Hemorrhoidal cushions are normal anatomical structure located within the anal canal, usually occupying the left lateral and right anterior and posterior position.

As they enlarge, they can protrude outside the canal causing symptoms.They become pathological or piles when swollen or inflamed.

at this point technically known as hemorrhoidal disease.

piles develops when the venous drainage of the anus is altered , causing the venous plexus and connecting tissue to dilate, this creating an outgrowth of anal mucosa from the rectal wall.

it can occur above or below the dentate line.

Epidemiology:-

4.4% in general population with peak incidence in both sexes between 45-65years.

Men are more likely to get hemorrhoids than females.

In india , it’s prevalence is 75% of the population.

Risk factors:-

Age between 45-65years.

chronic diarrhea or constipation

pregnancy or space occupying pelvic lesion

Hepatic insufficiency 

inadequate fiber diet

sedentary life style 

Gravidity 

Lack  of physical activity

Obesity 

colon malignancy

Alcoholism

Heart disease 

Sypmtoms:-

A total 40% of individuals with hemorrhoids are asymptomatic.

-Internal piles are usually painless.

-There may be constant feeling of vague discomfort.

-When the piles are prolapsed, this discomfort is increased.

-There may be bright red rectal bleeding during or following defecation.

-There may be discharge of mucus and itching in the anus.

Internal hemorrhoids

Based on the symptoms , internal hemorrhoids are classified into four grades.

Grade 1 hemorrhoids :-

-small inflammation usually painless and remain inside the lining of anus.

-They are not visible.

-Minor bleeding occur from time to time after a bowel movement.

 Grade 2 hemorrhoids:-

 -Swelling is larger than grade 1.

 -But also inside the anus. 

-When passing stool they may get pushed out , but returns spontaneously to its place afterwards.

Grade 3 hemorrhoids 

-Also called prolapsed hemorrhoid

-Appear outside the anus.

-The patient may feel hanging out

-They must be pushed back manually with the fingers.

Grade 4 hemorrhoids 

-prolapsed 

-It protrudes constantly and will fall out again if pushed back into rectum.

-There may or may not be bleeding

-Prolapsed hemorrhoids can be painful if they are struggled by anus or if a clots developed.

External Hemorrhoids 

-External piles often cause itching , burning may cause bleeding .They are bluish colored masses of venous engorgement with severe pain and anal spasm.They are small lumps that are located on the outside edges of anus.They are very itchy and can painful if blood clot forms inside.

Diagnosis

General physical Examination

  1. Lump or swelling

  2. Internal hemorrhoids that have fallen through the anal opening called prolapse.

3.External hemorrhoids with a blood clot in a vein

4. Leakage of  stool or mucus

5. skin irritations 

6. Skin tags

7. Anal fissures.

prevention

The best way to prevent the hemorrhoids is to keep Stool soft, so they pass easily.

To prevent the hemorrhoids and reduce the symptoms follow this tips:-

Drink plenty of fluids

Eat high fiber foods

Go as soon as feel the urge

Don‘t strain

Exercise