You are providing perineal care for Mr. Henderson when you notice he winces and tenses up. Upon inspection, you see swollen tissue around his anal area. These are hemorrhoids, a common and painful condition that requires your gentlest touch and careful observation.
What are Hemorrhoids?
Hemorrhoids (HEM-uh-roids) are swollen, inflamed veins in the lower rectum or anus. They are similar to varicose veins in your legs. They can be internal (inside the rectum) or external (under the skin around the anus). They often result from straining during bowel movements, but can also be caused by the pressure of sitting or lying in bed for long periods, which is common among long-term care residents.
Why Hemorrhoids Matter in Your Daily Care
For a resident, hemorrhoids are not just a nuisance; they are a source of constant pain, itching, and bleeding that can make toileting a terrifying experience. If a resident hurts when they wipe, they may hold in their stool, leading to constipation and making the hemorrhoids worse. Your role in providing gentle, hygienic care and reporting bleeding is crucial for their comfort and preventing complications like infection.
What You’ll See During Your Shift
During perineal care or toileting, you might see bluish or purple lumps around the anus, or notice bright red blood on the toilet paper or brief. The resident may complain of itching, burning, or pain while sitting.
“Nurse, I was providing perineal care for Mrs. Gomez and noticed some external hemorrhoids that look quite irritated. There was a small amount of bright red blood when I wiped her. She mentioned she hasn’t had a bowel movement in three days because it hurts too much.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Scrubbing the anal area vigorously to “get it clean.” This causes friction and immediate pain, potentially making the hemorrhoids bleed or swell more.
Pro Tip: Use a peri-bottle (spray bottle) with warm water to cleanse the area instead of dry toilet paper or rough washcloths. Always pat the area dry gently—never rub. If the facility allows, applying a soothing cream or barrier ointment after cleaning can provide immense relief.
Memory Aid for Hemorrhoid Care
Remember the phrase: “Pat, Don’t Rub.”
Imagine the area is covered in delicate bubble wrap. If you rub it, it pops (hurts/bleeds); if you pat it, it stays intact. This reminds you to use gentle pressure with your towel or wipes.
State Test Connection
Expect questions related to Perineal Care regarding how to handle sensitive areas. The key is always cleaning from front to back and using gentle, non-irritating techniques to preserve skin integrity.
Related Care Concepts
Understanding hemorrhoids connects directly to constipation management (increasing fluids and fiber), perineal care (your technique for cleaning), and personal care skills (assisting with sitz baths if ordered). It is also vital for infection control, as open skin from irritated hemorrhoids can be an entry point for bacteria.
Quick Reference
✓ Key signs: Swollen lumps around anus, bright red blood on tissue, complaints of itching/pain ✓ When to report: Any active bleeding, severe pain, or if the resident refuses to use the bathroom due to pain ✓ Care reminders: • Use warm water and a peri-bottle to cleanse • Always pat dry, never rub • Clean from front to back to prevent infection • Encourage fluids and fiber (with dietary approval) to soften stools • Wear gloves and maintain strict standard precautions
Bottom line: Residents with hemorrhoids are often in silent pain. By adjusting your care technique to be extra gentle, you advocate for their dignity and make the most basic human functions much less frightening for them.