Abdominal Pain Distribution

Haemorrhoids/ Piles

Piles= a ball or mass
Haemorrhoids= flowing blood

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.

Types:
1. Internal - above dentate line and covered by mucosa only.
2. External - below dentate line and covered by skin.

Classification of Internal piles:
Primary Hemorrhoids: 3,7 and 11 o'clock in lithotomy position. Hemorrhoids in other places are called secondary.

1st degree- doesn't come out
2nd degree- return back spontaneously
3rd degree- returned back by manual help
4th degree- doesn't return back

Clinical Features:
Bleeding
Mass per anum
Pain if infected
Visualized on inspection if prolapsed
Proctoscopically visualized

Treatment:
1: Non operative:
Sitz bath
Fiber diet + plenty water +
Laxatives
Antibiotics
2: Sclerotherapy
3: Banding
4: Cryosurgery
5: Stapled Haemorrhoidopexy
6: Open operation
Ligation and excision
Submucosal haemorrhoidectomy