Hemorrhoids & Anal Fissures :

 Hemorrhoids & Anal Fissures:

Introduction :

Hemorrhoids and anal fissures are two of the most common anorectal conditions affecting millions of people worldwide. Both cause pain, bleeding, and discomfort during bowel movements, often leading to significant distress. Although they share some similarities, their causes, presentations, and management differ. Nurses play a vital role in assessment, patient education, symptom management, and prevention of complications.

  HEMORRHOIDS :

What Are Hemorrhoids?

Hemorrhoids are swollen or inflamed veins in the lower rectum or anus. They may be internal (inside the rectum) or external (under the skin around the anus). Increased pressure in the anal canal leads to engorgement of venous cushions.

Causes / Risk Factors of  Hemorrhoids :

• Chronic constipation

• Prolonged straining during defecation

• Pregnancy

• Obesity

• Low-fiber diet

• Prolonged sitting

• Anal intercourse

• Aging (weakening connective tissues)

Types of Hemorrhoids

1. Internal Hemorrhoids

• Located inside the rectum

• Usually painless but may bleed

• Can prolapse

2. External Hemorrhoids

• Under the perianal skin

• Painful if thrombosed

• Can cause swelling, itching

Clinical Manifestations of  Hemorrhoids :

• Bright red rectal bleeding

• Perianal pain (usually external)

• Anal itching or irritation

• Swelling/lumps near anus

• Mucus discharge

• Painful defecation

Diagnosis of  Hemorrhoids :

• Physical examination

• Digital rectal exam

• Sigmoidoscopy (if bleeding needs further evaluation)

Medical Management of  Hemorrhoids :

Conservative Treatment

• High-fiber diet

• Adequate fluids

• Sitz baths

• Topical anesthetics and hydrocortisone

• Stool softeners

• Avoid straining

Procedural Interventions

• Rubber band ligation

• Sclerotherapy

• Infrared coagulation

Surgical Management

• Hemorrhoidectomy (for severe or recurrent cases)

ANAL FISSURES

What is an Anal Fissure?

An anal fissure is a tear in the lining of the anal canal, usually caused by trauma during bowel movement. It can be acute or chronic.

Causes / Risk Factors of Anal Fissure :

• Passing hard stools

• Chronic constipation or diarrhea

• Prolonged straining

• Anal trauma

• Inflammatory conditions (Crohn’s disease)

Clinical Manifestations of Anal Fissure :

• Sharp, severe pain during and after defecation

• Bright red blood on toilet tissue

• Visible crack near anus

• Fear of defecation due to pain

• Spasms of internal anal sphincter

Diagnosis of Anal Fissure :

• Visual examination of anus

• Digital rectal exam (often avoided due to pain)

Medical Management of Anal Fissure :

Conservative Treatment

• Stool softeners

• High-fiber diet

• Sitz baths

• Increased water intake

Medications

• Topical nitroglycerin

• Calcium channel blockers (diltiazem ointment)

• Lidocaine ointments

• Botulinum toxin injections

Surgical Treatment

• Lateral internal sphincterotomy for chronic fissures

Combined Nursing Care Plan (NCP) for Hemorrhoids & Anal Fissures

Nursing Diagnosis	Assessment Findings	Goals / Expected Outcomes	Nursing Interventions	Rationale	Evaluation
1. Acute Pain related to anal tissue irritation, inflammation, and tearing	• Pain during and after defecation • Burning, itching sensation • Guarding behavior • Facial grimacing • Patient reports pain score 6–10/10	• Pain reduces to ≤ 3/10 within 48–72 hrs • Patient demonstrates comfortable defecation • Improved mobility & comfort	• Assess pain characteristics regularly • Provide warm sitz baths 2–3 times/day • Administer prescribed analgesics, topical anesthetics • Encourage increased fiber & fluids • Teach stool softeners use • Avoid prolonged sitting on toilet	• Warm sitz baths reduce spasm and improve circulation • Analgesics relieve pain, facilitating mobility • Fiber softens stool, reducing strain & pain • Proper habits reduce irritation	• Patient reports decreased pain • Able to perform bowel movements without significant discomfort
2. Constipation related to painful bowel movement and reduced fluid/fiber intake	• Hard, dry stools • Straining during defecation • Infrequent bowel movements	• Soft stools passed without straining • Regular bowel habits established	• Monitor bowel pattern • Increase fluid intake 2–3 L/day (if not contraindicated) • Encourage high-fiber diet (fruits, vegetables, bran) • Administer stool softeners/laxatives as ordered • Promote physical activity	• Aids bowel motility • Prevents straining which worsens hemorrhoids/fissures • Reduces recurrence	• Patient reports normal, soft stools • No straining during bowel movements
3. Impaired Skin/Tissue Integrity related to inflammation and fissure formation	• Visible fissures or prolapsed hemorrhoids • Local redness, swelling • Bleeding	• Promote healing of hemorrhoidal tissues & fissures • Reduce bleeding and irritation	• Inspect anal area daily for changes • Apply prescribed ointments (hydrocortisone, nitroglycerin, nifedipine, lidocaine) • Maintain perianal hygiene • Use moist wipes instead of dry toilet paper	• Ointments reduce inflammation, relax sphincter & promote healing • Hygiene prevents infection & friction damage	• Reduced redness, swelling • Fissures healing • Decreased bleeding
4. Risk for Infection related to open fissures and bleeding hemorrhoids	• Open wound present in anal area • Mild bleeding • Pain during defecation	• Prevent infection • Promote clean and dry perianal region	• Perform perianal cleansing after each bowel movement • Encourage sitz baths • Keep area dry • Teach proper wiping techniques (front-to-back, pat dry—not rub) • Monitor for fever, pus, increased pain	• Clean area reduces bacterial colonization • Early identification prevents complications	• No signs of infection • Wound healing progresses normally
5. Knowledge Deficit related to lifestyle factors and disease management	• Patient asks questions about diet, hygiene, treatment • Unaware of preventive strategies	• Patient verbalizes understanding of condition & prevention • Demonstrates correct practices	• Educate on fiber-rich diet & adequate hydration • Teach bowel habits (avoid straining, regular schedule) • Demonstrate sitz bath method • Explain importance of avoiding prolonged sitting • Provide instructions on medication use	• Knowledge enhances compliance and prevents recurrence	• Patient explains disease management strategies correctly • Adopts recommended habits