PILES : DEFINITION , CLASSIFICATION , CLINICAL FEATURES , INVESTIGATIONS & COMPLICATIONS

DEFINITION :

Dilated plexus of superior haemorrrhoidal veins , in relation to anal canal .

CLASSIFICATION :

1. Primary haemorrhoids :
 (a) standing position of the human being is partly responsible for piles because blood has to flow against gravity .
 (b) anatomical factor -the veins passing through the submucosa of the rectum , get constricted during the act of defaecation .
 (c) genetic factor -absence of valves or congenital weakness of vein wall .
 (d) constipation causes excessive straining .

2. Secondary haemorrhoids :
 (a) carcinoma of rectum , by blocking the veins can produce back pressure & can manifest as piles .
 (b) portal hypertension is the common cause .
 (c) pregnancy due to compression on superior rectal vein or due to progesterone which relaxes smooth muscle in the wall of the veins .
3. Depending upon the location of haemorrhoids :
 (a) internal haemorrhoids -above the dentate line , covered with mucous membrane .
 (b) external haemorrhoids - at anal verge , covered  with skin .
 (c) interno-external - both varieties together .

                                                                   

     

PILES

   

CLINICAL FEATURES : 

1. Painless bleeding - fresh bleeding occurs after defaecation . Haemorrhoids which blood are called grade 1 haemorrhoids .
2. as the straining increases ,the haemorrhoids partly prolapse outside . after defaecation , it return back ( grade 2 haemorrhoids ) or can be digitally replaced ( grade 3 haemorrhoids ) .
3. permanently prolasped piles outside ( grade 4 haemorrhoids ) .
4. constipation .
5.itching .
6. discharge of mucous or irritation of perianal skin .

INVESTIGATIONS :

Per rectum examination is done mainly to rule out carcinoma of rectum or other causes of bleeding per  rectum . Sigmoidoscopy & proctoscopy are done  to rule out proximal cancer .

COMPLICATIONS :

1. Chronic anaemia .
2. Severe pain.
3. Ulceration & secondary infection .
4. Thrombosis & fibrosis .