HAEMORRIODS

INTRODUCTION
Haemorroids also known as pile, is a pathological condition caused by painful masses of dilated veins in swollen anal tissue OR Haemorroid are varicosities or swelling and inflammation of veins in the rectum and anus.
Anatomically Haemorroids refers to cushions of tissue filled with blood vessels at the junction of the rectum and the anus. Perianal hematoma are sometimes misdiagnosed and mislabeled as haemorroid, when in fact they have different causes and treatments.
Haemorroids are common. In the United States of America, the prevalence is about 4.4%. Annually, about 10% of patients with symptomatic Haemorroids require surgery. According to the British medical journal of 1972 haemorroids “are common in economically developed communities, rare in developing countries, and almost unknown in tribal communities. where the influence of western countries is slight”.

TYPES OF HAEMORROIDS
•EXTERNAL HAEMORROIDS: Are those that occur outside the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. itching, although often thought to be a symptom from external haemorroids, is more commonly due to skin irritation.

•INTERNAL HAEMORROIDS: Are those that occur inside the rectum. As this area lack pain receptors, internal haemorroids are usually not painful and most people are not aware that they have them. Internal haemorroids, however, may bleed when irritated. Untreated internal haemorroids can lead to two severe form of haemorroids.
Prolapsed and strangulated haemorroids.
Prolapsed haemorroids- are internal haemorroids that are so distended that they are pushed outside the anus.
If the anal sphincter muscles goes into spasm and traps a prolapsed haemorroid outside the anal opening, the blood supply is cut off, and the haemorroids becomes a strangulated haemorroids.
By degree of prolapsed, internal haemorroids can be graded .
Grade i: the haemorroids do not prolapsed
Grade ii: the haemorroids prolapse upon defecation but spontaneously reduce.
Grade iii: the haemorroids prolapse upon defecation, but must be manually reduced.
Grade iv: the haemorroids are prolapsed and cannot be manually reduced.

CAUSES OF HAEMORROIDS
•Increased straining during bowel movements, by constipation or diarrhea. It is thus a common condition due to constipation caused by water retention in women experiencing premenstrual syndrome or menstruation

•Excessive consumption of alcohol or caffeine

•Obesity can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause haemorroids. Poor muscle tone or poor posture can result in too much pressure in the rectal veins.

•Hypertension, particularly portal hypertension can also cause haemorroids because the connections between the portal vein and the vena cava which occur in the rectal wall known as portocaval anastomoses

SYMPTOMS OF HAEMORRIODS
Haemorriods usually are not dangerous or life threatening. In most cases, haemorriodal symptoms will go away within a few days. Although many people have haemorriods but not all experience symptoms.
The most common symptoms of internal haemorriod is bright red blood covering the stool, on toilet paper , or in the toilet bowl. However, an internal haemorroid may protrude through the anus outside the body, becoming irritated and painful. This is known as protruding haemorroids.
Symptoms of external haemorroids may include painful swelling or a hand lump around the anus that results when a blood clot form. This condition is known as a thrombosed external haemorroid.
In addition, excessive straining, rubbing or cleaning around the anus may cause irritation with bleeding or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.


PREVENTIONS OF HAEMORROIDS
Prevention of haemorroids include drinking more fluids, eating more dietary fibers (such as fruits, vegetables and cereals high in fiber) exercising, practicing better posture, and reducing bowel movement and strain.
Haemorroid sufferer should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote haemorroid development.
Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking dietary fiber and fluids a couple of days prior to that time.
Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with haemorroids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.



TREATMENTS OF HAEMORROIDS
Treatments for haemorroids vary in their cost, risk and effective. Different culture and individuals approach treatment differently. For many people, haemorroid are mild and temporary conditions that heals spontaneously or by the same measure recommended for prevention.
NATURAL TREATMENT : Some people claim to have successfully applied natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. However, self-care measures, including herbal or natural remedies, should not be undertaken without medical consent to avoid possible drug interaction. They include;
Eating fiber-rich bulking agents such as plantain and psyllium seed husks to help create a softer stool that is easier to pass, to lessen the irritation of existing haemorroid.
Taking herbs and dietary supplements that strengthen vein walls.
Topical application of natural astringents and soothing agents such as witch hazel(astringent), cranebill, aloe vera, and honey.
 Reducing regional pressure in such ways as improving posture.


SURGICAL AND NON-MEDICAL TREATMENT
Some people require the following medical treatments for chronic or severe hemorrhoids:
•Rubber band ligation
Sometimes called Baron ligation: Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.
•Hemorrhoidolysis/Galvanic Electrotherapy
Desiccation of the hemorrhoid by electrical current.
•Sclerotherapy(injection therapy)
Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
•Cryosurgery
A frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues. Rarely used anymore because of side effects.
•Hemorrhoidectomy
A true surgical procedure to excise and remove hemorrhoids. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason is often now recommended only for severe (grade IV) hemorrhoids.
•Stapled Hemorrhoidectomy
Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.
•Enema
This practice is used to clean the rectum. While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor. In an enema, water is injected into the rectum and then flushed out, cleaning the area.
• Doppler Guided Hemorrhoidal Artery Ligation
The only evidence-based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately.


REFERENCES
Keith L. Moore, Arthur F. Dalley (1999). Clinically Oriented Anatomy.
Fourth edition. Lippincott Williams and Wilkins. page 402.

M.A. Owen (2008). Why Suffer From Haemorroids?
@ http:www.HaemorroidsInPlainEnglish.com.

S.D. Richard (2008). Natural Treatment and Prevention of Haemorroids or
Piles.@ http:www.FindInArticle.com.

Wikimedia (2008).Haemorroids @http: Wikipedia.org/haemorroids