Hemorrhoids Nursing Care Plans Diagnosis and Interventions
Hemorrhoids NCLEX Review and Nursing Care Plans
Hemorrhoids, often known as piles, are inflamed veins in the anus and lower rectum that resemble varicose veins. Hemorrhoids can form inside the rectum, known as internal hemorrhoids, or beneath the skin near the anus, referred to as external hemorrhoids.
Some of the risk factors for hemorrhoids include age and pregnancy. Hemorrhoids also affect nearly three out of every four adults, especially when they reach the age of 50.
Then, during pregnancy and childbirth, many women experience hemorrhoids. The pressure of bearing a baby in the belly puts additional strain on the pelvic blood vessels. Struggling to push the baby out when giving birth adds strain on these blood vessels.
Hemorrhoids are a typical source of rectal bleeding. They frequently heal on their own. However, effective hemorrhoid treatment methods are currently available. Many people find healing through home remedies and lifestyle adjustments.
Signs and Symptoms of Hemorrhoids
- pruritus or irritation in the anal area
- discomfort or pain during bowel movements
- inflammation around the anus
- rectal bleeding
- feces with bright red blood
- prolapse or protruded hemorrhoids with pain and discomfort
- a perception or urge to defecate even after going to the toilet
Causes of Hemorrhoids
Under extreme pressure, the veins around the anus tend to extend and protrude or become inflamed, resulting to the formation of hemorrhoids. The causes of hemorrhoids include the following:
- constriction during bowel motions
- sitting on the toilet for extended periods.
- severe or chronic diarrhea or constipation
- being overweight
- pregnancy
- engaging in anal intercourse
- consuming a low-fiber diet
- persistent heavy lifting
Risk Factors to Hemorrhoids
Risk factors traditionally linked to the development of hemorrhoids include:
- Inflammatory Bowel Disease (IBD), such as Crohn’s disease and ulcerative colitis
- family history
- persistent diarrhea
- severe constipation
- sedentary lifestyle
- anal intercourse
- colorectal cancer
- liver disease
- obesity
- episiotomy
- patient’s lack of upright posture
- elevated anal resting pressure
- spinal cord injury
- rectal muscle tone loss
- rectal surgical procedure
Complications of Hemorrhoids
- Anemia. In rare cases, persistent blood loss from hemorrhoids may result in anemia, a blood disorder in which the body does not have sufficient healthy red blood cells to transport oxygen to the tissues.
- Strangulated hemorrhoid. If the blood supply to an internal hemorrhoid is disrupted, the hemorrhoid may become “strangulated,” causing excruciating discomfort.
- Blood clot. A clot can form in hemorrhoids on rare occasions (thrombosed hemorrhoids). Although it is not hazardous, it can be excruciating and must sometimes be surgically removed and drained.
- Sepsis. Although it is extremely rare, severe sepsis can occur after hemorrhoid therapy, and all surgeons who treat such patients should be mindful of the possible complications.
- Perianal thrombosis. This condition is the most common and most serious complication of hemorrhoids. A perianal thrombosis is a trail of blood that forms in the tissue surrounding the anus. A ruptured or leaking vein usually triggers it.
Diagnosis of Hemorrhoids
- Physical examination. Physical examination is beneficial to examine the patient’s anus and rectum for enlarged blood vessels, which indicate hemorrhoids. The doctor will check for the following in the area around the anus:
- inflammation or lumps
- internal hemorrhoids that have prolapsed through the anal opening
- external hemorrhoids accompanied by a blood clot in a vein
- stool or mucus leaks
- rashes on the skin around the anus
- skin tags or pieces of skin that remain after a blood clot in external hemorrhoid resolves
- anal fissures or tiny tears in the anus that can cause pruritus, pain, and bleeding
- Digital Rectal Examination (DRE). For the diagnosis of hemorrhoids, the healthcare professional inserts a gloved, greased (lubricated) finger into the rectum.
