Some of the common problems occurring at the Anus & Rectum

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SPECIALITY CENTRE FOR ANORECTAL PROBLEMS.

PILES (Haemorrhoids)

Internal piles: Soft swellings of engorged, tortuous vessels, covered by mucus membrane inside the lower rectum, usually 3 in numbers.

External piles: Similar swellings outside the anal canal, below the anal skin.
Interno-external piles: Both the piles combined together.

Though the piles are present in every individual, unless they start giving trouble or become pathological, they should not be considered for the treatment.

INTERNAL HAEMORRHOIDS
Causes: Hereditary- Morphological- Anatomical- Personal tendency to have piles.

Exciting causes: colitis, dysentery, diarrhea aggravates the latent hemorrhoids.

Secondary causes: straining due to constipation, carcinoma of rectum, pregnancy, urethral stricture or enlarged prostate.

Symptoms:

Bleeding: Slight to profuse. Prolapse : Piles comes out f of the anus as they grow. I to IV degree. Mucous discharge: irritation & discomfort. Pain: only if complications occur. Anaemia: due to blood loss.

First degree Piles: Do not prolapse, but bleed. Seen through proctoscope.

Second Degree Piles: The piles comes out up to the anal verge but reverts back spontaneously if straining is over.

Third degree: The piles comes out of the anus & has to be pushed in.

Fourth degree : The piles always remains outside the anus.

Complication of piles: Profuse bleeding, Inflammation, Ulceration, Thrombosis, Strangulation, Gangrene, Fibrosis, Suppuration & pyelephlebitis (rarely).

Treatment:

Non operative or conservative treatment:

1) Antibiotics & other medicines, Hot water tub bath & Proprietory ointments- are given to reduce the infection, pain & swelling.
2) Laxatives to soften the stools.
3) Life style management of diet, rest & stool habbits.

Active treatment:

Parasurgical procedures:
Sclerotherapy: Sclerosant injection in the internal piles will cause the fibrosis. Ideal for I & II degree piles.

Banding Treatment (Barron): A tight elastic band is slipped at the base of the pile which will strangulate the piles & will cause the fibrosis. Good for II degree.

Coagulation of piles: by Infrared, Laser, electrical, thermal or Radio frequency. May be useful for selected cases.

Surgical treatment:
Indications: III & IV degree piles, complicated piles, failure of non-operative treatment & external piles – requires surgery.

Many surgical procedures are available: Ligation and excision, MIPH-minimal invasive procedure or staple haemorrhodectomy, THD-Trans anal haemorrhoidal dearterilization.

Choice of the Procedure depends on the condition of the patient, the type & degree of the piles, and associated illnesses. Should suit to the individual patient. In one patient different procedures may have to be adopted.

1) Perianal Haematoma- Blood clot under anal skin.
If the pain & swelling does not subside with the conservative treatment, pt. may require evacuation of the clot under Local anaesthesia.