplish, oedematous, tender subcutaneous perianal mass.