- Invasive Medical Procedures
- Anoscopy. A hollow, lit tube is inserted into the anus. The purpose of this procedure is to detect internal hemorrhoids.
- Proctoscopy. An illuminated tube is inserted into the anus. This procedure provides an overview of the entire rectum.
- Sigmoidoscopy. This test examines the inside of a section of the large intestine. It aids in determining the source of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, illuminated tube (sigmoidoscope) is inserted via the rectum into the gut. This tube forces air into the intestine, causing it to expand. This procedure improves visibility inside. If necessary, obtaining a tissue sample for biopsy is also possible.
- Colonoscopy. This test examines the entire length of the large intestine. It can aid in detecting abnormal growths, red or inflamed tissue, sores (ulcers), or hemorrhages. A colonoscope is a long, flexible, illuminated tube inserted into the rectum and the colon. This tube allows the doctor to examine the colon’s lining and take a tissue sample (biopsy) to evaluate it.
Treatment of Hemorrhoids
- Home Remedies
- Consume high-fiber foods. Increase the intake of vegetables, fruits, and whole grains. High-fiber foods soften and bulk the stool, allowing an individual to avoid straining, which might aggravate discomfort from existing hemorrhoids.
- Soak in a warm bath or sitz bath regularly. Two to three times each day, soak the anal area in plain warm water for 10 to 15 minutes.
- Medications
- Analgesics and Non-steroidal anti-inflammatory drugs (NSAIDs). These medications are beneficial in relieving pain and inflammation caused by hemorrhoids.
- Topical treatments and suppository. Apply an over-the-counter hemorrhoid cream or administer a suppository to the anus to act as a numbing agent.
- Minimally Invasive Procedures
- Rubber band ligation. A little rubber band wrapped around the base of the hemorrhoid cuts off the vein’s blood supply.
- Electrocoagulation. An electric current is used to cut off blood flow to the hemorrhoid.
- Infrared Coagulation. For the removal of hemorrhoids, a tiny probe is inserted into the rectum to transfer heat.
- Sclerotherapy. Hemorrhoid tissue is destroyed by a chemical injected into the enlarged vein.
- Surgical Procedures
- Hemorrhoidectomy. This procedure is a type of surgical treatment that is used to remove big external hemorrhoids or internal hemorrhoids that have prolapsed.
- Hemorrhoid stapling. An internal hemorrhoid is removed with a stapling device. Moreover, this surgical procedure pulls and retains a prolapsed internal hemorrhoid inside the anus.
Prevention of Hemorrhoids
The most uncomplicated strategy to avoid hemorrhoids is to make the feces soft and easy to pass. Follow these guidelines to prevent hemorrhoids and alleviate their symptoms:
- Consume high-fiber foods. Increase the intake of fruits, veggies, and whole grains. These foods soften and bulk the feces, which helps to reduce the straining that can lead to hemorrhoids. To avoid flatulence, gradually incorporate fiber into the diet.
- Drink plenty of water. To help keep stools soft, drink six to eight glasses of water and other liquids (no alcohol) daily.
- Consider taking fiber supplements. Most people do not consume enough fiber, which is 20 to 30 grams daily. Over-the-counter fiber supplements have been demonstrated in studies to improve overall discomfort and hemorrhoid bleeding. However, drink at least eight glasses of water or other fluids every day while taking fiber supplements. Otherwise, the supplements have the potential to cause or aggravate constipation.
- Avoid too much straining. Straining and holding one’s breath while attempting to pass a stool increases pressure in the veins of the lower rectum.
- Ensure to defecate as quickly as possible. Waiting to pass a bowel movement may cause the stool to dry excessively and become more difficult to pass.
- Exercise regularly. Stay active to help avoid constipation and relieve vein pressure caused by prolonged standing or sitting. Excess weight related to hemorrhoids can also be lost through exercise.
- Avoid sitting for extended periods. Sitting for an extended period, particularly on the toilet, can put more pressure on the veins in the anus.
