PILES, FISSURES ANAD FISTULAS
Hemorrhoids also called piles, are
swollen and inflamed veins in your anus and lower rectum. Hemorrhoids may
result from straining during bowel movements or from the increased pressure on
these veins
Types
A] External piles- present as a swelling outside the anus with irritation and
itching. These can be painful sometimes and usually do not bleed.
B] Internal piles- Internal
piles are usually not painful but these bleed when they are irritated such as
during the passage of hard stools. They can be classified into four grades:
• Grade 1 piles are small swellings
on the inside lining of the anus. They cannot be seen or felt from outside the
anus.
• Grade 2 piles are partly pushed out
(prolapse) from the anus when you go to the toilet, but quickly 'retract back'
inside again.
• Grade 3 piles hang out (prolapse)
from the anus and are felt as one or more small, soft lumps that hang from the
anus. However, they can be pushed back inside the anus with a finger.
• Grade 4 piles permanently hang down
from within the anus, and cannot be pushed back inside. They can sometimes
become quite large
Primary haemorrhoids: These are three in
number seen at 3, 7 & 11 o’clock positions.
Secondary haemorrhoids: Presence of additional haemorrhoids in between the primary piles is
known as the secondary piles.
Signs and symptoms
Painless bleeding during bowel
movements — you might notice small amounts of bright red blood on your toilet
tissue or in the toilet bowl
·
Itching or irritation in your anal
region
·
Pain or discomfort
·
Swelling around your anus
·
A lump near your anus, which may be
sensitive or painful
·
Leakage of feces
Haemorrhoids
symptoms usually depend on the location.
Internal hemorrhoids lie inside
the rectum.You usually can't see or feel these hemorrhoids, and they usually
don't cause discomfort.
But straining or irritation when
passing stool can damage a hemorrhoid's delicate surface and cause it to bleed.
Occasionally, straining can push an internal hemorrhoid through the anal
opening. This is
known as a protruding or prolapsed
hemorrhoid and can cause pain and irritation.
External hemorrhoids are under
the skin around your anus. When irritated, external hemorrhoids can itch or
bleed. Sometimes blood may pool in an external hemorrhoid and form a clot
(thrombus), resulting in severe pain, swelling and inflammation.
Causes
The veins around your anus tend to
stretch under pressure and may bulge or swell. Swollen veins — hemorrhoids —
can develop from an increase in pressure in the lower rectum. Factors that
might cause increased pressure include:
·
Straining during bowel movements
·
Sitting for long periods of time on
the toilet
·
Chronic diarrhoea or constipation
·
Obesity
·
Pregnancy
·
Dietary habits: elimination of cereal
fibres from the diet results considerably in the high incidence of chronic
constipation and ultimately haemorrhoids
·
Anal
inter) Hereditary: Some
defect in the venous structure has been held responsible. e.g. congenital
weakness of the walls of vein.course
·
Constipation: Straining in
constipated persons results in the engorgement of internal haemorrhoidal veins,
giving rise to the disease piles.
2] Anal Fistula
WHAT IS AN ANAL FISTULA?
Anal fistula, or fistula-in-ano, is an abnormal
connection or channel like structure, between the surface of the anal canal
and the exterior perianal skin.
Anal
fistulae originate from the anal glands, which are located between the two
layers of the anal sphincters and which drain into the anal canal. If the
outlet of these glands becomes blocked, an abscess can form which can
eventually point to the skin surface. The tract formed by this process is the
fistula.
Ancient
Ayurveda surgeon, Susruta has described five types of Bhagandara(Sataponak,
Ustragriwa, Parisrabi, Sambukawarta, Unmargi). They have been classified
according to the vitiation of the three doshas and the shape & site of
the fistula tract.
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CAUSES OF FISTULA?
Anal fistulas commonly occur due to an anal abscess.
An abscess is a collection of pus and infected fluid. An anal abscess
usually develops after a small gland, just inside the anus, becomes infected
with bacteria.
A fistula may occur if an abscess has not completely healed, or if the
infected fluid has not been entirely drained away.
An anal fistula may also develop as a result of:
·
a growth or ulcer (painful sore)
·
a complication from surgery
·
a congenital abnormality (a health
problem that you were born with)
Anal fistulae are also a common complication of conditions that result
in inflammation of the intestines. Some of these conditions include:
·
Irritable bowel syndrome (IBS): a
chronic (long-term) disorder that affects the digestive system, causing
abdominal pain, diarrhoea and constipation.
