Basildon EM Handbook 2018

Bleeding haemorrhoids

•Bright red blood after stool

•Usually painless

•Perform and abdominal examination for masses

•Perform a digital rectal examination to exclude rectal malignancy

•Patients will need re-assurance and out patient surgical referral via GP

Peri-anal haematoma (thrombosed external piles)

•Painful lump that appear suddenly

•Is obvious on inspection of the anal region

•Will need incision and evacuation under LA usually

•Refer to the surgeon / smaller ones benefit from ICE and NSAID

Prolapsed haemorrhoids

•Can be painful

•Diagnosis obvious on inspection

•Most cases will resolve with bed rest and analgesia and stool softener

•Those that are strangulated need referral to the surgeons for admission

Peri-anal abscess

•Quite painful condition

•Patient present with a painful lump in the anal region

•Patient may be systemically unwell with high temperature

•Inspection of the anal region will reveal most of these abscess

•PR examination can be painful but is needed to diagnose submucous abscesses

•Refer all patients to surgeon as they need incision and drainage under GA

•There is no place for antibiotic in the treatment of these conditions

Pilo-nidal abscess

•Complicate pilo-nidal sinuses (with typical location in the natal cleft)

•Can be quite painful

•Fluctuation may be difficult to elicit because of tenseness of the tissues

•Will require incision and drainage under GA so refer to the surgical team

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