Hemorrhoids | Internal and External Hemorrhoids | Treatment for Piles

Hemorrhoids are also known as piles. These are dilated veins within the anal canal in the sub-epithelial region formed by branches of rectal veins. Hemorrhoids are clearly divided into 2 categories namely internal hemorrhoids and external hemorrhoids. The external hemorrhoids are situated outside the anal orifice and are covered by skin. The two varieties may co-exist and the condition is called as interno-external hemorrhoids.

External hemorrhoids varieties

  • Dilatation of the veins at the anal verge is sometimes seen in persons of sedentary life particularly straining.
  • Perianal hematoma or the thrombosed external hemorrhoids.

Treatment for External Hemorrhoid

Whenever a thrombosed external hemorrhoid is suspected, the treatment is to incise the hemorrhoid under local anesthesia.

The two halves of the hemorrhoids are excised.

Internal Hemorrhoids Causes

  • Hereditary: It is often seen in members of the same family.
  • Anatomical: Internal pile is a natural consequence of adaption of erect mankind.
  • Exciting causes: Straining to expel constipated stool causes dilatation of the venous plexus. Over purgation and diarrhea of colitis, dysentery, enteritis etc. aggravates latent hemorrhoids.
  • Diet: Low roughage diet may excite hemorrhoid formation.

Secondary hemorrhoids: Piles can be secondary to a few conditions. Carcinoma of the rectum, pregnancy, chronic constipation, difficulty in urination and portal hypertension are some of the factors.

Symptoms of Hemorrhoids

  • Bleeding: It is the principal and earliest symptom.
    It is bright red, painless and occurs along with defecation. This may continue for months or even years. As the veins become larger and heavier, partial prolapse will occur with each bowel movement.
  • Prolapse is a later symptom. Piles can be divided into four degrees.
    • First degree: Hemorrhoids do not come out of the anus.
    • Second degree: Hemorrhoids come out only during defecation and is reduced spontaneously after defecation.
    • Third degree: Hemorrhoids come out only during defecation and do not return by themselves, but need to be replaced manually and then they stay reduced.
    • Fourth degree: Hemorrhoids here are permanently prolapsed. At this stage great discomfort is complained of with a feeling of heaviness in the rectum.
  • Pain is not characteristic unless there is associated thrombosis or there is associated anal fissure.
  • Mucous discharge is a particular symptom of prolapsed hemorrhoids, which soften and excoriates the skin at the anus. Anal itching may be present.
  • Anemia is often seen in long standing cases of hemorrhoids due to persistent and profuse bleeding.
  • Complications: Two main complications of hemorrhoids are excessive bleeding and thrombosis. Other rare complications are strangulation of the piles leading to gangrene and fibrosis.

Treatment for Piles

  • Injection therapy: Sclerosant injection (5% phenol in almond or arachis oil with 140 mg of menthol to make 30 ml solution) has been the method of treatment of small vascular hemorrhoids and indeed is used to control all cases of first degree hemorrhoids whatever may be the presenting symptoms.
  • Rubber band ligation: It is an ideal method for treating first degree and second degree piles. Each hemorrhoid is visualized through the proctoscope and is grasped by an instrument and a small elastic band is slipped over it.
  • Cryosurgery: It involves freezing the tissues of the hemorrhoid for sufficient time to cause necrosis. In advanced cases this procedure is of little help.
  • Hemorroidectomy is recommended for large third degree hemorrhoids.
  • Ligature and excision: This is the most widely used operative nowadays. Hemorrhoids are pulled and ligated and hemorrhoids distal to the ligature are excised. Mucous membrane remains are sutured to prevent post-operative stenosis.

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