Hemorrhoids are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. This nursing diagnosis focuses on identifying symptoms, managing pain, preventing complications, and promoting healing through proper care and interventions.
Causes (Related to)
Hemorrhoids can develop due to various factors that increase pressure in the lower rectum:
- Chronic constipation or diarrhea
- Prolonged sitting or standing
- Pregnancy and childbirth
- Straining during bowel movements
- Obesity
- Heavy lifting
- Medical conditions such as:
- Portal hypertension
- Chronic liver disease
- Inflammatory bowel disease
- Lifestyle factors including:
- Low-fiber diet
- Sedentary lifestyle
- Poor toileting habits
- Dehydration
Signs and Symptoms (As evidenced by)
Hemorrhoids present with distinct signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Rectal pain or discomfort
- Itching around the anal area
- Burning sensation during bowel movements
- The feeling of fullness in the rectum
- Pain while sitting
- Anxiety about bowel movements
- Embarrassment about condition
Objective: (Nurse assesses)
- Visible external hemorrhoids
- Bright red blood on toilet paper
- Anal swelling
- Protruding tissue from the anus
- Skin irritation around the anus
- Signs of anemia (in severe cases)
- Changes in bowel habits
Expected Outcomes
The following outcomes indicate successful management of hemorrhoids:
- The patient will report decreased pain and discomfort
- The patient will demonstrate proper hygiene techniques
- The patient will maintain regular bowel movements
- The patient will avoid complications
- The patient will show improved comfort during daily activities
- The patient will demonstrate an understanding of preventive measures
- The patient will maintain adequate hydration and fiber intake
Nursing Assessment
Evaluate Pain and Discomfort
- Assess pain levels using a standardized scale
- Document characteristics of pain
- Note aggravating and relieving factors
- Monitor impact on daily activities
- Assess psychological impact
Assess Bowel Function
- Monitor bowel movement frequency
- Evaluate stool consistency
- Document bleeding episodes
- Assess dietary habits
- Note fluid intake
Inspect Affected Area
- Examine external hemorrhoids
- Note the size and appearance
- Check for complications
- Assess skin integrity
- Document any discharge
Review Risk Factors
- Evaluate lifestyle factors
- Assess occupation-related risks
- Review medical history
- Check medication use
- Document pregnancy status
Monitor Complications
- Check for excessive bleeding
- Assess for thrombosis
- Monitor for infection
- Evaluate for anemia
- Watch for strangulation
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to inflammation and pressure from hemorrhoids as evidenced by patient reports of pain during bowel movements and sitting.
Related Factors:
- Tissue inflammation
- Increased venous pressure
- Anal fissures
- Thrombosed hemorrhoids
Nursing Interventions and Rationales:
- Assess pain characteristics and intensity
Rationale: Establishes baseline and guides pain management - Apply cold/warm compresses as appropriate
Rationale: Reduces inflammation and provides comfort - Administer prescribed medications
Rationale: Controls pain and reduces inflammation - Teach proper positioning techniques
Rationale: Minimizes pressure on the affected area
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate comfort during daily activities
- The patient will use pain management strategies effectively
Nursing Care Plan 2: Impaired Skin Integrity
Nursing Diagnosis Statement:
Impaired Skin Integrity related to irritation and inflammation as evidenced by perianal tissue damage and discomfort.
Related Factors:
- Mechanical factors
- Chemical irritants
- Moisture
- Frequent cleaning
Nursing Interventions and Rationales:
- Perform gentle perineal care
Rationale: Prevents further tissue damage - Teach proper cleaning techniques
Rationale: Promotes healing and prevents infection - Monitor skin condition
Rationale: Identifies complications early
Desired Outcomes:
- The patient will demonstrate improved skin integrity
- The patient will maintain proper hygiene
- The patient will show no signs of infection
Nursing Care Plan 3: Constipation
Nursing Diagnosis Statement:
Constipation related to dietary habits and fear of pain as evidenced by infrequent, hard stools and straining during defecation.
Related Factors:
- Inadequate fiber intake
- Insufficient fluid intake
- Fear of pain
- Medications
Nursing Interventions and Rationales:
- Establish a regular toileting schedule
Rationale: Promotes normal bowel habits - Encourage increased fiber intake
Rationale: Softens stool and promotes regular bowel movements - Monitor fluid intake
Rationale: Prevents constipation
Desired Outcomes:
- The patient will maintain regular bowel movements
- The patient will demonstrate improved dietary habits
- The patient will report decreased straining
Nursing Care Plan 4: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about hemorrhoid management as evidenced by improper self-care techniques.
Related Factors:
- Limited exposure to information
- Misunderstanding of condition
- Cultural beliefs
- Language barriers
Nursing Interventions and Rationales:
- Provide education about hemorrhoid care
Rationale: Improves self-management skills - Demonstrate proper hygiene techniques
Rationale: Ensures correct care procedures - Review lifestyle modifications
Rationale: Prevents recurrence
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper self-care
- The patient will identify preventive measures
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic condition and lifestyle changes as evidenced by expressed concerns and hesitation about activities.
Related Factors:
- Chronic discomfort
- Social embarrassment
- Fear of complications
- Impact on daily activities
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and builds confidence - Teach coping strategies
Rationale: Helps manage stress and anxiety - Address concerns and questions
Rationale: Alleviates fears and misconceptions
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will use effective coping strategies
- The patient will maintain normal activities
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31):9245-52. doi: 10.3748/wjg.v21.i31.9245. PMID: 26309351; PMCID: PMC4541377.
- Rørvik, H. D., Davidsen, M., Gierløff, M. C., Brandstrup, B., & Olaison, G. (2023). Quality of life in patients with hemorrhoidal disease. Surgery Open Science, 12, 22-28. https://doi.org/10.1016/j.sopen.2023.02.004
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg. 2016 Mar;29(1):22-9. doi: 10.1055/s-0035-1568144. PMID: 26929748; PMCID: PMC4755769.
