Surg: Haemorrhoids: Free MSRA Podcast

🎧 Deep Dive: Haemorrhoids – The Painful TruthLet’s talk about the piles that no one talks about. Haemorrhoids affect up to 50% of adults over 30 — and yet they’re often misdiagnosed, misunderstood, or just plain ignored. In this high-yield MSRA-focused episode, we unpack everything from grading, causes, and red flag differentials, to banding, Botox, and when to refer.🧠 What You’ll Learn:✅ Definition & Classification• Swollen veins in the lower rectum/anus• Internal = above dentate line (painless bleeding)• External = below dentate line (painful, itchy)• Internal Grades I–IV: from non-prolapsing to irreducible✅ Pathophysiology• ↑ Pressure + weak connective tissue• Vessel engorgement → inflammation → symptoms• Triggered by straining, pregnancy, chronic diarrhoea, ageing✅ Risk Factors• Constipation, diarrhoea• Pregnancy, obesity, prolonged sitting• Low-fibre diet, chronic cough• IBD, spinal cord injury• Family history✅ Clinical Features• Bright red rectal bleeding• Anal itching or irritation• Lump or swelling (esp. external)• Pain = red flag for thrombosed external haemorrhoid• Soiling in advanced internal prolapse🩺 Differential Diagnosis• Anal fissure• Colorectal cancer• Rectal prolapse• Perianal abscess, fistula• IBD, polyps, anal cancer• STIs (warts, ulcers), dermatitis, threadworms📊 Epidemiology (UK)• Lifetime prevalence: ~50% adults over 30• Annual incidence: ~29,000• Prevalence ranges 13–36% (self-reported data may overestimate)🧪 Investigations• History + exam• DRE = essential• Anoscopy/proctoscopy for internal visualisation• Flexible sigmoidoscopy or colonoscopy if red flags• FBC if chronic bleeding (check for anaemia)💉 Management (Stepwise)1. Conservative• Fibre, fluids, avoid straining• Regular exercise• Good hygiene• Bulk-forming laxatives2. Topical Relief• Ointments, suppositories• Short-term corticosteroids• Local anaesthetics3. Minimally Invasive (for Grade I–III)• Rubber band ligation• Sclerotherapy• Infrared coagulation, diathermy4. Surgery (if refractory/severe)• Haemorrhoidectomy• Stapled haemorrhoidopexy• Haemorrhoidal artery ligation🧠 Thrombosed External Haemorrhoid?• If within 72 hrs: excision may rapidly relieve pain• After 72 hrs: conservative (analgesia, stool softeners)📈 Prognosis• Excellent with early lifestyle change• ~10% may need surgery• Recurrence common if risk factors persist• Pregnancy-related haemorrhoids often resolve postnatally⚠️ Complications• Acute thrombosis = severe pain• Chronic bleeding = anaemia• Strangulation (rare but serious)• Perianal sepsis (very rare)• Skin tags, infection, ischaemia📚 Free MSRA Resources📝 Revision Notes:https://www.passthemsra.com/topic/haemorrhoids-revision-notes/🃏 Flashcards:https://www.passthemsra.com/topic/haemorrhoids-flashcards/📖 Accordion Q&A:https://www.passthemsra.com/topic/haemorrhoids-accordion-qa-notes/🎯 Rapid Quiz:https://www.passthemsra.com/topic/haemorrhoids-rapid-quiz/🧪 Quiz Bank:https://www.passthemsra.com/quizzes/haemorrhoids/🌐 Platforms:https://www.passthemsra.comhttps://www.freemsra.com#MSRA #Haemorrhoids #MSRARevision #SurgeryMSRA #Piles #RubberBandLigation #MSRAFlashcards #MSRAQuiz #PassTheMSRA #FreeMSRA #DRE #ColorectalDifferentials