Definition:

• Haemorrhoids are referred to the condition in which the anal and perianal venous plexus is inflamed and dilated in and around the anus and lower abdomen. 

• They are described as the varicosities of the anal veins.

• • Piles (Latin – meaning balls)
  • And also Haemorrhoids (hem uh roids)

Anatomy :

• • Anal vein is terminated as internal and external venous plexus.
  • The Hemorrhoidal plexus is also called as Internal rectal venous plexus.

• • Both the internal and external venous plexus are thin-walled and dilated, when these dilated vessels protrude beneath the anal or rectal mucosa it is called Hemorrhoids

Types:

• • There are two types of hemorrhoids based on the region of inflammation either above or below the pectinate line (also called a dentate line).

• • They are;
    • • Internal hemorrhoids
    • • External hemorrhoids

• • Internal haemorrhoids are present above the pectinate line.
  • External haemorrhoids are present below the pectinate line.

Internal haemorrhoids :

• • Synonym – true piles.
  • They are present above the pectinate line.
  • Moreover the main cause is dilatation of the internal rectal venous plexus.
  • Overcoat – mucosa, and these bleeds.
  • These do not cause pain, because regions above the pectinate line are endodermic in origin.

• • These are grouped as primary piles and secondary piles
    • • Primary haemorrhoids:
        • • The primary piles occur in three positions, they are
            • • 3 ‘o’clock – left lateral position
            • • 7 ‘o’clock – right posterior position
            • • 11 ‘o’clock – right anterior position.
            • • Enlargement of the three main radicles of the superior rectal vein at respective regions causes primary piles.

    • • Secondary haemorrhoids:
        • • Varicosities in the other than these three positions of the lumen refers to secondary piles.
            • • Stage 1 – slight enlargement in the internal Haemorrhoid plexus
            • • Stage 2 – the Haemorrhoid finger passes the pectinate line
            • • Stage 3 – further protruding down where it is visible in the anal sphincter.
            • • Stage 4 – fully protruded out.

 

External Haemorrhoids :

• • Synonym – False piles
  • They are present below the pectinate line.
  • Cause – dilatation of the external rectal venous plexus.
  • Overcoat – skin
  • Location – below the anal skin -these skin stretch and form the skin tags.
  • This type causes pain because regions below the pectinate line are ectodermic in origin.
  • In external hemorrhoids, the Haemorrhoid protruded below the white line of Hilton.

Clinical features of Haemorrhoids:

• • Bleeding – first shown symptom, bleeds in bright red.
  • Moreover occurs during defecation.
  • Bleeding occurs as drops of red blood at the end of defecation.

• • Prolapse – 1⁰ hemorrhoids: bleeds but does not prolapse
    • • 2⁰ Haemorrhoids: prolapse on defecation but return spontaneously
    • • 3⁰ Haemorrhoids: bleeds and prolapse on defecation, it has to be replaced manually.
    • • 4⁰ Haemorrhoids: bleeds and permanently prolapsed.

• • Discharge – frequent mucoid discharge
  • Anemia – in case of severe chronic bleeding
  • Sudden painful condition along with discomfort.
  • Tender swelling is seen
  • Pain on defecation.
  • Constipation.

Causes of Haemorrhoids:

• • Firstly, Portal hypertension
  • Chronic constipation and straining in stool
  • Cardiac failure
  • Venous status of pregnancy
  • Hereditary predisposition
  • And also tumors of the rectum.

Risk factors:

• • First;y, Portal hypertension
  • Increased intra-abdominal pressure
  • Severe constipation and straining during defecation.
  • Pregnancy
  • Obesity
  • And also heavy lifting

Diagnosis:

• • Microscopically – In internal piles thin-walled and also dilated tortuous veins are seen under the rectal mucosa.
  • External piles are seen under the anal skin. In prolapsed piles, thrombosis, hemorrhage, inflammation, scarring, and strangulation are seen.
  • Investigation – digital examination, ano – proctoscopy examination and also sigmoidoscopy.