It is a dilated
tortuous veins in one or both hemorrhoid
plexuses within or near the anal canal
:
Hemorrhoids Description
:
Hemorrhoids
(often known as Piles) are enlarged
and engorged (Congested) blood vessels
in or around the back passage (anus).
These may be associated
with pain, bleeding, itching and feeling
as if a lump or bump is hanging down.
Hemorrhoids Symptoms :
- Pain or ache may
be noticed around the anus and lower
bowel (rectum), which can be quite
sever.
- There may be itching of the area.
- There may be bleeding from the
back passage. This will be bright
red blood often seen on the toilet
paper.
- There is often a feeling of something
coming down, or a bulge or lump
at the anus.
- If a hemorrhoid at the outside
of the anus gets a blood clot in
it (thrombosed external pile) it
leads to a particularly tender,
hardish lump.
Hemorrhoids Prevalence
:
- Hemorrhoids are extremely
common, occurring in up to 50 % of people
by the age of 50.
- They are more common in countries
where the diet has traditionally been
more processed and low in fiber.
- The main contributory causes involve
events that raise the pressure in the
abdomen. - - This causes the blood vessels
to swell and become engorged.
Hemorrhoids Causes :
- Individuals exposed
to raised abdominal pressure.
- Chronic Constipation or Diarrhea.
- Persistent straining at stool combined
with ingestion of diets deficient in
fiber.
- The elderly.
- Overweight people.
- People with heavy lifting jobs.
Hemorrhoids
Causes (cont.)
Hemorrhoids Types :
Normal
Anal Anatomy
Internal
Hemorrhoids
- Are
formed from the superior hemorrhoidal
plexus.
- If the hemorrhoids are ruptured
which usually happens from bowl
movements, bleeding will occur.
External Hemorrhoids :
- Arise from
the inferior plexus covered
with this peri-anal skin.
- Bleeding can occur if the
thin skin layer is ruptured.
Internal & External Hemorrhoids
:
Most
patients have a combination
of both internal and external
Hemorrhoids because there is
a free communication between
the two plexuses.
Hemorrhoids Clinical Features
:
- The main
symptoms are bright red blood on the
toilet paper or on the outside of the
stool, and blood may drip into the pan
after defecation.
- Prolapse of the hemorrhoid will present
as a mass outside the anus.
- Initially it will reduce spontaneously,
but if not treated will eventually prolapse
with each defecation.
Hemorrhoids : Diagnosis
- On anal examination, swollen
blood vessels usually indicate
hemorrhoids.
- Closer evaluation of the rectum
for hemorrhoids requires an exam
with an anoscope, a hollow, lighted
tube useful for viewing internal
hemorrhoids, or a proctoscope,
useful for more completely examining
the entire rectum.
- At proctoscopy, the hemorrhoids
bulge into the anal canal as the
instrument is slowly removed.
Anal Fissure Definition
:
An anal
fissure is a small tear or cut
in the skin lining the anus
which can cause pain and/or
bleeding.
Anal Fissure Anatomy
:
Normal
Anal Anatomy
A
Simple Acute Fissure,
Trans-anal View
Anal Fissure OVERVIEW
:
- A fissure
is a tear in the skin of the
anus, usually caused when
a large, hard stool overstretches
the anal opening and damages
the fragile skin.
- It is often associated with
constipation, and less frequently,
with chronic diarrhea, inflammatory
bowel disease or sexually
transmitted diseases that
involve the anus and rectum.
- Sometimes, the cause is
unknown.
Anal Fissure Description
:
- An anal fissure
is a tear in the squamous epithelium
that lines the anal canal.
- Most fissures (90%) occur in
the posterior midline and the
remaining 10% occur in the anterior
midline.
- The pathogenesis appears to
relate to a cycle of pain and
sphincter muscle spasm, - perhaps
with associated ischemia.
- The major symptom of a fissure
is Severe Pain, starting at the
time of defecation and lasting
up to several hours afterward.
In
addition to the pain, other symptoms
can include:
- Bleeding.
- Itching.
- Discharge.
Prevention: Hemorrhoids
Anal Fissure :
Mild Cases
:
- Avoid constipation.
- Drinking fluids.
- Rich fiber diet.
- Measures for softening of the
stool (laxolac, sorbit).
Treatment :
First
Line of Treatment
:
- Local
Soothing Cream
- Suppositories
SEDIPROCT
Surgical
Intervention
- Excision
or dilatation (Fissures)
Hemorrhoids:
- Rubber band ligation
- Surgical hemorrhoidectomy.
