The Hemorrhoidal Plexus of veins which is located in Sub mucosal space above the values of Morgagni.
The Anal canal separates it from the external Hemorrhoidal Venous Plexus, but the two spaces communicate under anal canal, the sub mucosal of which is attached to underlying tissue to form interhemorrhoidal depression.
Whenever internal hemorrhoidal Plexus is enclosed there is associated increase in supporting tissue mass, and the resultant venous swelling is known as Internal Hemorrhoids. When veins in the external hemorrhoidal Plexus become enlarged or thromboses, resultant bluish mass is known as External Hemorrhoidal.
External & Internal Hemorrhoids are very common and are associated with increased hydrostatic pressure in portal venous system, characteristically noted during
Incomplete Evacuation & feces.
Whenever Internal Hemorrhoids enlarge, pain is not common feature until it's complicated by thrombosis, infection or erosion & overlying mucosal surface.
Most persons often complain of bright red Blood on the toilet tissue or coating the stool, with a feeling of vague disquiet about the state of their Anus.
The Discomfort is increased when the hemorrhoidal enlargement becomes great or prolepses through Anus.
Prolapse if not treated usually becomes chronic as muscularis stays stretched as patient complains of constant soiling of under clothing with very little pain.
Prolapsed Hemorrhoids may become infected or thrombosesed the overlying mucous membrane may bleed profusely, as it results trauma of defecation.
External Hemorrhoid, lying as they do under the Skin are quite often very painful, particularly if there is a sudden increase in mass. These Episodes result in a tender blue swelling at anal verge due to thrombosis of vein in the external Plexus and also it need not be associated with enlargement of Internal Veins. Since, thrombus usually lies at the level of Sphinteric muscles, anal spasm often occurs.
The diagnosis of Internal and External Hemorrhoids is made by inspection; digital Examination and Direct vision through the Anoscopy and proctoscope.
Alarming situation is an Acute Blood loss to shock levels can more certainly be attributes to Internal Hemorrhoids seen to be bleeding actively. (Bleeding Hemorrhoid)
Most Hemorrhoids respect to conservative therapy such as :
Internal Hemorrhoids which don’t respond to conservative therapy.
Internal Hemorrhoids, which remain permanently prolapsed are the Best treated by Surgery only
Milder degree of prolapsed or enlargement with pruritis ani or intermittent Bleeding can be successfully handled by Laser and Surgery.
External Hemorrhoids which become actually thrombosed are treated by the Laser Ablation.
Hematoma extraction of the clot and compressing insisted are follows clot removal.
In majority of cases piles are not very serious and go away on their own after a few days. An individual suffering from piles experience below symptoms:
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