Nursing Diagnosis for Hemorrhoids
Nursing Care Plan for Hemorrhoids 1
Nursing Diagnosis: Impaired Skin Integrity related to hemorrhoid surgery and procedures, changes in activity and mobility, the aging process, and skin elasticity loss secondary to hemorrhoids as evidenced by skin tissue disruption from incisional sites, skin layer degradation, thrombosed hemorrhoids, discomfort, and inflammation.
Desired Outcomes:
- The patient’s skin will be intact, with no evidence of rectal protrusion or hemorrhage.
- The patient will show no indication of thrombosed hemorrhoids or rectal hemorrhage.
- The patient’s CBC will be normal, with no anemias observed.
- The patient will be able to appropriately express comprehension of hemorrhoid causes, comfort measures, and strategies for preventing hemorrhoids from worsening.
- The patient’s enlarged hemorrhoids will be reduced in size with no discomfort elicited.
- The patient will be able to withstand treatments to identify and treat hemorrhoids without complications.
| Hemorrhoids Nursing Interventions | Rationale |
| Examine the patient for hemorrhoids, pain, or swelling caused by hemorrhoids. Assess the patient’s hydration, food intake, and the presence of constipation as well. | This intervention provides baseline information regarding the type of hemorrhoids (external or internal), the extent of venous thrombosis, the existence of complications, including hemorrhage, and risk factors of having hemorrhoids to initiate an appropriate treatment plan for the patient. |
| Apply topical treatment as recommended. | Topical treatment relieves the patient’s discomfort by reducing inflammation, pain, and itching. |
| If necessary, provide a “donut cushion” for the patient to sit on. | Hemorrhoids are excruciatingly painful, and the sufferer may be unable to sit and apply pressure to the affected areas. Donut cushions can assist relieve hemorrhoid pressure. Moreover, be cautious about the occurrence of pressure regions. |
| Administer bowel softeners as prescribed. | Bowel softener minimizes straining and increases pressure, which may cause constricted vessels to rupture or another hemorrhoid to form. It also reduces discomfort by preventing the passage of hard fecal waste. |
| Assist the patient with treatment and procedures for hemorrhoids. | Sclerotherapy is beneficial if the hemorrhoid is detected in the early stage. It entails injecting quinine urea hydrochloride or other chemicals into sclerosed vessels, causing inflammation and death of the vessel, followed by reabsorption inside the body. Banding hemorrhoids may also be conducted. This procedure includes wrapping a rubber band around the base of each hemorrhoid, leading to the death and necrosis of the hemorrhoid. Laser surgery is also necessary but obtaining immediate symptomatic relief is impossible with this procedure. A hemorrhoidectomy is necessary if the patient has internal hemorrhoids with prolapse or both internal and external hemorrhoids. It provides instant relief but can result in scar tissue and other consequences; it should only be used as a last option. |
| Educate the patient, family, or significant other about the causes of hemorrhoids, how to avoid them, and what treatments are available. | Hemorrhoids occur due to straining, hard lifting, obesity, pregnancy, and any action that distends and induces rectal veins to prolapse. |
| Inform the patient, family, or significant other of any necessary procedures that the patient needs to undergo for the management of hemorrhoids. | Anoscopy or flexible sigmoidoscopy are typically used to diagnose internal hemorrhoids since the digital rectal exam cannot identify hemorrhoids accurately. Barium enemas or colonoscopy helps check that no intestinal masses are present. |
Nursing Care Plan for Hemorrhoids 2
Nursing Diagnosis: Constipation related to hemorrhoid discomfort, low residue diet, and a deficiency of nutritional volume secondary to hemorrhoids as evidenced by hard, formed stool passage, diminished bowel noises, inability to evacuate feces, palpable mass, feeling of rectal congestion, and flatulence.
