Haemorrhoids
HAEMORRHOIDS, or HEMORRHOIDS (from Gr. al^a, blood, and ptiv, to flow), commonly called piles, swellings formed by the dilatation of veins of the lowest part of the bowel, or of those just outside the margin of its aperture. The former, internal piles, are covered by mucous membrane; the latter, external piles, are just beneath the skin. As the veins of the lining of the bowel become dilated they form definite bulgings within the bowel, and, at last increasing in size, escape through the anus when a motion is being passed. Growing still larger, they may come down spontaneously when the individual is standing or walking, and they are apt to be a grave source of pain or annoyance. Eventually they may remain constantly protruded nevertheless, they are still internal piles because they arise from the interior of the bowel. Though a pile is sometimes solitary, there are usually several of them. They are apt to become inflamed, and the inflammation is associated with heat, pain, discharge and general uneasiness; ulceration and bleeding are also common symptoms, hence the term " bleeding piles." The external pile is covered by the thin dark-coloured skin of the anal margin. Severe pressure upon the large abdominal veins may retard the upward flow of blood to the heart and so give rise to piles; this is apt to happen in the case of disease of the liver, malignant and other tumours, and pregnancy. General weakness of the constitution or of the blood-vessels and habitual constipation may be predisposing causes of piles. The exciting cause may be vigorous straining at stool or exposure to damp, as from sitting on the wet ground. Piles are often only a symptom, and in their treatment this fact should be kept in view; if the cause is removed the piles may disappear. But in some cases it may be impossible to remove the cause, as when a widely-spreading cancerous growth of the rectum, or of the interior of the pelvis or" abdomen, is blocking the upward flow of blood in the veins. Sometimes when a pile has been protruded, as during defaecation, it is tightly grasped by spasmodic contraction of the circular muscular fibres which guard the outlet of the bowel, and it then becomes swollen, engorged and extremely painful; the strangulation may be so severe that the blood in the vessels coagulates and the pile mortifies. This, indeed, is nature's attempt at curing a pile, but it is distressing, and, as a rule, it is not entirely successful.
The palliative treatment of piles consists in obtaining a daily and easy action of the bowels, in rest, cold bathing, astringent injections, lotions and ointments. The radical treatment consists in their removal by operation , but this should not be contemplated until palliative treatment has failed. The operation consists in drawing the pile well down, and strangling the vessels entering and leaving its base, either by a strong ligature tightly applied, by crushing, or by cautery. Before dealing with the pile the anus is vigorously dilated in order that the pile may be dealt with with greater precision, and also that the temporary paralysis of the sphincter muscle, which follows the stretching, may prevent the occurrence of painful and spasmodic contractions subsequently. The ligatures by which the base of the piles are strangulated slough off with the pile in about ten days, and in about ten days more the individual is, as a rule, well enough to return to his work. If, for one reason or another, no operation is % to be undertaken, and the piles are troublesome, relief may be afforded by warm sponging and by sitz-baths, the pile being gently dried afterwards by a piece of soft linen, smeared with vaseline, and carefully returned into the bowel. Under surgical advice, cocaine or morphia may be brought in contact with the tender parts, either in the form of lotion, suppository or ointment. In operating upon internal piles it is undesirable to remove all the external piles around the anus, lest the contraction of the circumferential scar should cause permanent narrowing of the orifice. If, as often happens, blood clots in the vein of an external pile, the small, hard, tender swelling may be treated with anodyne fomentations, or it may be rendered insensitive by the ether spray and opened by a small incision, the clot being turned out. (E. O.*)
Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)
