Please forward this error screen to 69. Our resident medical expert, Scott, and a buddy of his recently started The Medicine Journal, where you can learn all sorts of interesting facts about all things medical related. Below is a sample article from their site. Much like bathroom-humor at the dinner table, hemorrhoids can be a taboo subject. The truth is, everyone has them. Your anus is controlled by one of the many sphincter muscles within the body. Sphincters are muscles that form like a doughnut around the many openings within the body, like the entrance and exit of your stomach.
Those would be the lower esophageal sphincter and pylori sphincter respectively. When sphincters relax, they allow the entrance or release of liquids and solids. As mentioned before, your anal sphincter is cushioned by hemorrhoids. Hemorrhoids themselves are made up of what are known as modified squamous epithelium. These highly vascular cushions reside along the anal canal in three main areas- the left, right and back of the canal. They are made up of elastic connective tissue and smooth muscles. Many of them do not contain muscular walls like arteries and veins do. When you have an increase in abdominal pressure, like when sneezing, the blood going back to your heart through your inferior vena cava is reduced.
This causes these vascular cushions to swell up with blood pushing on your sphincter, and thus, help prevent the infamous anal-leakage. Anything that causes an increase in your abdominal pressure can cause your hemorrhoids to become chronically inflamed. Thus, there risk factors for piles- things like being pregnant, chronic constipation, lifting heavy weights, straining when passing stool, being obese, and increasing age. Some studies have even suggested the tendency to develop piles is inherited. You have two types of piles, internal and external. A line known as the dentate line is what differentiates them. Located below the dentate line is external piles.
These are covered by a type of skin called Anoderm that contain nerve fibers, specifically fibers connected to the pudendal nerve. The cause of the itchy pain is revealed! Internal hemorrhoids are broken down in to 4 classifications. 1st degree protrude only into the anal canal. 2nd degree protrude outside the canal but go back in spontaneously. 3rd degree require you to push them back in manually, and 4th degree don’t go back in to your canal no matter what you do. The treatment for your piles depends on severity. If only minor, your doctor may choose to simply treat the symptoms, administering things like corticosteroids to reduce inflammation, laxatives if constipated, pain medication and anti-itch creams, as well as advising you to attempt not to strain while on the toilet, and to use simple pads to help with irritation.
If your pile is more cumbersome, your doctor can choose to remove or reduce the pile. They can do this in a variety of ways. Banding involves placing an elastic band around the base, cutting off blood-flow to the pile. After a few days, it will die and simply fall off. They can inject medications into the pile causing it to shrink, known as sclerotherapy. Let’s just hope it’s only a minor inflammation, because no one wants a Doctor cutting anything off down there! Probably best used at night just before sleeping. Subscribe today to check out our free Daily Knowledge Youtube video series! 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.
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