1. Apakah hemorrhoid externa berasal dari squamous sel?

2. Hubungan anatomi terhadap faktor risiko terjadi hemorrhoid?

Hemorrhoids are not varicosities; they are clusters of vascular tissue (eg, arterioles,
venules, arteriolar-venular connections), smooth muscle (eg, Treitz muscle), and connective
tissue lined by the normal epithelium of the anal canal. Hemorrhoids are present in utero and
persist through normal adult life. Evidence indicates that hemorrhoidal bleeding is arterial and
not venous. This evidence is supported by the bright red color and arterial pH of the blood.
Hemorrhoids are classified by their anatomic origin within the anal canal and by their
position relative to the dentate line; thus, they are categorized into internal and external
hemorrhoids.
External hemorrhoids develop from ectoderm and are covered by squamous epithelium,
whereas internal hemorrhoids are derived from embryonic endoderm and lined with the
columnar epithelium of anal mucosa. Similarly, external hemorrhoids are innervated by
cutaneous nerves that supply the perianal area. These nerves include the pudendal nerve and the
sacral plexus. Internal hemorrhoids are not supplied by somatic sensory nerves and therefore
cannot cause pain. At the level of the dentate line, internal hemorrhoids are anchored to the
underlying muscle by the mucosal suspensory ligament.
External hemorrhoidal veins are found circumferentially under the anoderm; they can
cause trouble anywhere around the circumference of the anus.

3. Mengapa terjadi retensio urin pada post hemorrhoidectomy?

Urinary retention

Urinary retention can occur in up to 15% of patients posthemorrhoidectomy. Many

factors are thought to contribute to urinary retention following hemorrhoidectomy, with pain
being a major contributor. Perioperative restriction of fluid intake has been shown to reduce the
need for catheterization. In general, most patients have no further issues after 1 catheterization.
Men with enlarged prostates may require an indwelling Foley catheter for up to 72 hours.
Urinary retention, which is the most common complication following hemorrhoidectomy,
occurs is as many as 20% of patients. Factors often held responsible include the following :
o Spinal anesthesia
o Rectal pain and spasm
o High ligation of the hemorrhoidal pedicle
o Rough handling of tissue
o Heavy suture material
o Numerous sutures
o Fluid overload
o Rectal packing
o Tight, bulky dressings
o Anticholinergics
o Narcotics
Generally, the incidence of urinary retention is not felt to be altered by the prophylactic
administration of Urecholic (bethanechol chloride). Prophylactic alfa adrenergic blockade has
failed to prevent this complication, as has the administration of an anxiolytic agent.

Rubber Band Ligation. Persistent bleeding from first, second, and selected
thirddegreehemorrhoidsmaybetreatedbyrubberbandligation.

Mucosalocated1to2cmproximaltothedentatelineisgraspedandpulledintoa
rubberbandapplier.Afterfiringtheligator,therubberbandstrangulatestheunderlying
tissue, causing scarring and preventing further bleeding or prolapse (Fig. 2931). In
general,onlyoneortwoquadrantsarebandedpervisit.Severepainwilloccurifthe
rubberbandisplacedatordistaltothedentatelinewheresensorynervesarelocated.
Other complications of rubber band ligation include urinary retention, infection, and
bleeding.Urinaryretentionoccursinapproximately1%ofpatientsandismorelikelyif
theligationhasinadvertentlyincludedaportionoftheinternalsphincter. Necrotizing
infection is an uncommon, but lifethreatening complication. Severe pain, fever, and
urinaryretentionareearlysignsofinfectionandshouldpromptimmediateevaluationof
thepatientusuallywithanexamunderanesthesia.Treatmentincludesdbridementof
necrotic tissue, drainage of associated abscesses, and broadspectrum antibiotics.
Bleeding mayoccurapproximately7to10daysafterrubberbandligation,atthetime
when the ligated pedicle necroses and sloughs. Bleeding is usually selflimited, but
persistent hemorrhage may require exam under anesthesia and suture ligation of the
pedicle.