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HAEMORRHOIDS

It is also known as piles, these are swellings that can occur in the anus and lower rectum (back passage).
There is a network of small veins (blood vessels) within the inside lining of the anus and lower rectum. These veins sometimes become wider and engorged with more blood than usual. These engorged veins and the overlying tissue may then form into one or more small swellings called haemorrhoids. Initially, they are located just inside the anus (internal haemorrhoids) but can sometimes protrude (external haemorrhoids). Haemorrhoids are not dangerous (unless you leave it to bleed).

Causes:
1. Sitting for long periods of time can start the hemorrhoidic process.
2. Increased straining during bowel movements caused by constipation or diarrhea may lead
    to hemorrhoids. It is thus a common condition due to constipation caused by water
    retention in women experiencing premenstrual syndrome or menstruation.
3. Hypertension, particularly portal hypertension, can also cause hemorrhoids because of the
    connections between the portal vein and the vena cava which occur in the rectal wall-
    known as portocaval anastomoses.
4. Obesity can be a factor by increasing rectal vein pressure. Poor muscle tone or poor
    posture can result in too much pressure on the rectal veins.
5. Pregnancy may lead to hypertension and increase strain during bowel movements, so
    hemorrhoids are often associated with pregnancy.
6. Cigarette smoking during bowel movements, may worsen hemorrhoid, may lead to severe
    internal bleeding of veins inside rectum area. Both can cause diarrhea. Note that caffeine
    ingestion increases blood pressure transiently, but is not thought to cause chronic
    hypertension.

Symptoms:
Internal Haemorrhoids-
Haemorrhoids may be present for many years but remain undetected until symptoms appear. They can cause anal bleeding and itching and also pain and discomfort.
Normally, the bleeding is limited to small stains of fresh blood on the toilet paper, but more severe bleeding can sometimes be present when stools are passed.
A lump may also be felt in the anus and large haemorrhoids give a sensation that the bowel hasn't emptied completely.
In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious circle of symptoms. Draining anal mucus, produced by the dentate line may also cause itching.

Grade of haemorrhoids-
1.Grade 1- are common, develop on the inside lining of the back passage, and cannot be seen or felt from outside the anus.
2.Grade 2- are larger, and are sometimes pushed out (prolapse) from the anus when you go to the toilet. However, afterwards, they return inside.
3.Grade 3- one or more small lumps hanging from anus can be felt. It will be able to push them back inside using finger.
4.Grade 4- can become quite large, and permanently protrude (hang down) form the anus. They cannot be pushed back inside.

Investigation:
After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor may conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor may also look for indications of rectal tumor or polyp, enlarged prostate and abscesses.
Visual confirmation of hemorrhoids can be done by doing an anoscopy, using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.
If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 60 cm of the colon and rectum are examined whereas in colonoscopy the entire large bowel (colon) is examined.

Treatment:
1.Avoid constipation and straining in toilet-
a.Drink plenty of water atleast 3to 4 litres in a day that will help in soften the feces.
b.Fibrous food must be added in the diet such as fruits, vegetables, cereals etc.
c.Avoid painkiller that contain codeine as they cause constipation.
d.Toileting- when urge is present to pass stool it should not be suppressed as suppression causes hardening of stools.
2. Use of ointments and cream for the passage of stool.
3. Surgery in cases of grade 4 piles.
4. homoeopathy- Homeopathic medicines are very effective in management of piles and the symptoms associated with it such as pain, bleeding, itching, etc. The point to be emphasized is that the relief of symptoms is obtained with absolute gentleness and without invasion or surgery of any kind. Moreover, the condition has high relapse rate following surgical treatment, since surgery does not target the root causes like genetic tendencies, habitual constipation, etc. Homeopathic medicines work at the root level and can modify these genetic tendencies thus reducing chances of relapse and recurrence of the condition significantly. Grade 1 and 2 of internal piles can be significantly helped with homeopathy. Grade 3 piles can find some relief of symptoms with homeopathy but may not be completely cured. Grade 4 piles can get symptomatic relief with medicines. 

Preventing the return of piles
Having got rid of piles there is a lot can be done to help prevent their recurrence. Stick to a high fibre diet and drink lots of liquid - every day
Do not rely on convenience foods/ fast foods.
When bowels are open, don't strain. The correct diet should ensure quick and comfortable passage of stools.
Drink plenty of water and exercise in moderation.

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