PILES / HAEMORRHOIDS

Piles / Haemorrhoids

Definition

Piles, or haemorrhoids, are masses of tissue that can be found inside the rectum (internal haemorrhoids) or around the anus (external haemorrhoids).

Vascular Anatomy of Haemorrhoidal Plexus

• The haemorrhoidal plexus is a network of veins surrounding the rectum.
• It receives blood from the superior and inferior rectal veins.
• The superior rectal vein is a branch of the inferior mesenteric vein.
• The inferior rectal vein is a branch of the internal pudendal vein.

Differentiation between Internal and External Haemorrhoids

• Internal Haemorrhoids
  • Located above the pectinate line (dentate line).
  • Commonly caused by increased venous pressure.
  • May be asymptomatic or present with painless bleeding.
• External Haemorrhoids
  • Located below the pectinate line (dentate line).
  • Commonly caused by trauma or straining during bowel movements.
  • May be painful and bleed.

Etiopathogenesis

• Causes
  • Increased venous pressure.
  • Constipation or straining during bowel movements.
  • Pregnancy.
  • Family history.
• Risk Factors
  • Age.
  • Obesity.
  • Lack of fibre in the diet.
  • Chronic liver disease.

Clinical Features

• Symptoms
  • Bleeding during bowel movements.
  • Prolapse of haemorrhoids during bowel movements.
  • Pain or discomfort.
  • Itching or irritation around the anus.
• Complications
  • Thrombosis of haemorrhoids.
  • Ulceration of surrounding skin.

Investigations

• Physical Examination
  • Digital rectal examination to feel the haemorrhoids.
  • Visual inspection of the anus and rectum.
• Endoscopy
  • Sigmoidoscopy or colonoscopy to visualize the rectum and colon.

Management

• Conservative Management
  • Dietary changes.
  • Increased fibre intake.
  • Regular bowel movements.
  • Pelvic floor exercises.
• Surgical Management
  • Haemorrhoidectomy (excision of haemorrhoids).
  • Rubber band ligation (banding).
  • Sclerotherapy (injection of sclerosing solution).

Procedures

• Rubber Band Ligation (Banding) → Step 1: Insertion of a lubricated anoscope. → Step 2: Placement of a rubber band around the base of the haemorrhoid. → Step 3: Cutting of the haemorrhoid below the rubber band.
• Sclerotherapy → Step 1: Insertion of a lubricated anoscope. → Step 2: Injection of a sclerosing solution into the haemorrhoid. → Step 3: Obstruction of blood flow to the haemorrhoid.

Homoeopathic Therapeutic Medicines

• Aesculus hippocastanum
  • Indication: Painful haemorrhoids.
• Hamamelis virginiana
  • Indication: Bleeding haemorrhoids.
• Nux vomica
  • Indication: Constipation and haemorrhoids.

Complications

• Thrombosis
  • Painful and bleeding haemorrhoids.
• Ulceration
  • Skin irritation and bleeding around the anus.