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269: HEMORRHOIDS

Debra F. Stern, DPT, DBA, MSM, PT; Wendy Song, DO

CONDITION/DISORDER SYNONYMS

  • External hemorrhoids

  • Internal hemorrhoids

ICD-9-CM CODES

  • 455.0 Internal hemorrhoids without mention of complication

  • 455.1 Internal thrombosed hemorrhoids

  • 455.2 Internal hemorrhoids with other complication

  • 455.3 External hemorrhoids without mention of complication

  • 455.4 External thrombosed hemorrhoids

  • 455.5 External hemorrhoids with other complication

  • 455.6 Unspecified hemorrhoids without mention of complication

  • 455.7 Unspecified thrombosed hemorrhoids

  • 455.8 Unspecified hemorrhoids with other complication

  • 455.9 Residual hemorrhoidal skin tags

  • Associated Diagnoses

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.70 Difficulty in walking

    • 728.2 Muscular wasting and disuse atrophy

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

ICD-10-CM CODES

  • I84 Hemorrhoids

  • K64.8 Other hemorrhoids

  • K64.9 Unspecified hemorrhoids

PREFERRED PRACTICE PATTERNS

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion (ROM) Associated with Localized Inflammation1

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning2

PATIENT PRESENTATION

A 52-year old female presents with tailbone (coccyx) pain. On history, she has noticed drops of bright red blood in the toilet and on tissue paper after bowel movements for 2 months. She admits to constipation with straining and rectal pain on a weekly basis. She reports her bleeding is worse when she is more constipated. Her last colonoscopy was 1 year ago and was normal. Vitals are Temperature: 98.2F, Pulse: 68, Respirations: 16, Blood pressure: 134/85, and SpO2%: 100%. Physical examination reveals a small purple, tender, hard, protruding swelling of the anal opening at the 7 o’clock position, no anal fissures or blood was found with inspection and digital rectal examination.

FIGURE 269-1

Common site of hemorrhoids. (A) Internal hemorrhoids at 2, 5, and 9 o’clock. (B) Protrusion of anal cushions, soft tissue containing vessels. (From Tintinalli JE, Stapczynski JS, John Ma O, et al. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Bright red rectal bleeding, usually associated with bowel movements

  • Bulging of the veins around the anus

    • Internal: Veins swelling inside the anal canal

    • External: Veins swelling near the opening of the anus

    • Protruding

  • Superficial pain in rectal area, especially with sitting or attempting to evacuate bowels

FIGURE 269-2

Perianal–perirectal abscesses. The anatomy of perianal and perirectal abscesses is illustrated. Also shown are anal fissure and internal and external hemorrhoids. (From Knoop KJ, Stack LB, Storrow AB, et al. The Atlas of Emergency Medicine. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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