Acute Proctology

Degree

Description

Hemorrhoids prolapse beyond the dentate line on straining

Hemorrhoids prolapse through the anus on straining but reduce spontaneously

III

Hemorrhoids prolapse through the anus; require manual reduction

Prolapsed hemorrhoids cannot be manually reduced

If untreated, prolapsed hemorrhoids may end up with ulceration and necrosis.

Presentations and treatment.

23.5 Strangulated Hemorrhoids

Usually arise from prolapsed grade 3 or 4 hemorrhoids that cannot be reduced due to excessive swelling
- Edema may progress to ulceration or necrosis if not treated with urgent three quadrant hemorrhoidectomy.
- Stapled hemorrhoidopexy without decompressing the edematous tissue is associated with more immediate pain (vs conventional hemorrhoidectomy technique in the immediate postoperative period) but subsides within 6 weeks.

Thrombosed or strangulated hemorrhoids due to hormonal changes and the pressure of the fetus on pelvic veins can cause a serious problem in pregnant and postpartum women.
Mild laxatives are helpful in the last 3 months of pregnancy.
Traumatic deliveries, such as perineal tear and heavy babies, are associated with thrombosed external hemorrhoids.
Requires hemorrhoidectomy under local anesthesia, ideally in the immediate postpartum period.

Quite common (almost 60 %).
Often associated with large esophageal varices but bleed less.
Bleeding from anorectal varices can be controlled with absorbable running sutures.
Bleeding hemorrhoids in patients with portal hypertension must be distinguished from anorectal varices, true consequence of portal hypertension.