A patient described as having ‘painful itchy piles’ may well be suffering from an anal fissure, particularly when associated with a sentinel tag masquerading as a pile. The term ‘strangulated piles’ may be misapplied to this condition, causing inappropriate and inevitably unsuccessful efforts at supposedly therapeutic replacement. Many patients have not tried manual replacement of their piles after defaecation, having been ‘afraid to’, and therefore put up with more discomfort than they need. Since anal cushions are normal structures , their distinction from piles is only one of degree. Bright red granularity of the mucosal part of a cushion is certain evidence of its disruption, and the extent to which the cushions bulge into the instrument’s end on straining and follow it out on withdrawal, provide a valuable guide. Defaecatory derangement can be excited by disrupted anal cushions causing a sensation of incomplete evacuation, particularly when further engorged by fruitless straining. Because piles are common, finding them does not rule out another condition higher in the rectum causing the symptoms. When a meticulous history suggests piles and the findings agree, examination can be confined to the anorectum.
Many, however, would disagree and argue for routine adjunctive fiber-optic inspection of the distal colon, at least in those over 40 years of age for rectal bleeding, however described and whatever the anoscopic findings. At the very least this will get you giggling. Typically, too, the pain of a fissure will start some 30 min after defaecation and continue for 2 to several hours. And the same treatments allow us to get rid of any pain being experienced by the individual such as plantar fasciitis, golf and tennis elbow, and pains to back, legs and hips, where we can treat men and women. This will get you excited and aroused. Thrombosis and clotting in the vein sacs also influence the appearance of the pile, but as an indication there will be associated discomfort or, depending on the extent of clotting and consequent infarction, frank pain. Often called ‘strangulated’ piles or an ‘attack of the piles’, they are usually due to greater or lesser degrees of infarction resulting from obstruction of venous drainage by thrombosis and consecutive clotting in the sacculated venous plexus. Fig. 19 Postdefaecation oedema also occasionally contributes greatly to the bulk of ‘prolapse’, and must result in some way from impairment of either venous or lymphatic drainage.
Clotting of a small part of the venous plexus causes an uncomfortable attack of swelling of the pile, with oedema but little infarction. Mucus discharge from a prolapsed pile, however, causes an alleviable irritation in some patients. Lack of circulation is one of the major causes of impotence so the basic key to overcome this condition is to drink lots of water. Greater degrees of obliteration of venous drainage embarrass the circulation accordingly . Although necrosis would supervene if circulatory impairment by venous blockage were sufficient, complete obstruction of venous return is in fact very rare and the usual outcome is spontaneous resolution as the clot shrinks and lyses and venous circulation is restored. It was also common to occur in people who had some type of blockage in childhood. Infarction is used here in its proper sense, denoting an intravascular and interstitial ‘stuffing with blood’, and not in its common contemporary misusage implying necrosis. Fig. 21 Later effects of clotting of the sacculated venous plexus with infarction of the pile.
However, even the fully infarcted pile will, despite its appearance, resolve. There is, however, no evidence for the claim still occasionally made that haemorrhoids can result from rectal carcinoma or pelvic masses. This would seem good evidence that successful treatment of the ED removes it as a cause of secondary depression. Although claimed to be a prominent and attributable problem, there seems to be no good reason why a disrupted anal cushion should actually be painful. It made me wonder why British royalty (with their British sense of humor) have not chosen to give all their female heir apparents the name Alice, who could then possibly grow up to marry men with the name Hatter. A fulfilling life has come to also mean a healthy life, which is why impotence sufferers and in fact, everyone would definitely want a chance at both. Over all, 52 percent of men from 40 to 70 had experienced varying degrees of impotence.