06 March,13

Haemorrhoids (\'piles\') are venous swellings of the tissues around the anus: those above the dentate line (the point where the modified skin of the outer anal canal becomes gut epithelium), which usually protrude into the anal canal, are termed internal haemorrhoids, while those below this point are called external haemorrhoids. Due to internal pressure, internal haemorrhoids tend to congest, bleed, and eventually prolapse; with external haemorrhoids painful thrombosis may develop.

Initial treatment of internal haemorrhoids involves a high-fibre diet and avoidance of straining at stool, so bulk laxatives and faecal softeners may be indicated. Small bleeding haemorrhoids may be injected with a sclerosing agent such as oily phenol injection, but rubber band ligation, or perhaps a technique such as infra-red coagulation, is more effective and associated with fewer complications.

More severe and prolonged prolapse generally requires surgery. Surgical excision to remove the clot is used for thrombosed external haemorrhoids.
An enormous range of mainly topical drug treatments is available for symptomatic relief, but in many cases their value is at best unproven.

Topical preparations are usually made up in a lubricating or emollient base. Local anaesthetics may be included to relieve pain, and corticosteroids may be used where infection is not present: preparations containing either group of drugs are intended only for short-term use. Inclusion of antibacterials is thought to be of little value and may encourage the development of resistant organisms.

Some preparations include heparinoids. Other agents frequently included for their soothing properties include various bismuth salts, zinc oxide, hamamelis, resorcinol, and peru balsam.

Bioflavonoids and various derivatives of aesculus may also be included in topical preparations; they have also been given systemically in some countries as have some other compounds such as calcium dobesilate and tribenoside, presumably for their supposed action on venous capillary walls. Oral micronised bioflavonoid preparations may reduce symptoms as an adjunct to surgery.

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