Patients frequently complain of bleeding with or without the defecation, a swelling, mild discomfort or irritation. Other symptoms may include soilage or the mucous discharge, pruritis, difficulties with the hygiene, and a sense of incomplete evacuation. Internal hemorrhoids are otherwise painless unless they are mainly thrombosed, prolapsed with edema, or strangulated. External hemorrhoids result in pain when the thrombosis occurs and bleeding if ulceration occurs from pressure necrosis. Skin tags may form from the prior acutely edematous or the thrombosed external haemorrhoids (Johanson et al., 1990

1. Relation between Haemorrhoids
and Constipation
DR.SREEREMYA
FACULTY OF BIOLOGY

2. • INTRODUCTION
• Patients frequently complain of bleeding with or without
the defecation, a swelling, mild discomfort or irritation.
Other symptoms may include soilage or the mucous
discharge, pruritis, difficulties with the hygiene, and a sense
of incomplete evacuation. Internal hemorrhoids are
otherwise painless unless they are mainly thrombosed,
prolapsed with edema, or strangulated. External
hemorrhoids result in pain when the thrombosis occurs and
bleeding if ulceration occurs from pressure necrosis. Skin
tags may form from the prior acutely edematous or the
thrombosed external haemorrhoids (Johanson et al., 1990).

3. • Hemorrhoid bleeding is common, but it is uncommon for
the patients to present with anemia. Pruritis and “burning”
can result from the discharges or difficulty with hygiene. It
may also result from a chronic wound such as the fissure or
fistula, condyloma, rectal prolapse, or prolapsing
hemorrhoids. A mass may be rakished to an abscess, skin
tags, neoplasia, or the thrombosed or prolapsed
haemorrhoid (Burkitt et al., 1975a).
• Due to the wide array of the pathology, a thorough
examination is required and can generally be accomplished
in the office with the patient in the knee–chest, prone–
jackknife, or left lateral position. Inspection of the anus and
the perianal region will exclude a thrombosed or prolapsing
hemorrhoid.

4. • Skin tags may be the clue to prior hemorrhoid disease, but may also represent
fissure disease particularly if located in the anterior or the posterior location.
Perianal sepsis from an abscess or the fistula disease should be excluded. A digital
exam may identify a distal rectal mass, an intersphincteric abscess or internal
hemorrhoids. An anoscopy should be performed to identify the internal
hemorrhoids or fissures. A rigid or flexible sigmoidoscopy may rule out the
presence of the rectosigmoid neoplasia, proctitis, or IBD (Burkitt et al., 1975b).
• It is also important to evaluate and assess sphincter integrity particularly in those
who report incontinence as the potential for the altered function exists with any
anorectal surgery. Appropriate clearance of the colon for neoplasia should also be
performed when needed.
• TREATMENT
• Treatment is often divided between the non-operative management, office
procedures, and the surgical management utilizing a specific operating room
(Burkitt et al., 1972). The least-invasive approach should be typically considered
given the physiologic importance of the hemorrhoid cushions and the bio potential
self-limiting nature of many hemorrhoid symptoms. The decision on how to treat it
depends on many factors including the degree of symptoms, the age, and other
medical conditions.

5. • Non operative Management
• All patients should benefits from minimizing straining and avoiding constipation.
Bulking of the stool facilitates this and can be accomplished by aggrandizing
dietary fiber and fluid intake. Stool softeners may also be availed. Sitz baths are
warm soaks that provide relief by reducing swelling and the sphincter spasm.
Topical agents utilizing astringents, analgesics, and steroids help garner relief in an
acute setting, but there is no evidence showing their benefit for prevention or the
long-term treatment of hemorrhoid disease (Talley et al., 2009).
• ACUTE THOMBOSIS OF HEMORRHOIDS
• Pain is the prime complaint with acutely thrombosed hemorrhoids and is most
often external in nature. A painful swelling suddenly and, mainly appears and on
examination a bluish-colored lump is noted (Johanson et al, 1994). Patients mainly
report straining, lifting, or prolonged sitting prior to the thrombosis, but many
recall no antecedent events. Treatment is mainly aimed at controlling the pain, but
because the pain is due to edema and pressure, topical agents tend not to be
helpful. The pain and also edema have been shown to peak at 48 hours and
subside after 4 day.

6. • CONNECTION OF HAEMORRHOID AND CONSTIPATION
• Prolonged sitting or straining, often allied with constipation or
diarrhea, may lead to hemorrhoids. Don't delay the bowel
movements during hemorrhoid flare-ups. Go when you need to go,
because putting off bowel movements can also worsen
constipation, which then aggravate the haemorrhoids (Delco et
al.,1998).Also, elevating the feet a bit with a step stool as you sit on
the toilet changes the position of the rectum in a way that could
mainly allow for easier passage of stools.
• Off-the-shelf hemorrhoid remedies
• Many over-the-counter products are available for aid with
hemorrhoids, such as witch hazel infused pads and also soothing
creams. Also, ask your doctor about prescription preparations,
which comprises stronger anti-inflammatory drugs and numbing
medications (Loder et al., 1994).

7. • Journal of Nursing Practice, Management and
Education, Relation between Haemorrhoids
and Constipation, Dr.S.Sreeremya ,2020.Vol
2(1):1-8.