Swelling in the upper anal canal and lower rectum due to engorgement of veins. May be internal or external

Causes

• Constipation and straining in defecation
• Portal hypertension from any cause
• Compression of pelvic veins: eg. in pregnancy, abdominal tumours
• Sedentary life style

Clinical features

• Painless anal bleeding
• Prolapse of the swelling, especially at defecation
• Mucous discharge at anus
• Pain in passing stool (rare)
• Visible swelling at the anus

Differential diagnosis

• Schistosomiasis
• Rectal polyps
• Prolapsed rectum
• Anal tags
• Tumour of rectum
• Anal warts
• Amoeboma

Management
HC2

Establish the cause

Correct any constipation

Insert a bismuth subgallate suppository rectally every 12 hours for 5 days

If infected:

Give metronidazole 400mg every 8 hours for 5 days
Give analgesics as required for the pain (see p345)

If there is no response:

Refer for surgery

Prevention

• Maintain high residue (fibre) diet
• Ensure adequate fluid intake