Desired Outcome: The patient will maintain and establish a natural elimination pattern.
| Hemorrhoids Nursing Interventions | Rationale |
| Assess the patient’s bowel habits, lifestyle, capacity to detect a defecation urge, severe hemorrhoids, and history of constipation. | This intervention aids in determining an efficient bowel regimen, impairment, and the need for support. As a result of poor digestion, GI function may suffer. Functional impairment caused by muscle weakness and immobility may result in reduced abdominal peristalsis and trouble identifying the need to defecate. |
| Examine the patient’s stool frequency, features, flatulence, stomach pain or distension, and stool straining. | Constipation can be caused by aging factors such as diminished rectal compliance, discomfort, and impaired rectal sensation. |
| Examine the bowel sounds for presence and quality. | Atypical sounds, including high-pitched tinkles, indicate difficulties such as ileus. |
| Thoroughly observe the patient’s nutrition and fluid intake. | Sufficient amounts of fiber and roughage produce bulk, and at least 2 L of liquids per day is beneficial in preventing hard stools. |
| Assess the patient for complaints of abdominal discomfort and distention. | Gas, abdominal distention, or ileus could all contribute to constipation. Impaired digestion can cause intestinal distention and, in severe cases, can result in ileus due to a lack of peristalsis. |
| Keep an eye on the patient’s mental state, syncope, heart palpitations, and any transient ischemic attacks. Inform the doctor if these symptoms develop. | Excessive straining may severely affect arterial circulation, resulting in heart, cerebral, or peripheral ischemia. |
| Examine the patient for rectal bleeding. | Extreme straining can result in hemorrhoids, rectal prolapse, or anal perforations, all of which cause damage to the tissue and bleeding. |
| As needed, administer bulk stool softeners, laxatives, suppositories, or enemas. | These medications help stimulate stool evacuation. |
| Advise the patient to consume high-fiber foods such as whole-grain cereals, bread, and fresh fruits. | This intervention enhances peristalsis and aids in elimination. |
| Monitor the patient’s medication that may predispose them to be constipated. | Some medications known to cause constipation include analgesics, anesthetics, anticholinergics, and diuretics. |
| Educate the patient in activity or exercise routines appropriate for the disease process. | Activity enhances peristalsis and defecation. Exercises serve to strengthen the stomach muscles, which helps with bowel movement. |
Nursing Care Plan for Hemorrhoids 3
Nursing Diagnosis: Acute Pain related to gastrointestinal bleeding, gastric mucosal irritation, swelling, and constipation secondary to hemorrhoids as evidenced by fever, lethargy, increased WBC, palpitations, hypertension, difficulty breathing, rectal hemorrhage, and rectal pruritus.
Desired Outcomes:
- The patient will be free of hemorrhoid pain and discomfort.
- The patient will verbalize that the pain caused by hemorrhoids is reduced or completely gone.
| Hemorrhoids Nursing Interventions | Rationale |
| Examine the patient for headaches, sore throats, overall malaise or bodily weakness, muscle spasms, and soreness. | Inflammation or an elevated temperature is frequently the root cause of headaches, sore throat, general malaise, muscle pains, and pain. These symptoms may indicate acute pain caused by hemorrhoids. |
| Examine the patient’s vital signs for deviations from baselines. | The autonomic response to pain usually causes an increase in vital signs. |
| As directed, administer analgesics. | Analgesics are a pharmacologic treatment for pain and discomfort that reduces brain prostaglandin production. If the pain is intolerable, analgesics are beneficial. |
| Provide a relaxing and peaceful environment for the patient. | This method decreases stimulation that may aggravate discomfort. |
| Give the patient a warm sitz bath. | Warmth induces vasodilation, which relieves hemorrhoids’ discomfort. |
| For the treatment of hemorrhoids, apply topical ointments or use a suppository. | Topical ointments and suppositories can help relieve pain and discomfort of hemorrhoids. |
| Educate the patient or significant other about breathing, relaxation, meditation, massage, and other nonpharmacologic interventions. | This strategy helps patients focus less on pain. These techniques will change the patient’s perception of pain and may improve the discomfort they are experiencing. |
Nursing Care Plan for Hemorrhoids 4
Nursing Diagnosis: Deficient Knowledge related to a lack of information regarding the treatment plan, appropriate diet, exercise, and precautions secondary to hemorrhoids as evidenced by insufficient understanding of how to manage the condition, which results in the occurrence of complications.
