Hemorrhoids (piles)

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

IntroductionGreek word..Haim; Blood Rhoos; FlowingLatin WordPila; Ball

IntroductionPrevalence of Asymptomatic Piles is greater than Symptomatic Piles.

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 HemorrhoidsThere 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 VEINSMans 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..

Author (A) - Other Theories or Causes told by Some Scholars!!

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)

Causes of Secondary Internal Hemorrhoids (Abdominal)

Causes of Secondary Internal Hemorrhoids (Neurological)

Causes of Secondary Internal Hemorrhoids (Pelvic)


Degrees of Hemorrhoids


MANAGEMENTMedical & Surgical

Conservative TreatmentExclude other cause of bleeding from anusNormalize bowel and defecation habits. Only evacuating stool when natural desire appearsAdopting defecation position so that minimal straining occur during defecationUse of stool softener and bulking agents.

Surgical Management

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