Please forward this error screen to 69. Follow the link for more information. Hemorrhoids, also called piles, are vascular structures in the anal canal. While the exact cause of hemorrhoids remains unknown, a number of factors which increase pressure in the abdomen are believed to be involved.
This may include constipation, diarrhea and sitting on the toilet for a long time. Often, no specific treatment is needed. Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest. Males and females are both affected with about equal frequency. If not thrombosed, external hemorrhoids may cause few problems. However, when thrombosed, hemorrhoids may be very painful. Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following a bowel movement.
The exact cause of symptomatic hemorrhoids is unknown. During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. The birth of the baby also leads to increased intra-abdominal pressures. Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery. Hemorrhoid cushions are a part of normal human anatomy and become a pathological disease only when they experience abnormal changes. There are three main cushions present in the normal anal canal. Sinusoids do not have muscle tissue in their walls, as veins do. This set of blood vessels is known as the hemorrhoidal plexus. Hemorrhoid cushions are important for continence.
Hemorrhoids are typically diagnosed by physical examination. A visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids. Internal hemorrhoids originate above the dentate line. They are covered by columnar epithelium, which lacks pain receptors. Grade IV: Prolapse with inability to be manually reduced. External hemorrhoids occur below the dentate or pectinate line. They are covered proximally by anoderm and distally by skin, both of which are sensitive to pain and temperature. Many anorectal problems, including fissures, fistulae, abscesses, colorectal cancer, rectal varices, and itching have similar symptoms and may be incorrectly referred to as hemorrhoids. Other conditions that produce an anal mass include skin tags, anal warts, rectal prolapse, polyps, and enlarged anal papillae.
A number of preventative measures are recommended, including avoiding straining while attempting to defecate, avoiding constipation and diarrhea either by eating a high-fiber diet and drinking plenty of fluid or by taking fiber supplements, and getting sufficient exercise. Conservative treatment typically consists of foods rich in dietary fiber, intake of oral fluids to maintain hydration, nonsteroidal anti-inflammatory drugs, sitz baths, and rest. Decreasing time spent on the toilet and not straining is also recommended. While many topical agents and suppositories are available for the treatment of hemorrhoids, little evidence supports their use. Flavonoids are of questionable benefit, with potential side effects. A number of office-based procedures may be performed. While generally safe, rare serious side effects such as perianal sepsis may occur. Rubber band ligation is typically recommended as the first-line treatment in those with grade 1 to 3 disease.
It is a procedure in which elastic bands are applied onto an internal hemorrhoid at least 1 cm above the dentate line to cut off its blood supply. Sclerotherapy involves the injection of a sclerosing agent, such as phenol, into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids to shrivel up. A number of cauterization methods have been shown to be effective for hemorrhoids, but are usually only used when other methods fail. A number of surgical techniques may be used if conservative management and simple procedures fail. Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid used primarily only in severe cases. Doppler-guided, transanal hemorrhoidal dearterialization is a minimally invasive treatment using an ultrasound doppler to accurately locate the arterial blood inflow. These arteries are then “tied off” and the prolapsed tissue is sutured back to its normal position.
It has a slightly higher recurrence rate, but fewer complications compared to a hemorrhoidectomy. Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomical position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids. It is difficult to determine how common hemorrhoids are as many people with the condition do not see a healthcare provider. Long-term outcomes are generally good, though some people may have recurrent symptomatic episodes. Only a small proportion of persons end up needing surgery. An 11th-century English miniature: On the right is an operation to remove hemorrhoids.
Smear a strip of fine linen there-with and place in the anus, that he recovers immediately. Galen advocated severing the connection of the arteries to veins, claiming it reduced both pain and the spread of gangrene. In medieval times, hemorrhoids were also known as Saint Fiacre’s curse after a sixth-century saint who developed them following tilling the soil. Hall-of-Fame baseball player George Brett was removed from a game in the 1980 World Series due to hemorrhoid pain. After undergoing minor surgery, Brett returned to play in the next game, quipping “my problems are all behind me. National Institute of Diabetes and Digestive and Kidney Diseases. Review of Hemorrhoid Disease: Presentation and Management”.
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