{
  "name": "Hemorrhoids & Hemorrhoidectomy",
  "slug": "hemorrhoids",
  "url": "https://nursingplex.com/care-plans/hemorrhoids",
  "category": "Surgery & Perioperative",
  "summary": "Anorectal vein care emphasizing pain relief, sitz baths, stool softening and bleeding checks.",
  "nursing_diagnoses": [
    "Acute pain",
    "Constipation",
    "Risk for bleeding"
  ],
  "overview": [
    "Hemorrhoids are dilated vascular cushions in the anal canal. Internal hemorrhoids arise above the dentate line and typically cause painless bright-red bleeding and prolapse; external hemorrhoids arise below it, are innervated, and cause pain — severe and acute when thrombosed.",
    "Straining with constipation, prolonged sitting, pregnancy, obesity and portal hypertension raise venous pressure and drive their formation. Most respond to fiber, fluids, stool softeners and sitz baths; refractory or thrombosed cases undergo banding, sclerotherapy or hemorrhoidectomy.",
    "Hemorrhoidectomy is notably painful and the first bowel movement is a major source of anxiety, so nursing care centers on analgesia, stool softening and reassurance, along with monitoring for bleeding and urinary retention."
  ],
  "key_facts": [
    {
      "label": "Post-op bleeding",
      "text": "Hemorrhage may be concealed internally; watch for tachycardia, restlessness and frequent urge to defecate."
    },
    {
      "label": "First stool",
      "text": "Give stool softeners routinely and analgesia before the first bowel movement; never allow constipation."
    },
    {
      "label": "Sitz baths",
      "text": "Warm sitz baths 3–4 times daily and after each stool relieve spasm and promote healing."
    },
    {
      "label": "Urinary retention",
      "text": "Common after anorectal surgery from spasm and anesthesia; assess voiding within 6–8 hours."
    }
  ],
  "nursing_priorities": [
    "Relieve pain and anal sphincter spasm.",
    "Prevent constipation and straining.",
    "Monitor for bleeding and urinary retention after surgery.",
    "Maintain perianal hygiene and skin integrity.",
    "Teach long-term bowel habits that prevent recurrence."
  ],
  "assessment": {
    "subjective": [
      "Reports of anal pain, burning or itching",
      "Reports of bright-red blood on toilet paper or in the bowl",
      "Complaints of a protruding lump or incomplete evacuation",
      "History of straining, constipation or prolonged sitting"
    ],
    "objective": [
      "Visible external hemorrhoids, skin tags or a tense purple thrombosed nodule",
      "Prolapsed internal hemorrhoids on inspection or straining",
      "Bleeding on rectal examination or anoscopy",
      "Post-op dressing saturation, bladder distention or inability to void",
      "Anemia on CBC with chronic bleeding"
    ],
    "related_factors": [
      "Chronic constipation and straining at stool",
      "Low-fiber diet and inadequate fluid intake",
      "Pregnancy and increased intra-abdominal pressure",
      "Prolonged sitting or standing, heavy lifting",
      "Portal hypertension"
    ]
  },
  "goals": [
    "The client will report reduced anal pain and itching.",
    "The client will pass a soft formed stool without straining.",
    "The client will remain free from significant bleeding and urinary retention.",
    "The client will describe dietary and bowel habits that prevent recurrence."
  ],
  "interventions": [
    {
      "title": "Comfort measures",
      "points": [
        "Provide warm sitz baths for 15–20 minutes several times daily and after each stool.",
        "Apply topical anesthetics or witch hazel pads as ordered; ice packs for acute thrombosis.",
        "Administer scheduled analgesia, timing doses before bowel movements.",
        "Position side-lying or prone and avoid prolonged sitting on hard surfaces."
      ]
    },
    {
      "title": "Bowel management",
      "points": [
        "Give stool softeners and bulk-forming fiber as ordered; avoid stimulant overuse.",
        "Encourage 25–30 g fiber daily and at least 2 liters of fluid unless restricted.",
        "Teach responding promptly to the urge and limiting toilet time.",
        "Document the first postoperative bowel movement and its character."
      ]
    },
    {
      "title": "Post-op monitoring",
      "points": [
        "Assess vital signs and dressings for bleeding; internal hemorrhage may be hidden.",
        "Check for bladder distention and voiding within 6–8 hours after surgery.",
        "Inspect the perianal area for infection, swelling or fissure.",
        "Maintain gentle perianal hygiene with water and patting dry."
      ]
    }
  ],
  "patient_teaching": [
    "Increase dietary fiber and fluids permanently to keep stools soft.",
    "Avoid straining, heavy lifting and long periods on the toilet.",
    "Continue sitz baths at home and use prescribed ointments as directed.",
    "Report heavy bleeding, fever, inability to urinate or worsening pain."
  ]
}