Hemorrhoids \figs\ piles

Piles = a ball or mass

Hemorrhoids = blood to ooze.
Figs= a kind of fruit.
It is sliding downwards of anal cushions abnormally
Due to straining or other causes.
Types
Internal – above the dentate line –covered with
mucous membrane.
External – below the dentate line- covered with
skin.
Interno -external – together occurs.
 Classification 1
Primary hemorrhoids
Located at 3,7,11 o'clock positions.
Secondary hemorrhoids –one which occurs
between the primary sites.
Classification 2 First degree
Piles within they may bleed but does not come out.
Second degree hemorrhoids
Piles that prolapse during defecation , but returns
back spontaneously.
 Cont
Third degree hemorrhoid
Piles prolapsed during defecation
Can be replaced back only by manual help.
Fourth degree hemorrhoids
Piles that are permanently prolapsed.
 Etiology
Hereditary
Morphological –weight of blood column without
Valves causes high pressure.
Straining .
Diarrhea .
Constipation.
Over purgation .
Carcinoma of rectum.
Pregnancy .
Portal vein hypertension.
Increased abdominal pressure.
Long standing .
 Clinical features
Bleeding- is the 1st symptom-bright , red and fresh
Occurs during defecation.
Mass per anus.
Discharge- a mucoid discharge.
Pruritus .pain.
Pain may be due to prolapse , infection ,or spasm.
Anemia – secondary .
On inspection prolapsed piles will be visualized .
On P\R only thrombosed piles can be felt.
Proctoscopy exact position can be made up.
Differential diagnosis
Carcinoma
Rectal prolapsed.
Pereanal warts.
Investigations
Heamatocrit.
Colonoscopy.
Barium enema x-ray.
Defecography.
 complications
Hemorrhage which may require blood transfusion.
Strangulation- Piles is being gripped by anal sphincter.
Thrombosis- piles appear dark purple/black,
Feel solid and tender.
Ulceration .
Gangrene.
Fibrosis.
Stenosis.
Suppuration leads to perianal or sub mucosal abscess.
Pyle phlebitis (portal pyaemia).can occur in 3rd degree
piles after surgery.
 Treatment
Sits both- means the patient has sit in warm water
For 20 minutes , 2-3 times in day.
Reduce edema , pain and promote healing.
Local application to reduce pain and edema.
Antibiotics , laxatives, are beneficial.
Fiber diet 35 gram /day and plenty water.
In case of inflamed, permanently prolapsed ,
Edematous piles– initially manual stretching of anal
canal sphincter when edema reduced in 1-2 weeks
Formal procedure is done Lord's dilatation.
 Cont
Injection –sclerosant therapy.
1st and early 2nd degree piles.
3-5% phenol with almond oil is injected into the sub
mucosal plane. Can be repeated in 6 weeks.
Barron's banding. It is done in 2nd degree piles
It causes ischemic necrosis and fall off.
At one time two piles should be band and 2cm
above the dentate line.
Cryosurgery –nitrous oxide( -98%) or liquid nitrogen
(_196%) extreme cold temperature is used to
coagulate and necrosis of piles.
 Cont
Infra – red coagulation –here heat is used to burn
the Piles
Laser therapy for piles- for 3rd degree piles.
Stapled hemorrhoidectomy –best method for
prolapsed piles.
Indications for surgery
3rd degree piles.
Failure of nonoperative methods.
fibrosed piles.
Ligation and excision of piles.
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