Desired Outcomes:
- The patient will learn how to manage hemorrhoids and prevent complications.
- The patient will understand how appropriate diet and exercise affect the healing of hemorrhoids.
- The patient will gain knowledge on how to prevent having hemorrhoids.
| Hemorrhoids Nursing Interventions | Rationale |
| Educate the patient about the importance of a warm sitz bath. | Sitting in a sitz bath can help reduce inflammation, promote hygiene, and increase blood flow to the anogenital region. The sitz bath is commonly used to maintain the anus clean, as well as to reduce swelling and pain caused by hemorrhoids. |
| Inform the patient about the clinical manifestations of anal infection. | Even though it is unlikely to happen, hemorrhoids still have the possibility of becoming infected. It is beneficial for the patient to know that when the pain resists and if there is a presence of foul-smelling anal drainage, it indicates infection. Therefore, consult the doctor immediately to prevent complications if these symptoms occur. |
| Educate the patient about the predisposing factors of hemorrhoids. | Predisposing factors of hemorrhoids include constipation or diarrhea, sedentary lifestyle, age, pregnancy, obesity, family history, and more. Knowing these factors can help the patient be mindful of their lifestyle and prevent acquiring hemorrhoids. |
| Educate the patient about the significance of good anal hygiene. | Wash the anal area with water every day to keep it clean. Avoid using soaps since they deplete the natural oils that protect the anus and may cause the area to become dry and irritated. Instead, use aqueous cream or a soap-free cleanser. These methods can help the patient avoid hemorrhoids. |
| Encourage the patient to take high-fiber foods, drink more fluids, and be physically active. | High-fiber foods, adequate fluid intake, and regular exercise prevent constipation. Thus, if the patient is not constipated, there is also a lesser possibility of acquiring hemorrhoids. |
| Educate the patient about the possible procedures he or she may undergo if the hemorrhoids become severe and infected. | This approach aims to educate the patient about invasive or surgical procedures to remove or treat hemorrhoids. In that case, the patient will not be frightened if these procedures are necessary. |
Nursing Care Plan for Hemorrhoids 5
Nursing Diagnosis: Impaired Comfort related to pain and distress secondary to hemorrhoids as evidenced by verbalization of exhaustion, rapid breathing, irritability, and restlessness.
Desired Outcomes:
- The patient will report improvement in pain and discomfort brought by hemorrhoids.
- The patient will be knowledgeable about different comfort measures to relieve hemorrhoid pain.
| Hemorrhoids Nursing Interventions | Rationale |
| Advise the patient to utilize a hemorrhoid pillow or cushion. | A hemorrhoid cushion, shaped like a donut, will allow the patient to rest comfortably with little to no tension on the affected areas. Using one daily can help reduce inflammation and relieve the most unpleasant hemorrhoid symptoms. |
| For the alleviation of the patient’s pain, administer prescribed medications. | Analgesics and anti-inflammatory creams are beneficial for the healing of hemorrhoids. These medications also aim to provide comfort for the patient. |
| Explain the procedures to the patient before implementing them. | When unwell and hospitalized, patients are frequently at the mercy of others and may feel vulnerable. Before any procedure, the nurse should always explain everything to the patient. Explain the steps of each procedure, and educate them prior to obtaining vital signs or how a particular medication may affect them. When a patient knows what to expect, it significantly reduces fear and discomfort. |
| Provide the patient with a relaxing and calming environment and strategies. | A patient who is feeling overwhelmed or anxious may require a relaxing environment to assure them that they are secure. Instruct the patients in breathing and meditation activities. |
| Teach the patient about proper anal hygiene and moisture-control techniques to avoid irritation. | Infection and discomfort may occur in dry anal areas. As a result, maintaining a hygienic and sanitized anal is advantageous. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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