Hemorrhoids (Piles)

S.S Hotchandani4th year BDS Student at Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan.

Introduction

Greek word..Haim; Blood Rhoos; Flowing

Latin Word

Pila; Ball

Introduction

Prevalence of Asymptomatic Piles is greater

than Symptomatic

Piles.

Piles

Internal

Primary

Secondary

External

Internal Hemorrhoids Piles inside Anus…

Occur in Anal Cushions, usually at 3, 7 & 11 o'clock Position.

AKA, Symptomatic Anal Cushions

Called as Secondary if they occur in b/w Primary masses…

Causes of PRIMARY Internal Hemorrhoids

There are some misconceptions about the anatomy of vascular system of anal canal and these misconceptions has led to give many theories about the Development of Primary Internal Hemorrhoids…

PORTAL HYPERTENSION & VERICOSE VEINS

Man’s upright or standing posture contribute to hemorrhoids formation, though there are no any cases of hemorrhoids in Animals!!

Portal venous system does not contain any valves and this causes backward flow and dilate Anal cushions’ blood vessels & cause piles.

Increased abdominal pressure contribute to formation of anal varicosity resulting piles.

Note; Prevalence of Ano rectal varices is greater than Piles in Patients of Portal Hypertension..

Other Theories or Causes told by Some Scholars!!

Hemangioma

Infection

Diet & Stool

Anal Hypertonia

Ageing

New Concept about Development of Piles.

Shearing forces which act on anus causes displacement of anal cushions caudally and also mucosal trauma..

With time, fragmentation of supporting structures causes loss of elasticity of cushion and they do not retract back after defecation

Causes of Secondary Internal Hemorrhoids (LOCAL)

Anorectal Deformity

Hypotonic Anal Sphincter

Causes of Secondary Internal Hemorrhoids (Abdominal)

ASCITES

Causes of Secondary Internal Hemorrhoids (Neurological)

Paraplegia

Multiple Sclerosis

Causes of Secondary Internal Hemorrhoids (Pelvic)

Gravid Uterus Uterine Neoplasm

Ovarian Neoplasm

Bladder Carcinoma

ClinicalFeatures

Bleeding

Pain

Anal irritation

Constipation

Mucous Discharge

Prolapse

• Permanently Prolapsed

4t

h Degree

• Prolapse but goes bac k ma nua lly

3r

d Degree

• Prola pse but g oes ba ck spontaneous ly

2n

d Degree

• Bleed only, no Prolapse

1s

t Degree

Degrees of Hemorrhoids

Ulceration

Gangrene

Portal Pyaemia

Fibrosis

Strangulation &

Thrombosis

Complications

MANAGEMENT

Medical & Surgical

Conservative Treatment

Exclude other cause of bleeding from anusNormalize bowel and defecation habits.

Only evacuating stool when natural desire appears

Adopting defecation position so that minimal straining occur during defecation

Use of stool softener and bulking agents.

Surgical ManagementInjection

Sclerotherapy

HaemorrhoidectomyBanding

THANKS!

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