·
Diverticulitis: the formation of
small pouches that stick out of the side of the large intestine (colon), which
become infected and inflamed.
·
Ulcerative colitis: a chronic
condition that causes the colon to become inflamed and can cause ulcers to form
on the lining of the colon.
·
Crohn's disease: a chronic condition
that causes inflammation of the lining of the digestive system.
SYMPTOMS OF FISTULA
Anal fistulae can present with many different symptoms such as:
·
Pain
·
Discharge - either bloody or purulent
·
Pruritus ani– itching around the anus
·
Systemic symptoms if abscess becomes
infected
DIAGNOSIS OF FISTULA
Diagnosis is by examination, either in an outpatient setting or under
anaesthesia. The examination can be an Anoscopy.
Possible findings:
·
The opening of the fistula onto the
skin may be seen
·
The area may be painful on
examination
·
There may be redness
·
A discharge may be seen
·
It may be possible to explore the
fistula using a fistula probe (a narrow instrument) and in this way it may be
possible to find both openings of the fistula
ANAL FISSURES
What is a fissure?
An anal fissure is a small tear in the skin that lines the anus.
An anal fissure may occur when you pass hard or large stools during a bowel
movement. An anal fissure typically causes pain and bleeding with bowel
movements.
Anal fissures most often affect people in middle age, but
fissures also are the most common cause of rectal bleeding in infants. Most
anal fissures heal within a few weeks with treatment for constipation, but some
fissures may become chronic
COMMON CAUSES OF
ANAL FISSURES
Anal fissures can be caused by trauma to the anus and anal
canal. The cause of the trauma can be one or more of the following:
·
Chronic constipation
·
Straining to have a bowel movement,
especially if the stool is large, hard, and/or dry
·
Prolonged diarrhea
·
Anal stretching
·
Insertion of foreign objects into the
anus
Other causes of anal fissures (other than trauma) include:
·
Longstanding poor bowel habits
·
Overly tight or spastic anal
sphincter muscles (muscles that control the closing of the anus)
·
Scarring in the anorectal area
·
Presence of an underlying medical problem:
such as Crohn’s disease and ulcerative colitis; anal cancer; leukemia;
infectious diseases (such as tuberculosis); and sexually transmitted diseases
(such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
·
Decreased blood flow to the anorectal
area
SYMPTOMS OF ANAL
FISSURE
Signs and symptoms include:
·
Pain during, and even hours after, a
bowel movement
·
Constipation
·
Blood on the outside surface of the
stool
·
Blood on toilet
·
A visible crack or tear in the anus
or anal canal
·
Burning and itch that may be painful
·
Discomfort when urinating, frequent
urination, or inability to urinate
·
Foul-smelling discharge
·
RISK FACTORS FOR
ANAL FISSURES
Factors that may increase your risk of developing an anal
fissure include:
·
Infancy. Many infants experience an
anal fissure during their first year of life, although experts aren't sure of
the reason.
·
Aging. Older adults may develop an
anal fissure partly because of slowed circulation, resulting in decreased blood
flow to the rectal area.
·
Constipation. Straining during bowel
movements and passing hard stools increase the risk of tearing.
·
Childbirth. Anal fissures are more
common in women after they give birth.
·
Crohn's disease. This inflammatory
bowel disease causes chronic inflammation of the intestinal tract, which may
make the lining of the anal canal more vulnerable to tearing
PREVENTION OF
ANAL FISSURES
For fissures in adults:
·
Keep the anorectal area dry
·
Wipe the area with soft materials, a
moistened cloth, or cotton pad; avoid rough and scented toilet paper
·
Promptly treat all occurrences of
constipation and diarrhea
·
Avoid irritating the rectum
COMPLICATIONS OF
ANAL FISSURES
Complications of anal fissure can include:
·
Anal fissure that fails to heal. An
anal fissure that doesn't heal can become chronic, meaning it lasts for more
than six weeks.
·
Anal fissure that recurs. If you've
experienced anal fissure once, you have an increased risk of another anal
fissure.
·
A tear that extends to surrounding
muscles. An anal fissure may extend into the ring of muscle that holds your
anus closed (internal anal sphincter). This makes it more difficult for your
anal fissure to heal. An unhealed fissure may trigger a cycle of discomfort
that may require medications or surgery to reduce the pain and repair or remove
the fissure.