haemorrhoids

(piles)

pl. n.

enlargement of the normal spongy blood-filled cushions in the wall of the anus (internal haemorrhoids), usually a consequence of prolonged constipation or, occasionally, diarrhoea. They most commonly occur at three main points equidistant around the circumference of the anus. Uncomplicated haemorrhoids are seldom painful; any pain is usually caused by an anal fissure. The main symptom is bleeding, and in first-degree haemorrhoids, which never appear at the anus, bleeding at the end of defaecation is the only symptom. Second-degree haemorrhoids protrude beyond the anus as an uncomfortable swelling but return spontaneously; third-degree haemorrhoids remain outside the anus and need to be returned by pressure.

First- and second-degree haemorrhoids may respond to bowel regulation using a high-fibre diet with faecal softening agents. If bleeding persists, an irritant fluid (a sclerosing agent) may be injected around the swollen cushions to make them shrivel up. Other effective treatments are infrared coagulation and the application of elastic bands. Third-degree haemorrhoids often require surgery (see haemorrhoidectomy), especially if they become strangulated (producing severe pain and further enlargement).

External haemorrhoids are either prolapsed internal haemorrhoids or - more often - perianal haematoma or the residual skin tags remaining after a perianal haematoma has healed.