Causes and diagnosis of haemorrhoids or piles

 Causes and diagnosis of haemorrhoids or piles

First the piles are classified into according to their location in the anal canal into

Internal piles

Above dentate line their vessels arise from superior haemorrhoidal plexus they are covered with pink rectal mucosa

 Below the dentate line their vessels arise from the inferior haemorrhoidal plexus they are covered with violet anal mucosa or skin

Internal -external mixture of the above two types usually with a groove between them also piles are further classified by the

 Degree of prolapse and for purposes of treatment into

 First degree

Project into the lumen during straining ,but don not prolapse

Second degree

 Prolapse during defecation then is reduced spontaneously into the anal canal
 
 Third degree

Prolapse during defecation require manual reduction
 
Fourth degree

prolapsed irreducible haemorrhoids  all patients should have at least rigid sigmoidoscopy to exclude colorectal cancer bleeding pile needs to differentiated from mucosal rectal prolapse anal warts and
                                                                                                                     carcinoma prolapsed rectal polyps or skin tags associated with anal fissures also should be distinguished from rectal varices in patient with portal hypertension internal piles can be classified into either primary or secondary

Secondary piles

 Where their is apparent organic causes as at the level of the heart congestive heart failure or constrictive pericarditis at the level of the liver portal hypertension loner down in abdomen or pelvis retroperitoneal sarcoma fibroid pregnant uterus and ovarian tumour  NB. carcinoma of rectum is an important and frequently overlooked causes of piles the growth as it infiltrates the rectal wall , obstruct the superior haemrrhoidal vein

 Primary piles

 Commonest no underlying causes their are either predisposing factors either anatomical or hereditary or precipitating factors as in chronic straining as in senile enlarged prostate or chronic constipation or prolonged standing number and position of the piles the position of the piles is determined by the superior rectal arty the artery divided into right branch which gives an anterior and posterior branches the left branch does not divided the dilatation of the veins accompanying

these main branches give rise to the three mother piles (3,7,11 o,clock)minor veins may give rise to daughter piles maximum five in number clinical features piles are commoner in males they are rare below 20 years

Symptoms

 Include 1- bleeding per rectum during or after defecation which is bright red in colour and separate from stools on surface not mixed within it is often slight and noted on toilet paper sometimes it is more pronounced and drips into the plan but is rarely massive 2- prolapsed piles 3- slight mucus discharge which may lead to pruritis ani may occurs in patient with prolapsed piles 3- mild anal discomfort .acute or sever pain is not a symptoms of piles unless there is complication such as thrombosis or anal fissure or rectal abscess4- mild obstructive defecatory symptoms occurs in patients with bulky prolapse piles digital rectal examination and proctoscopy confirms the diagnosis

tags:piles,haemorrhoids,causes,diagnosis