Hemorroids
Definition
Haemorrhoids are dilated veins occurring in relation to the anus.
Types of haemorrhoids:-
o external
o internal
External variety is covered by skin
The internal variety is covered by mucous membrane.
When both are present together - called intero-external haemorrhoids.
Pathophysiology
Pile mass descends - gripped by the sphincters - more engorgement
o Mucosal gathering in relation to the three branches of superior rectal arteries called anal cushions - necessary for continence
o They slide down and internal haemorroids develop in the prolapsing tissues.
Aetiology
Heredity - congenital weakness of vein walls
an abnormally large arterial supply to the rectal plexus.
Varicose veins of the legs and haemorrhouds often occur concurrently
Most are idiopathic
Carcinoma rectum
Pregnancy
Straining at micturition
Thesuperior rectal veins being tributaries of the portal vein have no valves.
Straining accompanying constipation or that induced by overpurgation
Diarrhoea of enteritis, colitis or the dysenteries aggravates the latent haemorrhoids
Internal HaemorrhoidsCommonest.
o Internal haemorrhoids are arranged in three groups at 3,7, and 11 O'clock positions during lithotomy position.
o It is bright red or purple
o An external haemorrhoid - blue veins can be seen.
Clinical features
Symptoms of haemorhhoids
o bright red painless bleeding
o Mucus discharge
o Prolapse
o Pain only on prolapse
o Anaemia
Investigations
External haemorrhoid is visible on inspection itself - Redundant folds or tags of skin
On straining the internal haemorrhoids may become visible transiently
Proctoscopy
Digital examination - if thrombosed felt
Sigmoidoscopy should be done as a precaution in every case.
Complications
Strangulation
Thrombposis
Ulceration
Gangrene
Fibrosis
Suppuration
Pylephlebitis
Treatment
o Symptomatic
o Injection of sclerosant
o Banding
o Endostapler - stapling
o Haemorrhoidectomy
o Cryosurgery - abandoned
Indications for haemorrhoidectomy
o third-degree haemorrhoids
o Failure of nonoperative treatments of second-degree haemorhoids
o Fibrosed haemorrhoids
o Interoexternal haemorrhoids when the external haemorrhoids is well defined
