INTERNAL HAEMORRHOIDS
Internal haemorrhoids involve the
haemorrhoidal veins proximal to
the anorectal line and are covered by
rectal mucosa.
These
cause more troublesome
symptoms of bleeding
and
protrussion.
In the early state (stage 1) they
appear as a group of small
veins.
They may bleed during the passage of hard stool or undue
straining.
Later
the haemorrhoidal masses increase in size. Rectal
mucosa
overlying the
varices becomes stretched until
the redundant
mucosa allows protusion of the
internal haemorrhoids outside the
anal orifice, retracts sponontaenously
(stage II).
Often
manual anal replacement
of the protruding
tissue is
necessary (Stage III).
Pain is not a prminent symptom. When protrusion of the internal
haemorrhoids into
the anal canal or beyond the
anal orifice
produces sphincter
spasm, severe pain may result
leading to
persistent protruision (Stage IV).
Painful muscle spasm occurs
particularly when examination reveals
protruding Hermorrhoids.
On PR(per rectal),
examination piles
may be seen at 3,7 or 11 O' clock
positions.
TREATMENT
Asymptomatic haemorrhoids require
no treatment. Careful
cleansing and softening the feces may
relieve the patient.
Troublesome bleeding may be controlled by injection therapy
or
sclerotherapy. Injections are given into one qudarant at
a time
and
at intervals of one week using a
gabriol syringe. The
injections is given above the pile
(Fig. 19.5)
HAEMORRHODECTOMY
Pain, bleeding or protrusion are
indications for haemorrhodectomy
(Fig. 19.6). The skin tags and pile mass are held and
isolated by
V shaped skin anal mucosal incised the pedicle is ligated.
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